The development of clinical ethic support in the UK arguably brings with it a series of legal questions, which need to be addressed. Most particularly, these concern questions of due process and formal justice, which I argue are central to the provision of appropriate ethical advice. In this article, I will compare the UK position with the more developed system in the USA, which often provides a template for development in the UK. While it is not argued that the provision (...) of clinical ethics support in the UK will necessarily follow the path mapped in the USA, there are lessons that can be learned from the US experience – particularly in terms of attention to process – from which UK clinical ethics support service might well benefit. (shrink)

The system of clinical ethics committees (CECs) in the United Kingdom is based on goodwill. No formal requirements exist as to constitution, membership, range of expertise or the status of their recommendations. Healthcare professionals are not obliged to use CECs where they exist, nor to follow any advice received. In addition, the make-up of CECs suggests that ethics itself may be under-represented. In most cases, there is one member with a training in ethics – the rest are healthcare professionals or (...) administrators, although a lawyer is generally also included in the membership. This begs the question as whether CECs can ‘do ethics’, as well whether or not they can take seriously the requirements of due process, formal justice and human rights. Moreover, the role of the patient in this system is opaque. (shrink)

A medical profession which did not seek improved means to conquer disease would be condemned for dereliction of its duty, Members of the public will not accept the current state of the medical arts as finite but feel justified in expecting the development of more effective therapies for illness, and the promotion of improved means of preventive care.With this assertion, the distinguished academic, Bernard Dickens, places research firmly in the domain of the public interest. Foster agrees, saying that, “[t]o improve (...) medical care as much as we can, if not to perfect it, means that we have to accept the need for research.” Giesen adds a further emphasis to the search for medical advancements, saying that “freedom of research and scientific inquiry is, in itself, an important aspect of open societies.“. (shrink)

A medical profession which did not seek improved means to conquer disease would be condemned for dereliction of its duty, Members of the public will not accept the current state of the medical arts as finite but feel justified in expecting the development of more effective therapies for illness, and the promotion of improved means of preventive care.With this assertion, the distinguished academic, Bernard Dickens, places research firmly in the domain of the public interest. Foster agrees, saying that, “[t]o improve (...) medical care as much as we can, if not to perfect it, means that we have to accept the need for research.” Giesen adds a further emphasis to the search for medical advancements, saying that “freedom of research and scientific inquiry is, in itself, an important aspect of open societies.“. (shrink)

ABSTRACTThis report on end‐of‐life decision‐making in Canada was produced by an international expert panel and commissioned by the Royal Society of Canada. It consists of five chapters.Chapter 1 reviews what is known about end‐of‐life care and opinions about assisted dying in Canada.Chapter 2 reviews the legal status quo in Canada with regard to various forms of assisted death.Chapter 3 reviews ethical issues pertaining to assisted death. The analysis is grounded in core values central to Canada's constitutional order.Chapter 4 reviews the (...) experiences had in a number of jurisdictions that have decriminalized or recently reviewed assisted dying in some shape or form.Chapter 5 provides recommendations with regard to the provision of palliative care in Canada, as well as recommendations for reform with respect to the various forms of assisted death covered in this document. (shrink)

The so-called genetics revolution rests on a history which at its least can be described as controversial. Modern genetics needs to bear this history in mind. In particular, as with the past, the area of reproductive choice seems particularly vulnerable to potential abuse. Courts in the UK and elsewhere have already shown themselves willing to interfere with the choices of women in the management of their pregnancies. Medical advance, perhaps particularly the capacity to visualise the developing foetus, has added complexity (...) to the question of whether the health care provider has one patient or two patients . Additionally, pregnancy is thoroughly monitored in modern medical practice and genetics may provide a further impetus or incentive to mandate increased policing of pregnancy. Gene therapy, once offered, will add further to the desire to ensure that women make the ‘right’ choice, especially when the invasion required is relatively minimal. Further, genetic information is at best predictive, but may, because of its scientific nature, appear to those receiving it to be certain. Thus, the provision of genetic information may reduce rather than enhance choice, unless carefully and sensitively provided. A mature and sophisticated debate about the role of genetics in reproduction is required—engaging rather than bypassing the public—if the real potential of genetics is to be vindicated. (shrink)

Institutional review board delays may hinder the successful completion of federally funded research in the U.S. military. When this happens, time-sensitive, mission-relevant questions go unanswered. Research participants face unnecessary burdens and risks if delays squeeze recruitment timelines, resulting in inadequate sample sizes for definitive analyses. More broadly, military members are exposed to untested or undertested interventions, implemented by well-intentioned leaders who bypass the research process altogether. To illustrate, we offer two case examples. We posit that IRB delays often appear in (...) the service of managing institutional risk, rather than protecting research participants. Regulators may see more risk associated with moving quickly than risk related to delay, choosing to err on the side of bureaucracy. The authors of this article, all of whom are military-funded researchers, government stakeholders, and/or human subject protection experts, offer feasible recommendations to improv... (shrink)

As support for clinical ethics committees in the UK grows, care must be taken to define their function, membership and method of working and the status of their decisions.The modern practice of medicine raises a plethora of complex issues—medical, ethical and legal. Doctors and other healthcare professionals increasingly must try to resolve these and may sometimes have to do so in the face of contrary opinion expressed by patients and/or their surrogates. While clearly qualified in the medical arena, and although (...) there is now more ethics teaching in the medical curriculum, healthcare professionals are seldom qualified to adjudicate on ethical or legal matters, or even, perhaps, to recognise them when they arise. Yet, as Doyal says, “clinical life must go on and moral and legal indeterminacy within medicine cries out for practical resolution.”1 Meanwhile, the expectations of patients and their families—and, indeed, of wider society—are that decisions about patient care, resources and therapeutic regimes should be soundly based on appropriate ethicolegal, as well as scientific, principle.Recognition of these additional burdens on healthcare professionals has generated some interest in the provision of ethics consultation. In the USA this has been undertaken by a variety of tribunals and individuals. Hospital ethics committees and ethics consultants feature in many US hospitals and perform a variety of roles. In Europe, a number of countries have also established clinical ethics committees and they are becoming more common in the UK—primarily in England and Wales for the moment. Whereas, however, “[i]n North America, CECs have … become an integral part of the organisational infrastructure of hospitals ...”,1 in the United Kingdom they remain essentially ad hoc bodies, generated for a variety of reasons and with different goals, structures, membership, methods of working and functions. The initial impetus for the …. (shrink)

The controversies in Bristol, Alder Hey and elsewhere in the UK surrounding the removal and retention of human tissue and organs have led to extensive law reform in all three UK legal systems. This paper reports a short study of the reactions of a range of health professionals to these changes. Three main areas of ethical concern were noted: the balancing of individual rights and social benefit; the efficacy of the new procedures for consent; and the helpfulness for professional practice (...) of the new legislation and regulation. Recognition of these concerns may help in forging a new partnership between professionals and patients and their families. (shrink)

The patient-doctor relationship has recently come under intense scrutiny, resulting in a re-evaluation of the basis of that relationship. The papers by Glannon and Ross, and McKay seek to identify the sources of authority in the patient-doctor relationship by evaluating it in terms of the concept of altruism. In this paper I argue that the analysis of Glannon and Ross, and of McKay is unnecessary and that the analysis offered by the latter is also flawed. I do acknowledge, however, that (...) Glannon and Ross's description of doctors' responsibilities and patients' roles has much to commend it. (shrink)

In this paper we show that the class of fork squares has a complete orthodox axiomatization in fork arrow logic (FAL). This result may be seen as an orthodox counterpart of Venema's non-orthodox axiomatization for the class of squares in arrow logic. FAL is the modal logic of fork algebras (FAs) just as arrow logic is the modal logic of relation algebras (RAs). FAs extend RAs by a binary fork operator and are axiomatized by adding three equations to RAs equational (...) axiomatization. A proper FA is an algebra of relations where the fork is induced by an injective operation coding pair formation. In contrast to RAs, FAs are representable by proper ones and their equational theory has the expressive power of full first-order logic. A square semantics (the set of arrows is ᵎ x ᵎ for some set ᵎ) for arrow logic was defined by Y. Venema. Due to the negative results about the finite axiomatizability of representable RAs, Venema provided a non-orthodox finite axiomatization for arrow logic by adding a new rule governing the applications of a difference operator. We address here the question of extending the type of relational structures to define orthodox axiomatizations for the class of squares. Given the connections between this problem and the finitization problem addressed by I. Németi, we suspect that this cannot be done by using only logical operations. The modal version of the FA equations provides an orthodox axiomatization for FAL which is complete in view of the representability of FAs. Here we review this result and carry it further to prove that this orthodox axiomatization for FAL also axiomatizes the class of fork squares. (shrink)

Logics for generally were introduced for handling assertions with vague notions,such as generally, most, several, etc., by generalized quantifiers, ultrafilter logic being an interesting case. Here, we show that ultrafilter logic can be faithfully embedded into a first-order theory of certain functions, called coherent. We also use generic functions (akin to Skolem functions) to enable elimination of the generalized quantifier. These devices permit using methods for classical first-order logic to reason about consequence in ultrafilter logic.

We compare fork arrow logic, an extension of arrow logic, and its natural first-order counterpart (the correspondence language) and show that both have the same expressive power. Arrow logic is a modal logic for reasoning about arrow structures, its expressive power is limited to a bounded fragment of first-order logic. Fork arrow logic is obtained by adding to arrow logic the fork modality (related to parallelism and synchronization). As a result, fork arrow logic attains the expressive power of its first-order (...) correspondence language, so both can express the same input–output behavior of processes. (shrink)

We compare fork arrow logic, an extension of arrow logic, and its natural first-order counterpart (the correspondence language) and show that both have the same expressive power. Arrow logic is a modal logic for reasoning about arrow structures, its expressive power is limited to a bounded fragment of first-order logic. Fork arrow logic is obtained by adding to arrow logic the fork modality (related to parallelism and synchronization). As a result, fork arrow logic attains the expressive power of its first-order (...) correspondence language, so both can express the same input-output behavior of processes. (shrink)

In this paper we show that the class of fork squares has a complete orthodox axiomatization in fork arrow logic (FAL). This result may be seen as an orthodox counterpart of Venema's non-orthodox axiomatization for the class of squares in arrow logic. FAL is the modal logic of fork algebras (FAs) just as arrow logic is the modal logic of relation algebras (RAs). FAs extend RAs by a binary fork operator and are axiomatized by adding three equations to RAs equational (...) axiomatization. A proper FA is an algebra of relations where the fork is induced by an injective operation coding pair formation. In contrast to RAs, FAs are representable by proper ones and their equational theory has the expressive power of full first-order logic. A square semantics (the set of arrows is U×U for some set U) for arrow logic was defined by Y. Venema. Due to the negative results about the finite axiomatizability of representable RAs, Venema provided a non-orthodox finite axiomatization for arrow logic by adding a new rule governing the applications of a difference operator. We address here the question of extending the type of relational structures to define orthodox axiomatizations for the class of squares. Given the connections between this problem and the finitization problem addressed by I. Németi, we suspect that this cannot be done by using only logical operations. The modal version of the FA equations provides an orthodox axiomatization for FAL which is complete in view of the representability of FAs. Here we review this result and carry it further to prove that this orthodox axiomatization for FAL also axiomatizes the class of fork squares. (shrink)

La relacion entre la etica y la medicina tiene una larga historia y tradicion que se puede remontar hasta la Grecia, China e India clasicas. La relacion entre ambas disciplinas es muy intensa porque la pregunta etica sobre el que debo hacer se aplica sobre la pregunta medica sobre que es mejor para la salud y el bienestar de una persona. Los textos que componen este libro tienen como hilo conductor el principio de autonomia. Este principio implica que las elecciones (...) individuales de planes de vida son valiosas y, por lo tanto, el Estado no debe interferir en ellas (dimension negativa) y debe disenar instituciones que faciliten la persecucion individual de estos planes de vida (dimension positiva). En los textos se observa que este enfoque eminentemente subjetivo se enfrenta a un enfoque colectivo (dimension relacional) que recuerda que las decisiones individuales se adoptan y repercuten positiva y negativamente en un entorno social. Este enfrentamiento permitiria observar que las elecciones individuales solo tienen un valor prima facie, pudiendose en algunos justificar limites mas amplios. (shrink)

An important function of the self is to identify external objects that are potentially personally relevant. We suggest that such objects may be identified through mere ownership. Extant research suggests that encoding information in a self-relevant context enhances memory , thus an experiment was designed to test the impact of ownership on memory performance. Participants either moved or observed the movement of picture cards into two baskets; one of which belonged to self and one which belonged to another participant. A (...) subsequent recognition test revealed that there was a significant memory advantage for objects that were owned by self. Acting on items had no impact on memory. Results are discussed with reference to the importance of self-object associations in cognition. (shrink)

Xenotransplantation - the transfer of living tissue between species - has long been heralded as a potential solution to the severe organ shortage crisis experienced by the United Kingdom and other 'developed' nations. However, the significant risks which accompany this biotechnology led the United Kingdom to adopt a cautious approach to its regulation, with the establishment of a non-departmental public body - UKXIRA - to oversee the development of this technology on a national basis. In December 2006 UKXIRA was quietly (...) disbanded and replaced with revised guidance, which entrusts the regulation of xenotransplantation largely to research ethics committees. In this article we seek to problematize this new regulatory framework, arguing that specialist expertise and national oversight are necessary components of an adequate regulatory framework for a biotechnology which poses new orders of risk, challenges the adequacy of traditional understandings of autonomy and consent, and raises significant animal welfare concerns. We argue for a more considered and holistic approach, based on adequate consultation, to regulating biotechnological developments in the United Kingdom. (shrink)

The rapidly changing face of modern medicine and the increasing involvement of public debate in its practice, are reflected in the wide range of contributions to this book, which takes a searching look at the issues which are currently at the forefront of modern debate in medical ethics and the law.

Issues surrounding the end of life, and in particular questions of patient choice, have seldom been so high on the legal, ethical and political agenda. This book examines these issues from a comparative perspective, drawing conclusions about the role of the doctor, the individual and the law-makers in this moral minefield.

pt. 1. Background you need. -- What is brain-compatible teaching -- The old and new of it -- When brain research is applied to the classroom everything will change -- Change can be easy -- We're not in Kansas anymore -- Where's the proof -- Tools for exploring the brain -- Ten reasons to care about brain research -- The evolution of brain models -- Be a brain-smart consumer: recognizing good research -- Action or theory: who wants to read all (...) that research -- Excellent sources of research -- Fun factoids on the brain -- What's in the human brain -- Brain teaser -- The brain divided -- The brain connected -- Brain geography -- Brain "cell" ebration: far-out facts about brain cells -- Learning happens but how -- Are today's kids different -- Boy's and girl's brain differences -- Learning disabilities; different brains -- The cranial soup bowl: understanding the chemicals in our brains -- pt. 2. The foundation for teaching is principles, not strategies. What are the principles -- Principle 1: the principle of change: brain is dynamic, not fixed -- Principle 2: the principle of variety: all brains are unique -- Principle 3: the principle of developmental sensitivity -- Principle 4: the principle of interaction: we have a social brain -- Principle 5: the principle of connectivity: the brain is an integrated system of systems -- Principle 6: the principle of memory malleability -- Principle 7: the principle of resource consumption -- necessity for processing -- pt. 3. So what; now what. Asking big questions: what's in a brain-compatible curriculum -- Brain-compatible test-taking success strategies -- Systemic change: the next level -- Big picture analysis: transformation happens -- Action research makes a difference -- The learning community -- What's next. (shrink)

The so-called genetics revolution rests on a history which at its least can be described as controversial. Modern genetics needs to bear this history in mind. In particular, as with the past, the area of reproductive choice seems particularly vulnerable to potential abuse. Courts in the UK and elsewhere have already shown themselves willing to interfere with the choices of women in the management of their pregnancies. Medical advance, perhaps particularly the capacity to visualise the developing foetus, has added complexity (...) to the question of whether the health care provider has one patient or two patients. Additionally, pregnancy is thoroughly monitored in modern medical practice and genetics may provide a further impetus or incentive to mandate increased policing of pregnancy. Gene therapy, once offered, will add further to the desire to ensure that women make the ‘right’ choice, especially when the invasion required is relatively minimal. Further, genetic information is at best predictive, but may, because of its scientific nature, appear to those receiving it to be certain. Thus, the provision of genetic information may reduce rather than enhance choice, unless carefully and sensitively provided. A mature and sophisticated debate about the role of genetics in reproduction is required—engaging rather than bypassing the public—if the real potential of genetics is to be vindicated. (shrink)

We consider the varieties and directions of influence that the source and target domains involved in a conceptual metaphor can have on each other during the course of understanding metaphorical utterances based on the metaphor. Previous studies have been restricted both as to direction of influence and as to type of influence. They have been largely confined to the “forward” (source to target) direction of influence, and they have concentrated on the transfer of features or propositions and (to some extent) (...) the highlighting of aspects of a domain. By contrast, this article stresses the importance both of other varieties of influence (e.g., transfer of queries and uncertainty effects) and of “reverse” influence (target to source). We seek to curb the natural tendency to think that, because metaphor involves an overall move from source to target, therefore all inter-domain influences in the course of understanding go in that direction. The bulk of the article explores the theoretical issues involved. These issues have arisen out of a reasoning-based approach to metaphor, seeking to make best use of information from metaphorical utterance, context, source and target domains, and known metaphorical mappings, by applying a complex overall reasoning process. The article briefly explains the thorough implementation of reverse influence in a computer program for metaphorical reasoning called ATT-Meta, although the theoretical considerations are relevant to all disciplines concerned with metaphor. We make some suggestions for further computational and psychological research on metaphor. (shrink)

The COVID-19 pandemic has impacted data collection for longitudinal studies in developmental sciences to an immeasurable extent. Restrictions on conducting in-person standardized assessments have led to disruptive innovation, in which novel methods are applied to increase participant engagement. Here, we focus on remote administration of behavioral assessment. We argue that these innovations in remote assessment should become part of the new standard protocol in developmental sciences to facilitate data collection in populations that may be hard to reach or engage due (...) to burdensome requirements. We present a series of adaptations to developmental assessments and a detailed discussion of data analytic approaches to be applied in the less-than-ideal circumstances encountered during the pandemic-related shutdown. Ultimately, these remote approaches actually strengthen the ability to gain insight into developmental populations and foster pragmatic innovation that should result in enduring change. (shrink)

Book reviewed in this article: The Willowbrook Wars: A Decade of Struggle for Social Justice. By David J. Rothman and Sheila M. Rothman.

Advance care directives for health care have been promoted as a way to improve end-of-life decision making. These documents allow a patient to state, in advance of incapacity, the types of medical treatments they would like to receive, to name a surrogate to make those decisions, or to do both. Although studies have shown that both physicians and patients generally have positive attitudes about the use of these documents, relatively few individuals have actually completed one.What underlies this discrepancy between attitudes (...) and behavior with regard to advance care directives? One obvious explanation is lack of access. Emanuel et al. estimated that approximately 90 percent of the population desire an advance care directive, and they pointed to access as the major barrier. Yet interventions that increase accessibility have typically failed to yield more than a 20 percent completion rate. Thus, it appears that access is not the sole determinant of advance care directive completion. (shrink)

To commemorate 40 years since the founding of the Journal of Business Ethics, the editors in chief of the journal have invited the editors to provide commentaries on the future of business ethics. This essay comprises a selection of commentaries aimed at creating dialogue around the theme Business versus Ethics?. The authors of these commentaries seek to transcend the age-old separation fallacy :409–421, 1994) that juxtaposes business and ethics/society, posing a forced choice or trade off. Providing a contemporary take on (...) the classical question “if it’s legal is it ethical?”, David Hess explores the role of the law in promoting or hindering stakeholder-oriented purpose and governance structure. Jeffrey Harrison encourages scholars to move beyond the presupposition that businesses are either strategic or ethical and explore important questions at the intersection of strategy and ethics. The proposition that business models might be inherently ethical or inherently unethical in their design is developed by Sheila Killian, who examines business systems, their morality, and who they serve. However, the conundrum that entrepreneurs are either lauded for their self-belief and risk-taking, or loathed for their self-belief and risk-taking, is discussed by M. Tina Dacin and Julia Roloff using the metaphor of taboos and totems. These commentaries seek to explore positions that advocate multiplicity and tensions in which business ethics is not either/or but both. (shrink)

A case study of Chinese grandparents’ transnational caregiving experiences in Canada highlights two issues that have received limited attention in the broader feminist care literature: elderly persons are usually positioned as receivers rather than providers of care; and transnational care studies focus on women migrating as part of “global care chains,” rather than on elderly family members migrating to meet the caring needs of adult kin who work in market economies that do not recognize caring responsibilities. The paper concludes by (...) arguing that the distribution of care responsibilities needs to be one of the pillars in the pursuit of transnational social justice. (shrink)

In 1990‐92 Britain's Institute of Management commissioned a working party of its Professional Practice Committee to review the Institute's Code of Conduct and Guides to Professional Management Practice. Sheila Evers, currently Vice‐Chairman of the Institute of Management, chaired the working party; and based on further discussions she has now written and compiled a supporting document, “The Manager as a Professional”, with checklists for the individual manager. Copyright of the documents, reproduced here with permission, rests with The Institute of Management, (...) which is, however, willing to permit their being used and quoted with due acknowledgement. (shrink)

Britain's Royal Society of Arts has recently produced a report on the conditions of future successful business in Britain, entitled Tomorrow's Company, in which the idea of the “inclusive company” is seen to be central to such success. How, and to what extent, does business ethics figure in this prospect for the future? The author is Vice‐Chairman of the Institute of Management and former Chair of its Professional Practice Committee.

Britain's Royal Society of Arts has recently produced a report on the conditions of future successful business in Britain, entitled Tomorrow's Company, in which the idea of the “inclusive company” is seen to be central to such success. How, and to what extent, does business ethics figure in this prospect for the future? The author is Vice‐Chairman of the Institute of Management and former Chair of its Professional Practice Committee.

Although many philosophers have attempted to explain how we do and how we ought to aesthetically appreciate nature, I argue that such appreciation has yet to be fully understood. I agree with the vast majority of aestheticians who argue that a successful model of nature appreciation will take into account the ways in which natural objects differ from art objects.Hence, the model I present illustrates that the way we appreciate art objects differs in important respects from the way we appreciate (...) natural objects. ;It seems to me that critics of the assimilation of nature appreciation to art appreciation have been too hasty. They mistakenly confine their analysis to the appreciation that an audience has for an artwork. By focussing on the spectator-to-artwork relationship, these critics have failed to notice the salient similarities between a certain type of experience of nature and a certain type of experience of art. I argue that nature appreciation, although not identical to, shares important similarities with the way a performing artist interprets an artwork. I call the model I present and defend the performative interpretation model of nature appreciation. (shrink)

In 1882 Koch discovered the tubercle bacillus and transformed both the medical and the social history of tuberculosis and the experiences of those who contracted it. For the first time, the absence or presence of the bacillus made it possible to define, in Koch’s terms, “the boundaries of the diseases to be understood as tuberculosis.” And for the first time the sick became subject to oversight and discrimination.Prior to Koch’s discovery, tuberculosis, or as it was then called, consumption, was considered (...) a hereditary and non-contagious disease, albeit a very deadly and persistent one. Over the first half of the nineteenth century, it was responsible for one out of every five deaths. It crossed all boundaries of geography, social class, age, and sex affecting residents in rural as well as urban areas, the prosperous as well as the poor, the young even more notably than the old, females more often than males. Physicians assumed a familial predisposition existed ; following the precepts of humoral medicine, they postulated that the disease originated in “irritations” whose sources were to be found in the interaction of an inherited constitution with a particular lifestyle and environment. (shrink)

In 1882 Koch discovered the tubercle bacillus and transformed both the medical and the social history of tuberculosis and the experiences of those who contracted it. For the first time, the absence or presence of the bacillus made it possible to define, in Koch’s terms, “the boundaries of the diseases to be understood as tuberculosis.” And for the first time the sick became subject to oversight and discrimination.Prior to Koch’s discovery, tuberculosis, or as it was then called, consumption, was considered (...) a hereditary and non-contagious disease, albeit a very deadly and persistent one. Over the first half of the nineteenth century, it was responsible for one out of every five deaths. It crossed all boundaries of geography, social class, age, and sex affecting residents in rural as well as urban areas, the prosperous as well as the poor, the young even more notably than the old, females more often than males. Physicians assumed a familial predisposition existed ; following the precepts of humoral medicine, they postulated that the disease originated in “irritations” whose sources were to be found in the interaction of an inherited constitution with a particular lifestyle and environment. (shrink)