Technological advances in veterinary medicine have produced considerable progress in the diagnosis and treatment of numerous diseases in animals. At the same time, veterinarians, veterinary technicians, and owners of animals face increasingly complex situations that raise questions about goals of care and correct or reasonable courses of action. These dilemmas are frequently controversial and can generate conflicts between clients and health care providers. In many ways they resemble the ethical challenges confronted by human medicine and that spawned the creation of (...) clinical ethics committees as a mechanism to analyze, discuss, and resolve disagreements. The staff of the North Carolina State University Veterinary Hospital, a specialty academic teaching institution, wanted to investigate whether similar success could be achieved in the tertiary care veterinary setting. We discuss the background and rationale for this method, as well as the approach that was taken to create a clinical ethics committee. (shrink)
Do studies of perception without awareness and studies of perception without attention address a similar underlying concept of awareness? To answer this question, we compared qualitative differences in performance across variations in stimulus quality with qualitative differences in performance across variations in the direction of attention . The qualitative differences were based on three different phenomena: Stroop priming, false recognition, and exclusion failure. In all cases, variations in stimulus quality and variations in the direction of attention led to parallel findings. (...) These results suggest that perception with and without awareness and perception with and without attention are equivalent ways of describing the same underlying process distinction. (shrink)
For many years a debate has raged over what constitutes futile medical care, if patients have a right to demand what doctors label as futile, and whether physicians should be obliged to provide treatments that they think are inappropriate. More recently, the argument has shifted away from the difficult project of definitions, to outlining institutional policies and procedures that take a measured and patient-by-patient approach to deciding if an existing or desired intervention is futile. The prototype is the Texas Advance (...) Directives Act, but similar procedures have been widely implemented both with and without the protection of the law. While this method has much to recommend it, there are inherent moral flaws that have not received as much discussion as warranted. Because these strategies adopt a semblance of procedural justice, it is assumed that the outcomes of such proceedings will be both correct and fair. In this paper, I argue that there are three main irremediable defects in the policy approach: there is the potential for arbitrary decision-making about futility in specific cases; there are structural, pre-ordained consequences for ethnic minorities who would be disproportionately affected by the use of these procedures; and the use of rationing justifications to support the use of these policies. These flaws detract so much from any benefit that could be derived that they make such strategies more harmful than helpful. (shrink)
The Institute of Medicine and the American Heart Association have issued a “call to action” to expand the performance of cardiopulmonary resuscitation in response to out-of-hospital cardiac arrest. Widespread advertising campaigns have been created to encourage more members of the lay public to undergo training in the technique of closed-chest compression-only CPR, based upon extolling the virtues of rapid initiation of resuscitation, untempered by information about the often distressing outcomes, and hailing the “improved” results when nonprofessional bystanders are involved. We (...) describe this misrepresentation of CPR as a highly effective treatment as the fetishization of this valuable, but often inappropriately used, therapy. We propose that the medical profession has an ethical duty to inform the public through education campaigns about the procedure's limitations in the out-of-hospital setting and the narrow clinical indications for which it has been demonstrated to have a reasonable probability of producing favorable outcomes. (shrink)
Periodic and unexpected shortages of drugs, biologics, and even medical devices have become commonplace in the United States. When shortages occur, hospitals and clinics need to decide how to ration their available stock. When such situations arise, institutions can choose from several different allocation schemes, such as first-come, first-served, a lottery, or a more rational and calculated approach. While the first two approaches sound reasonable at first glance, there are a number of problems associated with them, including the inability to (...) make fine, individual patient-centered decisions. They also do not discriminate between what kinds of patients and what types of uses may be more deserving or reasonable than others. In this article I outline an ethically acceptable procedure for rationing drugs during a shortage in which demand outstrips supply. (shrink)
As an alternative to establishing awareness thresholds, stimulus contexts in which there were either greater conscious or greater unconscious influences were defined on the basis of performance on an exclusion task. Target words were presented for brief durations and each target word was followed immediately by its three-letter stem. Subjects were instructed to complete each stem with any word other than the target word. With this task, failures to exclude target words indicate greater unconscious influences, whereas successful exclusion indicates greater (...) conscious influences. Conscious influences were dominant at long durations , but unconscious influences were dominant at short durations . Performance on the exclusion task successfully predicated both qualitative differences in Stroop priming and qualitative differences in recognition memory previously associated with the different effects of conscious and unconscious influences. Taken together, these results demonstrate that an exclusion task allows both unconscious and conscious influences to be defined in terms of significant deviations from baseline performance. As such, exclusion tasks provide a method for distinguishing conscious from unconscious influences that does not require establishing thresholds for null awareness. (shrink)
The current Ebola virus epidemic in Western Africa appears to be spiraling out of control. The worst-case projections suggested that the unchecked spread could result in almost 1.4 million cases by the end of January 2015 with a case fatality rate of at least 50%. The United States and European nations have begun to respond in earnest with promises of supplies, isolation beds, and trained health care personnel in an effort to contain the epidemic and care for the sick. However, (...) there is neither a vaccine nor specific treatment for Ebola infection, and therapy is ideally centered on supportive care. I have previously argued that the provision of palliative care is obligatory during an overwhelming health catastrophe, notably pandemic influenza. Since affected Ebola patients have best outcomes with technologically advanced intensive care—resources in scarce supply in the area—I suggest that the only acceptable approach to large numbers of very sick, dying, and suffering Ebola patients who overwhelm the reso.. (shrink)
The ongoing revolution in molecular genetics has led many to speculate that one day we will be able to change the expression or phenotype of numerous complex traits to improve ourselves in many different ways. The prospect of genetic enhancements has generated heated controversy, with proponents advocating research and implementation, with caution advised for concerns about justice, and critics tending to see the prospect of genetic enhancements as an assault on human freedom and human nature. Both camps base their arguments (...) on the unquestioned assumption that the science will realize either their dreams or nightmares. In this paper, I show that their beliefs are based upon two fundamental mistakes. First, they are based upon an unwarranted reliance in a genetic determinism that takes for granted that the traits that we might most want to enhance, like intelligence, aggression, shyness, and even athletic ability, can be causally directed by specific genes. In so doing, character descriptions are reified to be concrete and discrete entities, in this case, genes. Second, they have accepted on faith that there is, or will be, a science to translate their hopes or worries into reality when, in fact, that is unlikely to occur because of the irreducible complexity of phenotypic expression. (shrink)
The current outbreak of Ebola virus infection in West Africa continues to spread. Several patients have now been treated in the United States and preparations are being made for more. Because of the strict isolation required for their care, questions have been raised about what diagnostic and therapeutic interventions should be available. I discuss the ethical challenges associated with caring for patients in strict isolation and personnel wearing bulky protective gear with reduced dexterity and flexibility, the limitations this may place (...) on available treatments and the permissibility of consequent departures from the standards of care. Restricting access to some interventions such as surgery requiring an operating room, advanced imaging, etc. is reasonable due to concern for protecting other patients, visitors and staff. Cardiopulmonary resuscitation is a special case and the implications for withholding this intervention in situations where it may be desired is discussed, especially with respect to those patients who have suspected, but not proven, infection. These same restrictions are also considered under conditions where there are scarce resources and thus limited numbers of patients may receive care. While it is to be hoped that there is only limited and sporadic infection with Ebola virus in the US, careful thought must be given to the care of these patients under the unusual circumstances demanded by their isolation. I argue that an altered standard of care is reasonable and ethically acceptable under certain conditions. (shrink)
This paper reviews the history of psychological investigations of unconscious perception and summarizes the current status of experimental research in this area of investigation. The research findings described in the paper illustrate how it is possible to distinguish experimentally between conscious and unconscious perception. The most successful experimental strategy has been to show that a stimulus can have qualitatively different consequences on cognitive and affective reactions depending on whether it was consciously or unconsciously perceived. In addition, recent studies of patients (...) undergoing general anaesthesia have shown that the effects of stimuli perceived unconsciously during surgery can last for approximately 24 hours. Taken together, the results of these recent psychological investigations provide empirical support for the importance of unconsciously perceived information in determining cognitive and affective reactions. (shrink)
Rationing is an unavoidable mechanism for reining in healthcare costs. It entails establishing cutoff points that distinguish between what is and is not offered or available to patients. When the resource to be distributed is defined by vague and indeterminate terms such as “beneficial,” “effective,” or even “futile,” the ability to draw meaningful boundary lines that are both ethically and medically sound is problematic. In this article, I draw a parallel between the challenges posed by this problem and the ancient (...) Greek philosophical conundrum known as the “sorites paradox.” I argue, like the paradox, that the dilemma is unsolvable by conventional means of logical analysis. However, I propose another approach that may offer a practical solution that could be applicable to real-life situations in which cutoffs must be decided. (shrink)
Different ethical frameworks have been proposed as appropriate for integrating into crisis management strategies. This study examines an ethic of care approach to crisis management analysing the case of Northern Rock bank which was at the centre of the recent financial crisis in the UK. The development and maintenance of relationships is fundamental to an ethic of care approach and the research recognises this by examining the bank–stakeholder relationship both before and after the crisis. Considerable anger was directed at the (...) bank post-crisis and, subsequently, the management team resigned. An important contention is that because an ethic of care approach had not been followed external parties judged that management should have foreseen the crisis and the harm caused was deemed intentional, even though predicting the crisis would have been difficult and it is improbable any harm was intended. Additionally, this negative reaction was heightened due to three facets of Northern Rock’s history: (i) its previous existence as a building society, (ii) the ‘local’ nature of the bank and (iii) the creation of The Northern Rock Foundation. These historical factors caused local stakeholders to presume a ‘caring’ relationship between themselves, and the bank had continued to exist post-demutualisation. The events of the crisis compelled stakeholders to re-appraise this presumption, amplifying the post-crisis anger. (shrink)
CHAPTER I DEWEY'S CONCEPT OF EXPERIENCE AND NATURE John Dewey, ever the celebrant of experience, did not attempt to write a formal work in aesthetics until ...
Genetic determinism labels the morally problematical claim that some socially significant traits, traits we care about, such as sexual orientation, gender roles, violence, alcoholism, mental illness, intelligence, are largely the results of the operation of genes and not much alterable by environment, learning or other human intervention. Genetic determinism does not require that genes literally fix these socially significant traits, but rather that they constrain them within narrow channels beyond human intervention. In this essay we analyze genetic determinism in light (...) of what is now known about the inborn error of metabolism phenylketonuria , which has for so long been the poster child ‘simple’ argument in favor of some form of genetic determinism. We demonstrate that this case proves the exact opposite of what it has been proposed to support and provides a strong refutation of genetic determinism in all its guises. (shrink)
Studies investigating memory for events during anesthesia show a confusing pattern of positive and negative results. To establish whether there are any consistent patterns of findings across studies, we conducted a meta-analysis of the data from 2517 patients in 44 studies. The meta-analysis included two measures of the effects of positive suggestions on postoperative recovery: the duration of postoperative hospitalization and the amount of morphine administered via patient-controlled anesthesia, as well as two measures of memory for specific information presented during (...) anesthesia: direct tests and indirect tests. The meta-analysis indicated that positive suggestions presented during anesthesia have little or no effect on postoperative recovery. On the other hand, the meta-analysis showed that specific information is remembered following surgery, as long as testing is not delayed longer than 36 h. Studies of memory for events during anesthesia provide a useful avenue for exploring unconscious cognition. (shrink)
The phenomenon of contract cheating presents, potentially, a serious threat to the quality and standards of Higher Education around the world. There have been suggestions, cited below, to tackle the problem using legal means, but we find that current laws are not fit for this purpose. In this article we present a proposal for a specific new law to target contract cheating, which could be enacted in most jurisdictions.We test our proposed new law against a number of issues that would (...) need to be considered before any legal approach could be successful; would changing the legal status of contract cheating make it less likely to happen? Could this be achieved in a specific way? If so, who should actually be prosecuted and what offence are they committing? Would it actually address the causes of contract cheating? We suggest some answers to these questions, but then also identify a number of unintended potential consequences. We therefore additionally consider whether a legal approach is possible or even desirable.We conclude that a legal approach to contract cheating is possible, and, on balance, appropriate. Using UK law as an example, we offer a specific suggestion to lawmakers, around the world, for how this might be achieved, and conclude that the most successful approach would be to focus largely on a law targeting the providers of contract cheating, in particular commercial services. (shrink)
Corruption presents an assurance problem to businesses: all businesses are best off if none act corruptly but in the event that corruption occurs are better off if they act corruptly than if they do not, and because there is no assurance that other actors are not cheating a business does not know how to act. The usual solution to an assurance problem – criminal sanctions imposed on cheaters – does not work in a corrupt system. Integrative Social Contract Theory suggests (...) a solution to the assurance problem. Application of Integrative Social Contract Theory to corruption demonstrates that in the case of corruption it has advantages over international law, and that the theory's elegance lies in its recognition of norms generated by multiple communities. (shrink)
We propose a causal model theory to explain asymmetries in judgments of the intentionality of a foreseen side-effect that is either negative or positive (Knobe, 2003). The theory is implemented as a Bayesian network relating types of mental states, actions, and consequences that integrates previous hypotheses. It appeals to two inferential routes to judgment about the intentionality of someone else's action: bottom-up from action to desire and top-down from character and disposition. Support for the theory comes from three experiments that (...) test the prediction that bottom-up inference should occur only when the actor's primary objective is known. The model fits intentionality judgments reasonably well with no free parameters. (shrink)
We highlight one way in which Jones & Love (J&L) misconstrue the Bayesian program: Bayesian models do not represent a rejection of mechanism. This mischaracterization obscures the valid criticisms in their article. We conclude that computational-level Bayesian modeling should not be rejected or discouraged a priori, but should be held to the same empirical standards as other models.
