Required request policies create clinical, psychological and economic conflicts of interest. They should be repealed or substantially modified to restore public confidence in organ donation.
The offender who desires to restore or maintain a relationship after a conflict apologises to his or her victim. Not only an individual but also a group can make apology. Groups do it through their representatives who are recognised as such by both sides. Sometimes offenders acknowledge wrongdoing and express regret for it. At other times while apologising, they may also ask for forgiveness. Does apology without a request for forgiveness mean the same as apology with such a (...) class='Hi'>request? Are there any cases where apology may be appropriate, but not a request for forgiveness? Do those who apologise without asking for forgiveness really not want to be forgiven? This article answers these questions by exploring the notion of apology and its relation to forgiveness. (shrink)
The paper explores the ethical and psychological issues that arise when family members request that "everything possible" be done for a particular patient. The paper first illustrates this phenomenon by reviewing the well known case of Helga Wanglie. We proceed to argue that in Wanglie and similar cases family members may request futile treatments as a means of conveying that (1) the loss of the patient is tantamount to losing a part of themselves; (2) the patient should not (...) be abandoned or disvalued in any way; or (3) the patient is owed special obligations by virtue of the special relationship in which the family and the patient stand. We maintain that families can best express these important messages by caring for patients, rather than by making requests for futile interventions. Likewise, when life-sustaining measures are futile, health providers can best fulfill their professional obligations by assuring patients' dignity and comfort, rather than by applying futile interventions. Keywords: medical futility, medical decision-making, palliative care, autonomy, paternalism CiteULike Connotea Del.icio.us What's this? (shrink)
This paper reviews the usefulness of bioethical instruments such as the informed consent principle to handle ethical and political challenges of clinical trials in genotyping and DNA-banking and discusses an informed request model as well as other contractual relations between research institutions, patients, and their families.
We propose that in addition to children's requests for word names being a reflection of an understanding of the referential nature of words, they may also be requests for adult's teaching. These possible requests for teaching among toddlers, along with other indications, suggest that teaching may be a natural cognition that may be related to the development of theory of mind.
Although it seems intuitively clear that acts of requesting are different from acts of commanding, it is not very easy to sate their differences precisely in dynamic terms. In this paper we show that it becomes possible to characterize, at least partially, the effects of acts of requesting and compare them with the effects of acts of commanding by combining dynamified deontic logic with epistemic logic. One interesting result is the following: each act of requesting is appropriately differentiated from an (...) act of commanding with the same content, but for each act of requesting, there is another act of commanding with much more complex content which updates models in exactly the same way as it does. We will also consider an application of our characterization of acts of requesting to acts of asking yes-no questions. It yields a straightforward formalization of the view of acts of asking questions as requests for information. (shrink)
Although chimpanzees have been reported to understand to some extent others' visual perception, previous studies using food requesting tasks are divided on whether or not chimpanzees understand the role of eye gaze. One plausible reason for this discrepancy may be the familiarity of the testing situation. Previous food requesting tasks with negative results used an unfamiliar situation that may be difficult for some chimpanzees to recognize as a requesting situation, whereas those with positive results used a familiar situation. The present (...) study tested chimpanzees' understanding of others' attentional states by comparing two requesting situations: an unfamiliar situation in which food was put on a table, and a familiar situation in which chimpanzees requested food held by an experimenter. Chimpanzees showed evidence of understanding the experimenter's attentional variations and the role of eye gaze only in the latter task. This suggests that an unfamiliar requesting situation may keep subjects from expressing their understanding of others' attentional states even though they are sensitive to them. Keywords: Understanding attention; Social cognition; Chimpanzees. (shrink)
John Searle offers what he thinks to be a reasonable scientific approach to the understanding of consciousness. I argue that Searle is demanding nothing less than a Kuhnian-type revolution with respect to how scientists should study consciousness given his rejection of the subject-object distinction and affirmation of mental causation. As part of my analysis, I reveal that Searle embraces a version of emergentism that is in tension, not only with his own account, but also with some of the theoretical tenets (...) of science. I conclude that Searle has offered little to motivate scientists to adopt his proposal. (shrink)
1.1 Are commercial societies unfriendly to friendship? Many critics of commercial societies, from both the left and the right, have thought so. They claim that the free-market system of property rights, freedom of contract, and other liberty rights – the “negative” right of individuals to peacefully pursue their own ends – is impersonal and dehumanizing, or even inherently divisive and adversarial. Yet (their complaint goes) the psychology and morality of markets and liberty rights pervade far too many relationships in a (...) commercial society, eroding the bonds of personal and civic friendship. My main aim in this paper is to analyze and evaluate this claim. In this section I will give an overview of the critics’ complaints against various features of the free-market system, discuss the empirical data that might be thought to support their complaints, and show why they largely fail to do so. In Section II I will get to the heart of the matter: the nature of the market and of friendship. I will address the thesis that the modes of valuation proper to production are radically opposed to the modes of valuation proper to friendship, love, sexuality, and so on, arguing that the thesis rests on a misunderstanding of both markets and friendship. A proper understanding of the two reveals that, as voluntary, reciprocal relationships, market relationships and friendship share important moral and psychological properties, and are not the natural enemies, or even the odd bed-fellows, many critics take them to be. In Section III I will address the related thesis that market societies – societies based on the free-market system of property rights, freedom of contract, and other liberty rights - tend to commodify relationships and, thereby, weaken the bonds of personal and civic friendship. I will argue that free markets are the most powerful force for decommidifying or, more generally (since commodification is not the only way of objectifying people), deobjectifying people and relationships.. (shrink)
While there is now considerable experimental evidence that, on the one hand, participants assign to the indicative conditional as probability the conditional probability of consequent given antecedent and, on the other, they assign to the indicative conditional the ?defective truth-table? in which a conditional with false antecedent is deemed neither true nor false, these findings do not in themselves establish which multi-premise inferences involving conditionals participants endorse. A natural extension of the truth-table semantics pronounces as valid numerous inference patterns that (...) do seem to be part of ordinary usage. However, coupled with something the probability account gives us?namely that when conditional-free ? entails conditional-free ?, ?if ? then ?? is a trivial, uninformative truth?we have enough logic to derive the paradoxes of material implication. It thus becomes a matter of some urgency to determine which inference patterns involving indicative conditionals participants do endorse. Only thus will we be able to arrive at a realistic, systematic semantics for the indicative conditional. (shrink)
1. Any statutory definition of inherent patentability or other threshold exclusion from patentability should have a clear normative basis. In the case of inherent patentability, that basis should relate to the patent system’s aim of encouraging and rewarding inventive activity for the benefit of society.
In a book I once wrote about free will, I contended that the best and most important argument for the incompatibility of free will and determinism was “the Consequence Argument.” I gave the following brief sketch of the Consequence Argument as a prelude to several more careful and detailed statements of the argument: If determinism is true, then our acts are the consequences of the laws of nature and events in the remote past. But it is not up to us (...) what went on before we were born, and neither is it up to us what the laws of nature are. Therefore, the consequences of these things (including our present acts) are not up to us.[i] The reading that follows this one, Reading 41, “The Mystery of Metaphysical Freedom,” contains a statement of the Consequence Argument. The argument is contained in the paragraph (p. xxx) that starts, “As Carl Ginet has said . . . .” But, as you will see if you compare the “brief sketch” with that paragraph, “The Mystery of Metaphysical Freedom” presents the Consequence Argument in a disguise that is not easy to penetrate. Some teachers of philosophy who have used the first edition of Metaphysics: The Big Questions as a textbook have asked for a more straightforward statement of the Consequence Argument (since much of the recent discussion of the question of the compatibility of free will and determinism in the philosophical literature has taken the form of criticisms of the Consequence Argument that are rather hard to apply to the argument in the form in which it is presented in Reading 41). This essay is an attempt to meet this request. (shrink)
It is widely accepted in clinical ethics that removing a patient from a ventilator at the patient’s request is ethically permissible. This constitutes voluntary passive euthanasia. However, voluntary active euthanasia, such as giving a patient a lethal overdose with the intention of ending that patient’s life, is ethically proscribed, as is assisted suicide, such as providing a patient with lethal pills or a lethal infusion. Proponents of voluntary active euthanasia and assisted suicide have argued that the distinction between killing (...) and letting die is flawed and that there is no real difference between actively ending someone’s life and "merely" allowing them to die. This paper shows that, although this view is correct, there is even less of a distinction than is commonly acknowledged in the literature. It does so by suggesting a new perspective that more accurately reflects the moral features of end-of-life situations: if a patient is mentally competent and wants to die, his body itself constitutes unwarranted life support unfairly prolonging his or her mental life. (shrink)
In 1997, a Scottish surgeon by the name of Robert Smith was approached by a man with an unusual request: he wanted his apparently healthy lower left leg amputated. Although details about the case are sketchy, the would-be amputee appears to have desired the amputation on the grounds that his left foot wasn’t part of him – it felt alien. After consultation with psychiatrists, Smith performed the amputation. Two and a half years later, the patient reported that his life (...) had been transformed for the better by the operation [1]. A second patient was also reported as having been satisfied with his amputation [2]. (shrink)
I was asked to lecture at the 2004 Wittgenstein conference in Kirchberg on the subject of phe- nomenology. This request surprised me somewhat because I am certainly not a scholar on the writings of phenomenological philosophers, nor have I done much work that I consider phe- nomenological in any strict sense. However, I was glad to accept the invitation, since I have had some peculiar experiences with phenomenology. Also, it seemed worth discussing this issue at a Wittgenstein conference because (...) the recent revival of interest in consciousness among ana- lytic philosophers has lead to a renewed interest in phenomenological authors, since, of course, phenomenology is in large part concerned with consciousness. (shrink)
In Rahul Banerjee and Bikas K. Chakrabarti (eds.), Progress in Brain Research, 168: 215-246. Amsterdam: Elsevier. Electronic offprint available upon request.
Although I agree with Sabine Muller’s conclusion that we should first seek to find alternatives to amputation for patients suffering from Body Integrity Identity Disorder (BIID), I disagree with one of the major premises that she uses to argue for her claim. Muller argues that patients with BIID are likely not autonomous when they request that the limb be amputated. Muller’s argument that BIID suffers are not autonomous is flawed because she conflates philosophical conceptions of autonomy with the conception (...) of autonomy that is operative in the context of medicine. (shrink)
Whether the law should permit voluntary euthanasia or physician-assisted suicide is one of the most vital questions facing all modern societies. Internationally, the main obstacle to legalisation has proved to be the objection that, even if they were morally acceptable in certain 'hard cases', voluntary euthanasia and physician-assisted suicide could not be effectively controlled; society would slide down a 'slippery slope' to the killing of patients who did not make a free and informed request, or for whom palliative care (...) would have offered an alternative. How cogent is this objection? This book provides the general reader (who need have no expertise in philosophy, law or medicine) with a lucid introduction to this central question in the debate, not least by reviewing the Dutch euthanasia experience. It will interest all in any country whether currently for or against legalisation, who wish to ensure that their opinions are better informed. (shrink)
Multiculturalism requires sustained and serious philosophical reflection, which in turn requires public outreach and communication. This piece briefly outlines concerns raised by the philosophy of multiculturalism and, conversely, multiculturalism in philosophy, which ultimately force us to reconsider the philosopher’s own role and responsibility. I conclude with a provocative suggestion of philosophy as /public diplomacy/. (As this is intended to be a piece for a general audience, secondary literature is only referred to in the conclusion. References gladly provided upon request.).
Reeder’s article offers a new and intriguing approach to the study of people’s ordinary understanding of freedom and constraint. On this approach, people use information about freedom and constraint as part of a quasi-scientific effort to make accurate inferences about an agent’s motives. Their beliefs about the agent’s motives then affect a wide variety of further psychological processes, including the process whereby they arrive at moral judgments. In illustrating this new approach, Reeder cites an elegant study he conducted a number (...) of years ago (Reeder & Spores, 1983). All subjects were given a vignette about a man who goes with his date to a pizza parlor and happens to come across a box that has been designated for charitable donations. In one condition, the man’s date then requests that he make a donation; in the other, she requests that he steal the money that is already in the box. In both conditions, the man chooses to comply with this request. The key question is how subjects will use his behavior to make inferences about whether he is a morally good or morally bad person. The results revealed a marked difference between conditions. When the man donated to charity, subjects were generally disinclined to conclude that he must have been a morally good person. It is as though they were thinking: ‘He didn’t just do this out of the goodness of his heart. (shrink)
I believe that Tom is the proud father of a baby boy. Why do I think his child is a boy? A natural answer might be that I remember that his name is ‘Owen’ which is usually a boy’s name. Here I’ve given information that might be part of a causal explanation of my believing that Tom’s baby is a boy. I do have such a memory and it is largely what sustains my conviction. But I haven’t given you just (...) any causally relevant information, I’ve given my grounds for my belief. I’ve given reasons that might justify me in supposing that Tom’s baby is a boy. Less naturally, the question might be taken as a request for a broader causal explanation of my holding this belief. Appropriate answers might cite all manner of facts concerning the evolution of the human race, why I chose to pursue philosophy and hence came to know Tom, the mechanisms of email transmission, the firing of various neurons, the circumstances of concept formation as a result of which I’m able to grasp the thought that Tom’s baby is a boy, and so on. It is an interesting question what distinguishes the narrower set of answers that I first suggested. I won’t pursue that here. I assume you have a good enough sense of the distinction I’m drawing. We might call the narrower set of answers justifying reasons, the kind of reasons I might cite in justifying my belief. Answers of the first sort are clearly relevant to epistemological evaluation. In assessing whether you know p or are rational in believing it to the degree you do, I will naturally want to consider what reasons you have for your belief. In deliberating myself about whether to believe p, in seeking an answer to the question of whether p, I will naturally consider what reasons or grounds I have to suppose that p. But what I want to focus on here is how explanations of the broader sort bear on such questions as whether to believe p. From a third-person perspective we can ask, ‘In assessing the epistemic status of S’s belief that p, what is the relevance of causal information that lies outside of the realm of justifying reasons?’ From the first-person standpoint we can ask ‘In seeking to answer whether p, how should such causal information affect my deliberations?’ At first it might seem that such broader causal information could have little relevance if any. Like any belief my belief that p can be traced back to innumerable causes from far and wide.. (shrink)
The question "Why should I be moral?," taken as a request for reasons to be moral, strikes many philosophers as silly, confused, or otherwise out of line. Hence we find many attempts to dismiss it as spurious. This paper addresses four such attempts and shows that they fail. It does so partly by discussing various errors about reasons for action, errors that lie at the root of the view that "Why should I be moral?" is ill-conceived. Such errors include (...) the mistake of confusing different uses of "moral reason for A to ø" and the mistake of treating as axiomatic, as in need of no argument, the view that moral considerations furnish every agent with practical reasons. Among the philosophers discussed are John Hospers, Philippa Foot, Stephen Toulmin, H. A. Prichard, and William Frankena. (shrink)
Emergency contraception — also known as the morning after pill — is marketed and sold, under various brand names, in over one hundred countries around the world. In some countries, customers can purchase the drug without a prescription. In others, a prescription must be presented to a licensed pharmacist. In virtually all of these countries, pharmacists are the last link in the chain of delivery. This article examines and ultimately rejects several standard moves in the bioethics literature on the right (...) of pharmacists conscientiously to refuse to dispense emergency contraception. Its central thesis is that the standard ‘moderate’ solution to this problem is mistaken. Thus, when all publicly relevant interests are given their due, it is not acceptable to allow refusals in the big city, where pharmacies are plentiful, but forbid them in rural settings, where pharmacies are scarce. Rather, there should be strong public policy requiring that all pharmacists dispense emergency contraception to customers who request it, regardless of pharmacists' moral or religious objections. (shrink)
I am writing a mediocre paper on a topic you are not particularly interested in. You don't have, it seems safe to assume, a (normative) reason to read my draft. I then ask whether you would be willing to have a look and tell me what you think. Suddenly you do have a (normative) reason to read my draft. By my asking, I managed to give you the reason to read the draft. What does such reason-giving consist in? And how (...) is it that we can do it? In this paper, I characterize what I call robust reason giving, the kind present in requests. I distinguish it from epistemic and merely triggering reason-giving, I discuss in detail the phenomenology of robust reason-giving, and I offer an analysis of robust reason-giving in terms of the complex intentions of the reason-giver and of the normative background. (shrink)
A scientific theory is successful, according to Stanford (2000), because it is suficiently observationally similar to its corresponding true theory. The Ptolemaic theory, for example, is successful because it is sufficiently similar to the Copernican theory at the observational level. The suggestion meets the scientific realists' request to explain the success of science without committing to the (approximate) truth of successful scientific theories. I argue that Stanford's proposal has a conceptual flaw. A conceptually sound explanation, I claim, respects the (...) ontological order between properties. A dependent property is to be explained in terms of its underlying property, not the other way around. The applicability of this point goes well beyond the realm of the debate between scientific realists and antirealists. Any philosophers should keep the point in mind when they attempt to give an explanation of a property in their field whatever it may be. (shrink)
This paper evaluates Kuipers' account of functional explanation in biology in view of an example of such an explanation taken from real biology. The example is the explanation of why electric fishes swim backwards (Lannoo and Lannoo 1993). Kuipers' account depicts the answer to a request for functional explanation as consisting only of statements that articulate a certain kind of consequence. It is argued that such an account fails to do justice to the main insight provided by the example (...) explanation, namely the insight into why backwards swimming is needed by fishes that locate their food by means of an electric radar. The paper sketches an improved account that does justice to this kind of insight. It is argued that this account is consistent with and complementary to Kuipers' insight that function attributions are established by means of a process of hypothetico-deductive reasoning guided by a heuristic principle. (shrink)
Advance directives (ADs), which are also sometimes referred to as ‘living wills’, are statements made by a person that indicate what treatment she should not be given in the event that she is not competent to consent or refuse at the future moment in question. As such, ADs provide a way for patients to make decisions in advance about what treatments they do not want to receive, without doctors having to find proxy decision-makers or having recourse to the doctrine of (...) necessity. While patients can request particular treatments in an AD, only refusals are binding. This paper will examine whether ADs safeguard the autonomy and best interests of the incompetent patient, and whether legislating for the use of ADs is justified, using the specific context of the legal situation in the United Kingdom to illustrate the debate. The issue of whether the law should permit ADs is itself dependent on the issue of whether ADs are ethically justified; thus we must answer a normative question in order to answer the legislative one. It emerges that ADs suffer from two major problems, one related to autonomy and one to consent. First, ADs’ emphasis on precedent autonomy effectively sentences some people who want to live to death. Second, many ADs might not meet the standard criteria for informed refusal of treatment, because they fail on the crucial criterion of sufficient information. Ultimately, it transpires that ADs are typically only appropriate for patients who temporarily lose physical or mental capacity. (shrink)
I am writing a mediocre paper on a topic you are not particularly interested in. You don't have, it seems safe to assume, a (normative) reason to read my draft. I then ask whether you would be willing to have a look and tell me what you think. Suddenly you do have a (normative) reason to read my draft. What exactly happened here? Your having the reason to read my draft – indeed, the very fact that there is such a (...) reason – depends, it seems, on my having asked you to read it. By my asking, I managed to make it the case that you have such a reason, or to give you the reason to read the draft. What does such reason-giving consist in? And how is it that we can do it? In the next section, I distinguish between purely epistemic reason-giving, merely triggering reason-giving, and the kind of reason-giving I will be primarily interested in, the kind presumably involved in requests, which I call robust reasongiving. Then, in section 3, I try to characterize in some detail the intuitive or phenomenological data. I try, in other words, to clarify what it is we want an account of robust reason-giving to accommodate. But at the end of section 3 it remains entirely open whether any possible account in fact satisfies the desiderata elaborated in that section. In section 4 I thus proceed to inquire whether such an account is there to be found. I argue that the only plausible way of making sense of robust reason-. (shrink)
Even if the question, “What is the meaning of life?” is coherent, the fact remains that it is vague. Its vagueness largely centers on the use of the term “meaning.” The most prevalent strategy for addressing this vagueness is to discard the word “meaning” and reformulate the question entirely into questions such as, “What is the purpose of life?” or “What makes life valuable?” among others. This approach has philosophical merit but does not account for the intuitions and sub-questions driving (...) the original question as plausibly as does an interpretation that I call the narrative interpretation. I will argue that the question, “What is the meaning of life?” should be understood as the request for a narrative that narrates across those elements and accompanying questions of life of greatest existential import to human beings. (shrink)
Kant's views on logic and logical theory play an important role in his critical writings, especially the Critique of Pure Reason. However, since he published only one short essay on the subject, we must turn to the texts derived from his logic lectures to understand his views. The present volume includes three previously untranslated transcripts of Kant's logic lectures: the Blumberg Logic from the 1770s; the Vienna Logic (supplemented by the recently discovered Hechsel Logic) from the early 1780s; and the (...) Dohna-Wundlacken Logic from the early 1790s. Also included is a new translation of the Jasche Logic, compiled at Kant's request and published in 1800 but which also appears to stem in part from a transcript of his lectures. Together these texts provide a rich source of evidence for Kant's evolving views on logic, on the relations between logic and other disciplines, and on a variety of topics (e.g. analysis and synthesis) central to Kant's mature philosophy. They also provide a portrait of Kant as lecturer, a role in which he was both popular and influential. This volume contains substantial editorial apparatus: a general introduction, linguistic and factual notes, glossaries of key terms (both German/English and English/German) and concordances relating Kant's lectures to Georg Frederich Meier's Excerpts from the Doctrine of Reason, the book on which Kant lectured throughout his life and in which he left extensive notes. (shrink)
Deep Brain Stimulation (DBS) is a treatment involving the implantation of electrodes into the brain. Presently, it is used for neurological disorders like Parkinson’s disease, but indications are expanding to psychiatric disorders such as depression, addiction and Obsessive Compulsive Disorder (OCD). Theoretically, it may be possible to use DBS for the enhancement of various mental functions. This article discusses a case of an OCD patient who felt very happy with the DBS treatment, even though her symptoms were not reduced. First, (...) it is explored if the argument that ‘doctors are not in the business of trading happiness’, as used by her psychiatrist to justify his discontinuation of the DBS treatment, holds. The relationship between enhancement and the goals of medicine is discussed and it is concluded that even though the goals of medicine do not set strict limits and may even include certain types of enhancement, there are some good reasons for limiting the kind of things doctors are required or allowed to do. Next, the case is discussed from the perspective of beneficence and autonomy. It is argued that making people feel good is not the same as enhancing their well-being and that it is unlikely—though not absolutely impossible—that the well-being of the happy OCD patient is really improved. Finally, some concerns regarding the autonomy of a request made under the influence of DBS treatment are considered. (shrink)
The growing support for voluntary active euthanasia (VAE) is evident in the recently approved Dutch Law on Termination of Life on Request. Indeed, the debate over legalized VAE has increased in European countries, the United States, and many other nations over the last several years. The proponents of VAE argue that when a patient judges that the burdens of living outweigh the benefits, euthanasia can be justified. If some adults suffer to such an extent that VAE is justified, then (...) one may conclude that some children suffer to this extent as well. In an attempt to alleviate the suffering of extremely ill neonates, the University Medical Center Groningen developed a protocol for neonatal euthanasia. In this article, I first present the ethical justifications for VAE and discuss how these arguments relate to euthanizing ill neonates. I then argue that, even if one accepts the justification for VAE in adults, neonatal euthanasia cannot be supported, primarily because physicians and parents can never accurately assess the suffering of children. I argue that without the testament of the patient herself as to the nature and magnitude of her suffering, physicians can never accurately weigh the benefits and burdens of a child’s life, and therefore any such system would condemn to death some children whose suffering is not unbearable. I conclude that because the primary duty of physicians is to never harm their patients, neonatal euthanasia cannot be supported. (shrink)
In defending his rejection of Maverick Molinism (Faith and Philosophy 20.1, (January 2003), pp. 91-100) from my criticisms (Faith and Philosophy 19 (2002), pp. 348-357), Tom Flint attributes three central claims to my argument, and disagrees with two of them. He also notes my request for a defense of the Law of Conditional Excluded Middle, which his argument employs. He portrays that discussion as taking “potshots” at his argument, in part because I denied that concerns about the Law are (...) compelling, but it is a mistake to think that controversial premises need no defense simply because the case against them is not compelling. Regarding the points where Flint is more forthcoming, one of his points places further demands on his rejection of this version of Molinism. The other point involves a serious misrepresentation of my argument. (shrink)
Upon first consideration, the desire of an individual to amputate a seemingly healthy limb is a foreign, perhaps unsettling, concept. It is, however, a reality faced by those who suffer from body integrity identity disorder (BIID). In seeking treatment, these individuals request surgery that challenges both the statutory provisions that sanction surgical operations and the limits of consent as a defence in New Zealand. In doing so, questions as to the influence of public policy and the extent of personal (...) autonomy become important. Beyond legal issues, BIID confronts dominant conceptions of bodily integrity, medical treatment, and ethical obligations. This paper seeks to identify the relevant public policy concerns raised by BIID in New Zealand and the limits of autonomy, before moving on to consider how BIID sufferers may legally seek the treatment they require and how a doctor might be protected from criminal proceedings for assault for performing this treatment. It will be argued that it is possible to legally consent to the amputation of a healthy limb as medical treatment and that public perception should not be allowed to take precedence over this right. (shrink)
Dutch euthanasia legislation states that an act of euthanasia is only permissible if it is based on a voluntary request made in a situation of unbearable suffering to which there are no alternatives.The central question of this article is whether these criteria can be satisfied simultaneously. In an analysis of several (partly overlapping) definitions of voluntariness it is argued that there are circumstances in which this question should be answered negatively.The possible incompatibility of the criteria reveals a tension between (...) different defences of the permissibility of euthanasia. (shrink)
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The isolation of the Netherlands as the only country in which voluntary euthanasia is legal is about to end. In October 2001 the Belgian Senate voted by almost a 2:1 margin to allow doctors to act on a patient's request for assistance in dying. The legislation is expected to pass the lower house shortly. That the Netherlands' closest neighbor is likely to be the next country to take this step should provide food for thought among those who have denounced (...) voluntary euthanasia in the Netherlands as rife with abuses. If that were really the case, why would the country that is better placed than all others to know what goes on in the Netherlands – not only because of its geographical proximity, but because most of its people are Dutch-speaking – be ready to copy the Dutch model? (shrink)
It is a widely supported claim that liberal democratic institutions should treat citizens with equal respect. I neither dispute nor champion this claim, but investigate how it could be fulfilled. I do this by asking, as a sort of litmus test, how liberal democratic institutions should treat with respect citizens holding minority convictions, and thereby dissenting from a deliberative output. The first step of my argument consists in clarifying the sense in which liberal democracies have a primary concern for the (...) respectful treatment of citizens qua self-legislating persons. Taking the second step, I address critically the common tendency in the literature to concentrate on what I have termed the ex ante legem phase, focusing solely on the structure of institutionalized decision-making processes. I submit, rather, that the principle of equal respect for persons demands more of liberal democratic institutions to enhance citizens' chances to give voice to their consciences and influence, on that ground, the formulation of the rules to which they should conform. Fulfilling this commitment requires democratic theorizing to go beyond the ex ante legem phase and regard forms of ex post legem contestation as an extension of citizens' right to political participation. Against this backdrop, I take the third and last step and argue that a promising way forward consists in the adoption of an ex post legem version of conscientious exemptionism, granting citizens a conditional moral right to request exemptions on the grounds of conscience from certain controversial legal and political provisions. (shrink)
Does the ethical value of a work of art ever contribute to its aesthetic value? I argue that when conventionally interpreted as a request for a conceptual analysis the answer to this question is indeterminate. I then propose a different interpretation of the question on which it is understood as a substantial and normative question internal to the practice of aesthetic criticism.
The influence of direct-to-consumer advertising and physician promotions are examined in this study. We further examine some of the ethical issues which may arise when physicians accept promotional products from pharmaceutical companies. The data revealed that direct-to-consumer advertising is likely to increase the request rates of both the drug category and the drug brand choices, as well as the likelihood that those drugs will be prescribed by physicians. The data further revealed that the majority of responding physicians were either (...) neutral or did not feel that accepting some types of gifts from pharmaceutical companies affected their ethical behaviors. (shrink)
Ape species-specific communication is grounded on the present, possesses some referential qualities and is mostly used to request objects or actions from others. Artificial systems of communication borrowed from humans transform apes' communicative exchanges by freeing them from the present (i.e. displaced reference) although requests still predominate as the main reason for communicating with others. Symbol use appears to enhance apes' relational abilities and their inhibitory control. Despite these substantial changes, it is concluded that even though artificial communication enhances (...) thought and enables its expression more openly, it does not create it or modify the motivation behind communicative exchanges. (shrink)
Prior to passage of the Oregon Death with Dignity Act, opponents of assistance in dying argued that legalization would have serious harmful consequences. Specifically, they argued that the quality and availability of palliative care would decline, that the harms of legalization would affect certain vulnerable groups disproportionately, that legal assisted dying could not be confined to the competent terminally ill who voluntarily request assistance, and that the practice would result in frequent abuses. Data from Oregon's decade-long experience decisively refute (...) the first three predictions. As to abuses, the record is not quite as clear, but if an appropriate framework for analysis is utilized, the most reasonable conclusion is that the risks of abuse do not outweigh the benefits of legalization. To the extent projected harmful consequences are relevant to the debate over legalization, Oregon's experience argues in favor of legalization of assistance in dying. (shrink)
The isolation of the Netherlands as the only country in which voluntary euthanasia is legal is about to end. In October 2001 the Belgian Senate voted by almost a 2:1 margin to allow doctors to act on a patient's request for assistance in dying. The legislation is expected to pass the lower house shortly. That the Netherlands' closest neighbor is likely to be the next country to take this step should provide food for thought among those who have denounced (...) voluntary euthanasia in the Netherlands as rife with abuses. If that were really the case, why would the country that is better placed than all others to know what goes on in the Netherlands – not only because of its geographical proximity, but because most of its people are Dutch-speaking – be ready to copy the Dutch model? (shrink)
Making use of facilitating payments is a very widespread form of corruption. These consist of small payments or gifts made to a person – generally a public official or an employee of a private company – to obtain a favour, such as expediting an administrative process; obtaining a permit, licence or service; or avoiding an abuse of power. Unlike the worst forms of corruption, facilitating payments do not usually involve an outright injustice on the part of the payer as they (...) are entitled to what they request. This may be why public opinion tends to condone such payments; often they are assumed to be unavoidable and are excused on the grounds of low wages and lack of professionalism among public officials and disorganisation in government offices. Many companies that take the fight against “grand” corruption very seriously are inclined to overlook these “petty” transgressions, which are seen as the grease that makes the wheels of the bureaucratic machine turn more smoothly. Despite this, facilitating payments have a pernicious effect on the working of public and private administrations: all too often they are the slippery slope to more serious forms of corruption; they impose additional costs on companies and citizens; and in the long run they sap the ethical foundations of organisations. Although many articles on corruption mention facilitating payments, there have been no systematic studies from a company’s point of view. This article thus focuses on facilitating payments from the point of view of the company that makes the payment, either as the active partner (when it is the company that takes the initiative) or as the passive partner (when the official or employee is the instigator). (shrink)
Defenders of patient autonomy have successfully supported the legal adoption of advance directives. More recently, some defenders of patient autonomy have also supported the legalization of voluntary active euthanasia. This paper explores the wisdom of combining both practices. If euthanasia were to become legal, should it be permitted by advance directives? The paper juxtaposes the most significant doubts about advance directives, with the most significant doubts about euthanasia. It argues that the doubts together raise more concern about the combined practices (...) than about either euthanasia or advance directives separately. Not all cases of voluntary euthanasia by advance directive are equally problematic, however. Advance directives can help in the defense of euthanasia for patients who make the request in advance and reaffirm it under circumstances of severe suffering. Keywords: advance directives, durable power of attorney, euthanasia, living will, patient interests CiteULike Connotea Del.icio.us What's this? (shrink)
When people speak, they often insinuate their intent indirectly rather than stating it as a bald proposition. Examples include sexual come-ons, veiled threats, polite requests, and concealed bribes. We propose a three-part theory of indirect speech, based on the idea that human communication involves a mixture of cooperation and conflict. First, indirect requests allow for plausible deniability, in which a cooperative listener can accept the request, but an uncooperative one cannot react adversarially to it. This intuition is sup- ported (...) by a game-theoretic model that predicts the costs and benefits to a speaker of direct and indirect requests. Second, language has two functions: to convey information and to negotiate the type of relationship holding between speaker and hearer (in particu- lar, dominance, communality, or reciprocity). The emotional costs of a mismatch in the assumed relationship type can create a need for plausible deniability and, thereby, select for indirectness even when there are no tangible costs. Third, people perceive language as a digital medium, which allows a sentence to generate common knowledge, to propagate a message with high fidelity, and to serve as a reference point in coordination games. This feature makes an indirect request qualitatively different from a direct one even when the speaker and listener can infer each other’s intentions with high confidence. (shrink)
This article examines the epistemology of risk assessment in the context of financial modelling for the purposes of making loan underwriting decisions. A financing request for a company in the paper and pulp industry is considered in some detail. The paper and pulp industry was chosen because (1) it is subject to some specific risks that have been identified and studied by bankers, investors and managers of paper and pulp companies and (2) certain features of the industry enable analysts (...) to quantify the impact of specific risk events of a given dimension on a company's future financial performance. While companies in other industries may be subject to similar risk factors, the impact of risk events may be more difficult to gauge in those industries. The ability of financial analysts to model the impact of a risk event, and hence quantify a credit risk, increases the predictive accuracy of the model. I argue that bankers and regulators should recognise the uncertainty associated with unquantifiable credit risk in financial models, and they should view this uncertainty as a credit risk factor in and of itself. Evaluating the relative degree to which credit risk is quantifiable in financial models is a potentially significant yet largely unrecognised tool for credit risk management. I consider some possible applications of this assessment tool for managing risk within the banking industry. (shrink)
Epistemic transparency tells us that, if an agent S knows a given proposition p , then S knows that she knows that p . This idea is usually encoded in the so-called KK principle of epistemic logic. The paper develops an argument in favor of a moderate version of KK , which I dub quasi-transparency , as a normative rather than a descriptive principle. In the second Section I put forward the suggestion that epistemic transparency is not a demand of (...) ideal rationality, but of ideal epistemic responsibility, and hence that ideally responsible agents verify transparency principles of some sort; I also contend that their satisfaction should not be tied to an internalist epistemology. The central argument in favor of transparency is then addressed in Sections 3 to 8, through the development of a formal system. I show that, in a well-behaved formal setting, a moderate version of transparency is imposed upon us as a result of a number of independent decisions on the structure of higher-order probabilities, as long as we request that our probability and knowledge attributions cohere with each other. Thus I give a rationale to build a model for a hierarchy of languages with different levels of knowledge and probability operators; we obtain an analogous to KK for successive knowledge operators without actually demanding transitivity. The formal argument reinforces the philosophical intuition that epistemic transparency is an important desideratum we should not be too ready to dismiss. (shrink)
In this paper, I will explore a notion of a truth-bearing entity that is distinct both from a proposition and from an intentional event, state, or action, and that is the notion of an attitudinal object. Attitudinal objects are entities like ‘John’s belief that S’, John’s claim that S’, ‘John’s desire that S’, or ‘John’s request that S’. The notion of an attitudinal object has an important precedent in the work of the Polish philosopher Twardowski (1912), who drew a (...) more general distinction between ‘actions’ and ‘products’, such as walking, screaming, judging, and thinking on the one hand and a walk, a scream, a judgment, and a thought on the other hand. While Twardowski left the distinction at an intuitive level, I will propose an ontological account of the distinction, based on the notion of a trope or particularized property. (shrink)
Michael Clark has recently argued that the slippery slope argument against voluntary euthanasia is ‘entirely consequentialist’ and that its use to justify continued prohibition of voluntary euthanasia involves a failure to treat patients who request assistance in ending their lives as ends in themselves. This article agues that in fact the slippery slope is consistent with most forms of deontology, and that it need not involve any violation of the principle that people should be treated as ends, depending upon (...) how that principle is construed. It is concluded that supporters of voluntary euthanasia cannot dismiss the slippery slope argument on the basis of deontological principles but must take seriously the consequences that it postulates and engage in factual argument about their likely extent and about the likely effectiveness of any proposed safeguards. (shrink)
Arguments in favor of legalized assisted suicide often center on issues of personal privacy and freedom of choice over one's body. Many disability advocates assert, however, that autonomy arguments neglect the complex sociopolitical determinants of despair for people with disabilities. Specifically, they argue that social approval of suicide for individuals with irreversible conditions is discriminatory and that relaxing restrictions on assisted suicide would jeopardize, not advance, the freedom of persons with disabilities to direct the lives they choose. This paper examines (...) the idea promoted by some proponents of assisted suicide that it is reasonable to be depressed about one's diminished quality of life in cases of irreversible illness or disability and, therefore, such depression should not call into question the individual's competence to request assistance in dying. The concept of rational depression is defined and examined in the context of: four real-life cases involving individuals with disabilities who requested assistance in dying; a set of criteria commonly applied to decision-making to determine rationality; and research bearing on the emotional status of people with disabilities. It is concluded that although disability is associated with particular socially mediated stressors, there is no theoretical or empirical evidence to indicate that depression and its role in the right to die is dynamically different, more natural, or more reasonable for disabled people than for non-disabled people. (shrink)
Currently, the preferred accommodation for conscientious objection to abortion in medicine is to allow the objector to refuse to accede to the patient’s request so long as the objector refers the patient to a physician who performs abortions. The referral part of this arrangement is controversial, however. Pro-life advocates claim that referrals make objectors complicit in the performance of acts that they, the objectors, find morally offensive. McLeod argues that the referral requirement is justifiable, although not in the way (...) that people usually assume. (shrink)
Suppose that there are good or morally defensible reasons for not responding truthfully to a question or request for information. Is a lie or a deception better as a means to avoid telling the truth? There are many situations in public and private life in which the answer to this question would serve as a useful moral guide, for instance, clinical situations involving dying patients, educational situations involving young children and personal situations involving close friends. Intuitively, we feel that (...) there is a moral asymmetry in favor of deceiving over lying. However, doubts have been cast on such intuition. The aim of this paper is to bolster this intuition. It will be argued that the claim of moral asymmetry in favor of deception can be supported on a consideration of the different degrees of expectation involved in communicative ethics. Two other objections to the claim of asymmetry will also be considered. (shrink)
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Research Objective: This study focuses on ADs in the Netherlands and introduces a cross-cultural perspective by comparing it with other countries. Methods: A questionnaire was sent to a panel comprising 1621 people representative of the Dutch population. The response was 86%. Results: 95% of the respondents didn't have an AD, and 24% of these were not familiar with the idea of drawing up an AD. Most of those familiar with ADs knew about the Advanced Euthanasia Directive (AED, 64%). Both low (...) education and the presence of a religious conviction that plays an important role in one's life increase the chance of not wanting to draw up an AD. Also not having experienced a request for euthanasia from someone else, and the inconceivability of asking for euthanasia yourself, increase the chance of not wanting to draw up an AD. Discussion: This study shows that the subjects of palliative care and end-of-life-decision-making were very much dominated by the issue of euthanasia in the Netherlands. The AED was the best known AD; and factors that can be linked to euthanasia play an important role in whether or not people choose to draw up an AD. This differentiates the Netherlands from other countries and, when it comes to ADs, the global differences between countries and cultures are still so large that the highest possible goals, at this moment in time, are observing and possibly learning from other cultural settings. (shrink)
Patients sometimes request procedures their doctors find morally objectionable. Do doctors have a right of conscientious refusal? I argue that conscientious refusal is justified only if the doctor's refusal does not make the patient worse off than she would have been had she gone to another doctor in the first place. From this approach I derive conclusions about the duty to refer and facilitate transfer, whether doctors may provide 'moral counseling,' whether doctors are obligated to provide objectionable procedures when (...) no other doctor is available, why the moral consensus among doctors seems relevant even though it does not determine whether something is morally acceptable, and whether doctors should stay out of fields whose standard procedures they find morally unacceptable. (shrink)
This article is a response to McLeod and Baylis (2007) who speculate on the dangers of requesting fresh ‘spare’ embryos from IVF patients for human embryonic stem cell (hESC) research, particularly when those embryos are good enough to be transferred back to the woman. They argue that these embryos should be frozen instead. We explore what is meant by ‘spare’ embryos. We then provide empirical evidence, from a study of embryo donation and of embryo donors' views, to substantiate some of (...) their speculations about the problems associated with requesting fresh embryos. However, we also question whether such problems are resolved by embryo freezing, since further empirical evidence suggests that this raises other social and ethical problems for patients. There is little evidence that the request for embryos for research, in itself, causes patients distress. We suggest, however, that no requests for fresh embryos should be made in the first cycle of IVF treatment. Deferring the request to a later cycle ensures that potential donors are better informed (by experience and reflection) about the possible destinations of their embryos and about the definition of ‘spare embryos’. Both this article, and that by McLeod and Baylis, emphasize the need to consider the views and experiences of embryo donors when evaluating the ethics of embryo donation for hESC research. (shrink)
Children often refer to things ambiguously but learn not to from responding to clarification requests. We review and explore this learning process here. In Study 1, eighty-four 2- and 4-year-olds were tested for their ability to request stickers from either (a) a small array with one dissimilar distracter or (b) a large array containing similar distracters. When children made ambiguous requests, they received either general feedback or specific questions about which of two options they wanted. With training, children learned (...) to produce more complex object descriptions and did so faster in the specific feedback condition. They also tended to provide more information when requesting stickers from large arrays. In Study 2, we varied only distracter similarity during training and then varied array size in a generalization test. Children found it harder to learn in this case. In the generalization test, 4-year-olds were more likely to provide information (a) when it was needed because distracters were similar to the target and (b) when the array size was greater (regardless of need for information). We discuss how clear cues to potential ambiguity are needed for children to learn to tailor their referring expression to context and how several cues of heuristic value (e.g., more distracters > say more) can promote the efficiency of communication while language is developing. Finally, we consider whether it would be worthwhile drawing on the human learning process when developing algorithms for the production of referring expressions. (shrink)
Initroduction : From the man of reason to the cynical insider -- Diogenes of Sinope and philosophy as a way of life -- Diogenes the cynic as "counsellor" and malcontent in early modern England -- From rude cynics to "cynical revilers" -- The cynic unveiled : innocence, disenchantment, and rationalization in Rousseau -- Edmund Burke and the counter-enlightenment attack on the "philosopher of vanity" -- Cynicism and dandyism -- Epilogue : How not to talk about cynicism : a conclusion, and (...)request for further discussion. (shrink)
In this paper, I present a new reading of Simone de Beauvoir’s first major work, L’Invitée ( She Came to Stay ), in order to reveal the text as a vital place of origin for feminist phenomenological philosophy. My reading of L’Invitée departs from most scholarly interpretations of the text in three notable respects: (1) it is inclusive of the “two unpublished chapters” that were excised from the original manuscript at the publisher’s request, (2) it takes seriously Beauvoir’s claim (...) that phenomenological philosophy is often better expressed in novels than essays or treatises, and (3) it views the novel’s main characters, Françoise and Xavière, as one woman who has multiple, contradictory, excessive selves. Thus approached, L’Invitée provides us with a thick description of one woman’s embodied consciousness and thereby shows us with specificity what a consciousness whose underlying structures reflect sexual difference looks like. This consciousness not only experiences itself as being both gendered, categorized, disciplined, and defined and in excess of these genders, categories, disciplines, and definitions at the same time, but also experiences its own self-relation through the presence of multiple selves who are each simultaneously attracted to and negating of the other. As such, the defining features of this consciousness involve experiences that I have respectively labeled “ontological multiplicity” and “auto-jealousy.”. (shrink)
Palliative care and hospice should be the standards of care for all terminally ill patients. The first place for clinicians to go when responding to a request for assisted death is to ensure the adequacy of palliative interventions. Although such interventions are generally effective, a small percentage of patients will suffer intolerably despite receiving state-of-the-art palliative care, and a few of these patients will request a physician-assisted death. Five potential “last resort” interventions are available under these circumstances: (1) (...) accelerating opioids for pain or dyspnea; (2) stopping potentially life-prolonging therapies; (3) voluntarily stopping eating and drinking; (4) palliative sedation (potentially to unconsciousness); and (5) physician-assisted death. Patient, family, and clinicians should search for the least harmful way to respond to intolerable end-of-life suffering in ways that are effective and also respect the values of the major participants. A system that allows an open response to such cases ultimately protects patients by ensuring a full clinical evaluation and search for alternative responses, while reinforcing the need to be responsive and to not abandon. (shrink)
Speakers often do not state requests directly but employ innuendos such as Would you like to see my etchings? Though such indirectness seems puzzlingly inefficient, it can be explained by a theory of the strategic speaker, who seeks plausible deniability when he or she is uncertain of whether the hearer is cooperative or antagonistic. A paradigm case is bribing a policeman who may be corrupt or honest: A veiled bribe may be accepted by the former and ignored by the latter. (...) Everyday social interactions can have a similar payoff structure (with emotional rather than legal penalties) whenever a request is implicitly forbidden by the relational model holding between speaker and hearer (e.g., bribing an honest maitre d’, where the reciprocity of the bribe clashes with his authority). Even when a hearer’s willingness is known, indirect speech offers higher-order plausible deniability by preempting certainty, gossip, and common knowledge of the request. In supporting experiments, participants judged the intentions and reactions of characters in scenarios that involved fraught requests varying in politeness and directness. (shrink)
However much one may wish for nonviolent solutions to the problems of unjust and unrestrained human violence that Glover explores in Humanity, some of those problems at present require violent responses. One cannot read his account of the Clinton administration’s campaign to sabotage efforts to stop the massacre in Rwanda in 1994 – a campaign motivated by fear that American involvement would cost American lives and therefore votes – without concluding that Glover himself believes that military intervention was morally required (...) in that case. Military intervention in another state that is intended to stop one group within that state from brutally persecuting or violating the human rights of members of another group is now known as “humanitarian intervention.” Those against whom the intervention is directed are almost always the government and its supporters, though this is not a necessary feature of humanitarian intervention. It is, however, a conceptual condition of humanitarian intervention that it does not occur at the request or with the consent of the government. The use of force within another state with the consent of the government counts as assistance rather than intervention. The principal reason that humanitarian intervention is contentious is that it seems to violate the target state’s sovereign right to control its own domestic affairs. Because humanitarian intervention is a response to human rights violations within the target state, it is regarded as altogether different from wars of defense against aggression. Indeed, since aggression is normally understood to be war against a state that.. (shrink)
Among the many explanations for antibiotic overprescription, some doctors cite the risk of malpractice liability if they deny a patient's request for an antibiotic and the patient's condition worsens. In this paper, I examine the merits of this concern—i.e., whether physicians could, in fact, face malpractice liability for refusing to prescribe an antibiotic when, from a public health perspective, the use of the antibiotic would be considered inappropriate. I conclude that the potential for liability cannot be dismissed entirely, but (...) the risk is remote—even in cases where there is a chance that the antibiotic might have benefited the patient. (shrink)
Advances in science are the combined result of the efforts of a great many scientists, and in many cases, their willingness to share the products of their research. These products include data sets, both small and large, and unique research resources not commercially available, such as cell lines and software programs. The sharing of these resources enhances both the scope and the depth of research, while making more efficient use of time and money. However, sharing is not without costs, many (...) of which are borne by the individual who develops the research resource. Sharing, for example, reduces the uniqueness of the resources available to a scientist, potentially influencing the originator’s perceived productivity and ultimately his or her competitiveness for jobs, promotions, and grants. Nevertheless, for most researchers—particularly those using public funds—sharing is no longer optional but must be considered an obligation to science, the funding agency, and ultimately society at large. Most funding agencies, journals, and professional societies now require a researcher who has published work involving a unique resource to make that resource available to other investigators. Changes could be implemented to mitigate some of the costs. The creator of the resource could explore the possibility of collaborating with those who request it. In addition, institutions that employ and fund researchers could change their policies and practices to make sharing a more attractive and viable option. For example, when evaluating an individual’s productivity, institutions could provide credit for the impact a researcher has had on their field through the provision of their unique resources to other investigators, regardless of whether that impact is reflected in the researcher’s list of publications. In addition, increased funding for the development and maintenance of user-friendly public repositories for data and research resources would also help to reduce barriers to sharing by minimizing the time, effort, and funding needed by individual investigators to comply with requests for their unique resource. Indeed, sharing is an imperative, but it is also essential to find ways to protect for both the original owner of the resource and those wishing to share it. (shrink)
This article deals with the euthanasia debate in light of new life-sustaining technologies such as the left ventricular assist device (LVAD). The question arises: does the switching off of a LVAD by a doctor upon the request of a patient amount to active or passive euthanasia, i.e. to ‘killing’ or to ‘letting die’? The answer hinges on whether the device is to be regarded as a proper part of the patient's body or as something external. We usually regard the (...) switching off of an internal device as killing, whereas the deactivation of an external device is seen as ‘letting die’. The case is notoriously difficult to decide for hybrid devices such as LVADs, which are partly inside and partly outside the patient's body. Additionally, on a methodological level, I will argue that the ‘ontological’ arguments from analogy given for both sides are problematic. Given the impasse facing the ontological arguments, complementary phenomenological arguments deserve closer inspection. In particular, we should consider whether phenomenologically the LVAD is perceived as a body part or as an external device. I will support the thesis that the deactivation of a LVAD is to be regarded as passive euthanasia if the device is not perceived by the patient as a part of the body proper. (shrink)
In this paper I use philosophical accounts on the relationship between trust and knowledge in science to apprehend this relationship on the Web. I argue that trust and knowledge are fundamentally entangled in our epistemic practices. Yet despite this fundamental entanglement, we do not trust blindly. Instead we make use of knowledge to rationally place or withdraw trust. We use knowledge about the sources of epistemic content as well as general background knowledge to assess epistemic claims. Hence, although we may (...) have a default to trust, we remain and should remain epistemically vigilant; we look out and need to look out for signs of insincerity and dishonesty in our attempts to know. A fundamental requirement for such vigilance is transparency: in order to critically assess epistemic agents, content and processes, we need to be able to access and address them. On the Web, this request for transparency becomes particularly pressing if (a) trust is placed in unknown human epistemic agents and (b) if it is placed in non-human agents, such as algorithms. I give examples of the entanglement between knowledge and trust on the Web and draw conclusions about the forms of transparency needed in such systems to support epistemically vigilant behaviour, which empowers users to become responsible and accountable knowers. (shrink)
Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period (...) of time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. (shrink)
