An ethical conflict arises when we must perform research in the interest of future patients, but that this may occasionally injure the interests of today''s patients. In the case of cognitively impaired persons, the question arises whether it is compatible with humane healthcare not only to treat, but also to use these patients for research purposes. Some bioethicists and theologians have formulated a general duty of solidarity, also pertaining to cognitively impaired persons, as a justification for research on these persons. (...) If one examines this thesis from the theory of justice according to John Rawls, it is revealed that such a duty of solidarity cannot necessarily be extrapolated from Rawls' conception of justice. This is at least true of Rawls' difference principle, because accordingto the difference principle only those measures are justifiable which serve the interest of the respective least well off. Those measures which would engender additional injury for the least well off could not be balanced by any utility according to Rawls. However, John Rawls' difference principle is subordinate to the first principle, which is that each person has an equal right to the most extensive basic liberty compatible with the same liberty for others. These primary goods are determined by the freedom and integrity of the person. This integrity of decisionally impaired persons would be in danger if one would abstain from research and thus forego the increase in knowledge related to their disease. Thus one could conclude, at least from Rawls' first principle, that society must take on a duty to guarantee the degrees of freedom for cognitively impaired persons and thus also support the efforts for their healing. (shrink)

Intellectual humility, which entails openness to other views and a willingness to listen and engage with them, is crucial for facilitating civil dialogue and progress in debate between opposing sides. In the present research, we tested whether intellectual humility can be reliably detected in discourse and experimentally increased by a prior self-affirmation task. Three-hundred and three participants took part in 116 audio and video-recorded group discussions. Blind to condition, linguists coded participants’ discourse to create an intellectual humility score. As expected, (...) the self-affirmation task increased the coded intellectual humility, as well as participants’ self-rated prosocial affect (e.g., empathy). Unexpectedly, the effect on prosocial affect did not mediate the link between experimental condition and intellectual humility in debate. Self-reported intellectual humility and other personality variables were uncorrelated with expert-coded intellectual humility. Implications of these findings for understanding the social psychological mechanisms underpinning intellectual humility are considered. (shrink)

Apresentam-se os resultados clínicos principais de uma primeira investigação efectuada a familiares de doentes sob tratamento paliativo no domicílio da área de Lisboa, com o instrumento de medida da satisfação SERVQUAL Modificado. Dos 58 familiares/doentes que responderam ao questionário apenas uma minona estava insatisfeita (uma classe de 5 indivíduos mostra-se francamente insatisfeita), uma classe de 15 estava moderadamente satisfeita, havendo 38 individuos fortemente satisfeitos com a qualidade e prontidäo dos serviços prestados. Porém urna percentagem elevada de doentes, segundo a opinião (...) retrospectiva dos cuidadores, faleceu com sintomatologia agravada, nomeadamente dores (60%), obstipação (67%) e depressão/ansiedade (43%). Discute-se a consistência e validade do questionáno SERVQUAL Modificado, contextualizam-se os resultados no que é o standard da prática da MCP e integram-se na promoção da dignidade humana no fim da vida. We present the main clinical findings of research on palliative home care, carried out among relatives of patients in the Lisbon area. An adapted version of SERVQUAL was used. Of a total of 58 carers surveyed only a small number (5) was unsatisfied 15 were only moderately satisfied. 38 family carers were strongly satisfied with the services. Yet, a high percentage of patients, as viewed in retrospect by their relatives died with some aggravated symptoms: 60% with more pain, 67% constipation, and 43% anxiety/depression. We discuss the consistency and validity of this adapted SERVQUAL tool and the main results are contextualized beanng in mind the standard practice of palliative medicine and the pursuit of human dignity in death. (shrink)

Apresentamos um resumo do desenvolvimento e do contexto institucional do Projecto Humanização dos Cuidados Paliativos em Contexto Domiciliário, aprovado e financiado pela Fundação Calouste Gulbenkian. Utilizam-se largamente os próprios documentos que o justificaram e os relatórios oficiais para dar uma imagem vivida, realista e técnica das dificuldades da profissionalização e reforma dos Cuidados Paliativos, mesmo quando integrada em acções de formação num serviço de um Centro de Tratamento Compreensivo do Cancro. We put forward a synopsis of the development and institutional (...) context of the Project Humanização dos Cuidados Paliativos em Contexto Domiciliário, approved and financed by the Calouste Gulbenkian Foundation. The groundwork documents are widely used as well as official reports so as to convey a lively, realistic and technical image arising from professionalizing and reforming Palliative Medicine even when it is based on in-service training programmes in an Comprehensive Cancer Center. (shrink)

The λ-continuum of inductive methods was derived from an assumption, called λ-condition, which says that the probability of finding an individual having property $x_{j}$ depends only on the number of observed individuals having property $x_{j}$ and on the total number of observed individuals. So, according to that assumption, all individuals with properties which are different from $x_{j}$ have equal weight with respect to that probability and, in particular, it does not matter whether any individual was observed having some property similar (...) to $x_{j}$ (the most complete proof of this result is presented in Carnap, 1980). The problem thus remained open to find some general condition, weaker than the λ-condition, which would allow for the derivation of probability functions which might be sensitive to similarity. Carnap himself suggested a weakening of the λ-condition which might allow for similarity sensitive probability functions (Carnap, 1980, p. 45) but he did not find the family of probability functions derivable from that principle. The aim of this paper is to present the family of probability functions derivable from Carnap's suggestion and to show how it is derived. In Section 1 the general problem of analogy by similarity in inductive logic is presented, Section 2 outlines the notation and the conceptual background involved in the proof, Section 3 gives the proof, Section 4 discusses Carnap's principle and the result, Section 5 is a brief review of the solutions which have previously been proposed. (shrink)

The semantical structures called T x W frames were introduced in (Thomason, 1984) for the Ockhamist temporal-modal language, $[Unrepresented Character]_{o}$ , which consists of the usual propositional language augmented with the Priorean operators P and F and with a possibility operator ◇. However, these structures are also suitable for interpreting an extended language, $[Unrepresented Character]_{so}$ , containing a further possibility operator $\lozenge^{s}$ which expresses synchronism among possibly incompatible histories and which can thus be thought of as a cross-history 'simultaneity' operator. (...) In the present paper we provide an infinite set of axioms in $[Unrepresented Character]_{so}$ , which is shown to be strongly complete for T x W-validity. Von Kutschera (1997) contains a finite axiomatization of T x W-validity which however makes use of the Gabbay Irreflexivity Rule (Gabbay, 1981). In order to avoid using this rule, the proof presented here develops a new technique to deal with reflexive maximal consistent sets in Henkin-style constructions. (shrink)

The semantical structures called T×W frames were introduced in (Thomason, 1984) for the Ockhamist temporal-modal language, ℒO, which consists of the usual propositional language augmented with the Priorean operators P and F and with a possibility operator ⋄. However, these structures are also suitable for interpreting an extended language, ℒSO, containing a further possibility operator ⋄s which expresses synchronism among possibly incompatible histories and which can thus be thought of as a cross-history ‘simultaneity’ operator. In the present paper we provide (...) an infinite set of axioms in ℒSO, which is shown to be strongly complete forT ×W-validity. Von Kutschera (1997) contains a finite axiomatization of T×W-validity which however makes use of the Gabbay Irreflexivity Rule (Gabbay, 1981). In order to avoid using this rule, the proof presented here develops a new technique to deal with reflexive maximal consistent sets in Henkin-style constructions. (shrink)

The writings of the Scottish physician and philosopher John Gregory play an important role in the modern codification of medical ethics. It is therefore appropriate to use his work as a historical example in approaching the question how elements of aesthetics were incorporated in 18th century medical ethics. The concept of a Gentleman is pivotal to the entire medical ethics of John Gregory as it provides him with the ethical source of the duty to patients. Gregory makes the trustworthiness of (...) the physician a central point of his medical ethics, and it is in this context that Gregory declares good manners as an essential moral quality of a physician. This paper delineates how good manners are ethically justified in Gregory's medical ethics and concludes with an exploration of the importance of Gregory's conception for present day reflection on the inherence of aesthetics in ethical determinations. (shrink)

In the search for a globally binding ethical minimal consensus in dealing with research on human beings the awareness of the cultural specificity of such questions will be of central importance. France provides a good example of such cultural specificities. Three basic structures of French discussion on research ethics can be enumerated: first the particular weight placed on therapeutic benefit, second a particular accentuation on freedom and voluntarism, and third its lesser attention to the aspect of ability to give consent. (...) The weak emphasis on the ability to give consent is rooted as much in the traditionally paternalistically imbued physician-patient relationship as in the French legal system, in which the doctrine of consent is not given the fundamental position of importance found in the Anglo-Saxon countries. As an important Roman country, a different accentuation in the ethical discussion on research on humans can be recognised, a discussion in which for a long time the right of self determination was less of a criterion for decision than the teleology of medical action. It is precisely this aspect of latent cultural influence in ethical convictions which is of decisive importance for future discussion on research on humans. (shrink)

Reflection Principles are commonly thought to produce only strong axioms of infinity consistent with V = L. It would be desirable to have some notion of strong reflection to remedy this, and we have proposed Global Reflection Principles based on a somewhat Cantorian view of the universe. Such principles justify the kind of cardinals needed for, inter alia , Woodin’s Ω-Logic.

While many European countries are entering unknown legal terrain where the embryo in vitro is concerned, France can already look back on a long tradition of public discussion and legal codification of ways of dealing with in vitro embryos. In its comprehensive law of 1994, France had still rejected embryo research; however, due to the promising perspectives of stem cell research, the new law now pending implies a clear liberalization of the 1994 provisions. Both the French lawmakers and the National (...) Ethics Commission have repeatedly argued that possible utilization of embryos for research purposes may seem legitimate from the moment that there is no more "parental project." De facto, this concept implies that an embryo can be transformed into an object from the moment that the parents cease to desire it and that the value of protection is solely dependent on the will of third persons. At the same time, France is still speaking of guaranteeing respect for the "dignity of the embryo," which would mean that an embryo must not be reduced to a thing and treated for purposes which are not his own. Therefore, the French solution is not a consistent and honest solution, and in its new legal provisions, France has involved herself in manifold contradictions. France has rejected the conception of pre-embryo, but is de facto following Britain's model without making it explicit. (shrink)

Individuals who deviate from social norms by committing crimes may have reduced facial emotion recognition abilities. Nevertheless, a specific category of offenders – i.e. organised crime (OC) members – is characterised by hierarchically organised social networks and a tendency to manipulate others to reach their illicit goals. Since recognising emotions is crucial to building social networks, OC members may be more skilled in recognising the facial emotion expressions of others to use this information for their criminal purposes. Evidence of a (...) difference between OC and non-organised crime (NOC) offenders in terms of facial emotion recognition is still lacking. To fill this gap in the literature, we tested 50 OC, 50 NOC offenders, and 50 non-offender controls for their ability to identify six basic emotions (happiness, sadness, fear, anger, disgust, and surprise). All participants underwent a cognitive and psychological evaluation to avoid alternative explanations. Results show that OC members were more able to detect the expression of fear in others as compared to NOC. We interpreted this finding in light of the social context and the behavioural criminal attitude of OC members. (shrink)

A narrative analysis of a sequence from a documentary on the withholding of treatment in persistent vegetative state allows the discernment of several characteristics of the approach of the media to medical ethical problems: (1) The arrangement of the story units in the film sequence corresponds to established patterns of movie dramaturgy. (2) The documentary ”hollywoodizes” morality; it interprets the arena of the problem in the realm of the movie theatre and not in the realm of ethical discourse. (3) The (...) moral decision occurs in the return to mythical narrative structures which show a tendency to confirm perceived established world interpretation. (4) Morality is reduced to black and white characterizations. (5) The ethical conflict is transmitted through the plane of personal action which tends to blot out complex interdependencies. (6) Private happiness forms the basis for an essential set of criteria for all actions and decisions. The rational weighing of criterion is not easily transmittable by television; instead, television, due to its audiovisual sensory nature, has a great potential to awaken insight into and understanding of specific situations and personal experience. Thus television can supplement the philosophical discipline of hermeneutical bioethics in generating sympathy and deeper understanding. (shrink)

There is a view that the U.S. Supreme Court has acted as a “republican schoolmaster,” defining and educating the public on the permissible interaction between government and religion. The Court gave government, especially state governments, considerable latitude until incorporation of the religion clauses in the 1940s. In Everson v. Board of Education (1947), the Court articulated a rigid conception of church and state which set precedents for decades. Those precedents restricted accommodation to religion by government, based on an incomplete reading (...) of the Founding debates on religion. It has been gradually corrected since Justice William Rehnquist’s dissent in Wallace v. Jaffree (1985). The implications of the separationist interpretation have had consequences that remain. The most obvious being forestalling experimentation with school choice for non-public school students and precluding the use of public facilities for religious groups until a series of corrective rulings beginning, for the most part, in the 1990s. The republican schoolmaster is now accountable for the intellectual lineage it uses. (shrink)

In my recent article, I addressed the question of whether a potential categorical exclusion of decisionally impaired patients from non-therapeutic medical research would be inaccordance with the Principle of Justice as Fairness. I came to the conclusion that a categorical exclusion of decisionally impaired persons from relevant research projects may collide with Rawls’s understanding of Justice as Fairness. Derek Bell has criticized my paper by denying that it is legitimate to apply Rawls to this bioethical problem. In my restatement I (...) try to show that an extrapolation of John Rawls’s thought to such bioethical cases is possible, because Rawls himself has written that his orientation towards decisionally non-impaired persons is an idealized situation that allows extrapolations. In a second part I try to show that Bell hasroughly misunderstood my concept of “presumed consent” which I make a prerequisite for the legitimisation of research on decisionally impaired persons. In using advance consent as a proposal for resolving the problem, Bell has indirectly confirmed my approach because he is using a similar construct of consent, which operates with similar hypotheses and probabilities of error. I see here no categorical difference between Bell’s conclusion and my discussion. Thus, Bell’s reply does not represent a refutation of my thoughts, but rather it is a para phrased confirmation of my central theses. I conclude by showing the relevance of Rawls, pointing out that the discussion between Bell and me illustrates how Rawls’s concept of reflective equilibrium is an appropriate approach to finding a solution to this bioethical problem. (shrink)

The justification of non-therapeutic research on incapacitated persons isastill unsolved problem, because in this situation, both legitimising factors of research - informed consent and therapeutic benefit - are absent and the question arises as to whether such research is morally justifiable at all. The paperwill ask if there could be arguments for such research. One argument could be that under certain circumstances, an institutionally decreed global renunciation of any type of research on this group of persons could also be illegitimate. (...) Not doing research can do injury to the Principles of Justice because in this manner the needs of a particular group may unjustifiably be ignored. This would aggravate the disadvantaged position of this group in a groundless manner and, in particular, would deprive its members of the basis of self respect Precisely in view of this aspect of Justice non-therapeutic studies on decisionally impaired persans must also be permitted in order to ensure the preservation of basic social goods in regard to these persons. (shrink)

The corporate sustainability, and responsibility, movement has considerable implications for and impact on the discipline of brand management. It creates pressures to which the discipline must adjust, and new growth opportunities for it to enjoy.In Maio''s view, "brand" permeates all aspects of the corporation and therefore the values of the brand can serve as an effective touchstone for all corporate behaviours: in the Boardroom, in financial markets, in negotiations with employees, in customer interactions, in dialogue with other stakeholders. Moreover, (...) most corporations already have "plumbing" in place (the organizational substructures and processes to manage their brand), that can serve as effective conduits for nurturing values-driven behaviours and measuring them. (shrink)

Scientific realists have suggested that changes in our scientific communities over the course of their history have rendered those communities progressively less vulnerable to the problem of unconcieved alternatives over time. I argue in response not only that the most fundamental historical transformations of the scientific enterprise have generated steadily mounting obstacles to revolutionary, transformative, or unorthodox scientific theorizing, but also that we have substantial independent evidence that the institutional apparatus of contemporary scientific inquiry fosters an exceedingly and increasingly theoretically (...) conservative form of that inquiry. I conclude that contemporary scientific communities are actually more vulnerable to the problem of unconceived alternatives than their historical predecessors, and I briefly suggest how we might seek to pursue scientific inquiry in a less theoretically conservative way. (shrink)

Meeting in the petri dish? -- Screen, test, weed out? -- Prettier, better, stronger? -- Is health a duty? -- The crisis of confidence in organ donation -- On the value of age : beyond the fitness imperative -- Living wills : are forms replacing dialogue? -- Being able to let go : for a new culture of dying -- Epilogue: happiness lies in our attitude toward the world.