The conference entitled ‘Best Practices in Clinical Ethics Consultation and Decision-Making’, held in London 8–9 July 2010, was the first of its kind dedicated to identifying best practices in clinical ethics consultation and decision-making. Academics, health and social care professionals, clinical ethics committee members, lawyers, service users and carers from the UK, USA, Europe, Canada, Australia and Asia attended lectures, workshops, parallel paper sessions and clinical ethics case discussions across adult, maternity, children's, older persons, mental health and learning disabilities settings. (...) Seventy-eight best-practice points impacting on the quality of clinical ethics consultations and subsequent decisions were identified and grouped into eight themes: who tells the story; how the story is told; how the analysis, discussion and subsequent decisions are made; how values are weighted and balanced against one another; who decides; how the decision is made; how group dynamics and conflict are handled; how decisions are recorded. (shrink)
Many public debates become polarized, degenerating into a pattern of mutual suspicion and name-calling that preclude communication or compromise. The debate over animal research has typically followed this path. To understand how polarization might be avoided, we examine the factors that helped prevent it in one local controversy: Cambridge, Massachusetts in the late 1980s. These factors include the personal style of the leader of the main animal protection group, the financing for the group, the group's ability to win a symbolic (...) victory in the form of a relatively toothless city ordinance, and, especially, the relative avoidance by both sides of rigid ideological posturing in favor of "casuistic" argumentation about specific cases and policies. (shrink)
We begin by taking “naturalism” in the sense in which P. F. Strawson (“Scepticism, Naturalism and Transcendental Arguments”, 1985) presented Wittgenstein’s anti-sceptical arguments as “naturalistic”. According to Strawson, this naturalism connects the philosophy of Wittgenstein with that of Hume. Then, we proceed to compare Hume’s and Wittgenstein’s positions and establish a tenet common to them, which we qualify as “meta‐philosophical”: philosophy rests on a bedrock that resists our demands of justification, a contingent “so we are, so we act” that is (...) beyond philosophical analysis. But this negative thesis leads to differentcommitments in each philosopher: a commitment with the autonomy of nature in the case of Hume, and a commitment with the autonomy of grammar in the case of Wittgenstein. Next, we analyze the epistemological implications of each commitment, particularly with reference to the status of natural science. We find a deep divergence between Hume and Wittgenstein on this point, so that the former, but not the latter, could still be labelled as “naturalist” in a positive, more substantial sense. Our central point here is the difficulty to give a naturalistic interpretation of such Wittgensteinian notions as “language game” or “form of life”. Finally, we stress that the distance between Hume and Wittgenstein is most clearly evidenced when we consider the normative (moral) implications of Hume’s concept of nature, which are completely absent from Wittgenstein’s approach, this being a feature of Wittgenstein’s philosophy that remained unchanged all along his work. (shrink)
In two pre-registered online studies during the COVID-19 pandemic and the early 2020 lockdown we elicit risk-tolerance for 1,254 UK residents using four of the most widely applied risk-taking tasks in behavioral economics and psychology. Specifically, participants completed the incentive-compatible Balloon Analog Risk Task and the Binswanger-Eckel-Grossman multiple lotteries task, as well as the Domain-Specific Risk-Taking Task and the self-reported questions for risk-taking used in the German Socio-economic Panel study. In addition, participants in the UK representative sample answered a range (...) of questions about COVID-19-related risky behaviors selected from the UCL COVID-19 Social Survey and the ICL-YouGov survey on COVID-19 behaviors. Consistently with pre-COVID-19 times, we find that risk tolerance during the UK lockdown was higher in men than in women and decreased with age. Undocumented in pre-COVID-19 times, we find some evidence for healthier participants displaying significantly higher risk-tolerance for self-reported risk measures. We find no systematic nor robust patterns of association between the COVID-19 risky behaviors and the four risk-taking tasks in our study. Moreover, we find no evidence in support of the so-called “risk compensation” hypothesis. If anything, it appears that participants who took greater risk in real-life COVID-19-relevant risky behaviors also exhibited higher risk-tolerance in our experimental and self-reported risk-taking measures. (shrink)
_Confines of Democracy_ is a collection of critical assessments and interpretations of Richard J. Bernstein’s extensive and illuminating work on pragmatism, epistemology, hermeneutics, and social and political theory, including Bernstein’s replies to the contributors.
Research Ethics Committees (RECs) are frequently a focus of complaints from researchers, but evidence about the operation and decisions of RECs tends to be anecdotal. We conducted a systematic study to identify and compare the ethical issues raised in 54 letters to researchers about the same 18 applications submitted to three RECs over one year. The most common type of ethical trouble identified in REC letters related to informed consent, followed by scientific design and conduct, care and protection of research (...) participants, confidentiality, recruitment and documentation. Community considerations were least frequently raised. There was evidence of variability in the ethical troubles identified and the remedies recommended. This analysis suggests that some principles may be more institutionalized than others, and offers some evidence of inconsistency between RECs. Inconsistency is often treated as evidence of incompetence and caprice, but a more sophisticated understanding of the role of RECs and their functioning is required. (shrink)
There has been longstanding interest in the consistency of decisions made by research ethics committees in the UK, but most of the evidence has come from single studies submitted to multiple committees. A systematic comparison was carried out of the decisions made on 18 purposively selected applications, each of which was reviewed independently by three different RECs in a single strategic health authority. Decisions on 11 applications were consistent, but disparities were found among RECs on decisions on seven applications. An (...) analysis of the agreement between decisions of RECs yielded an overall measure of agreement of κ = 0.286 , indicating a level of agreement that, although probably better than chance, may be described as “slight”. The small sample size limits the robustness of these findings. Further research on reasons for inconsistencies in decision making between RECs, and on the importance of such inconsistencies for a range of arguments, is needed. (shrink)
That brings me to the crux of my disagreement with Hillis Miller. The central contention is not simply that I am sometimes, or always, wrong in my interpretation, but instead that I—like other traditional historians—can never be right in my interpretation. For Miller assents to Nietzsche's challenge of "the concept of 'rightness' in interpretation," and to Nietzsche's assertion that "the same text authorizes innumerable interpretations : there is no 'correct' interpretation."1 Nietzsche's views of interpretation, as Miller says, are relevant to (...) the recent deconstructive theorists, including Jacques Derrida and himself, who have "reinterpreted Nietzsche" or have written "directly or indirectly under his aegis." He goes on to quote a number of statements from Nietzsche's The Will to Power to the effect, as Miller puts it, "that reading is never the objective identifying of a sense but the importation of meaning into a text which had no meaning 'in itself.'" For example: "Ultimately, man finds in things nothing but what he himself has imported into them." "In fact interpretation is itself a means of becoming master of something."2 On the face of it, such sweeping deconstructive claims might suggest those of Lewis Carroll's linguistic philosopher, who asserted that meaning is imported into a text by the interpreter's will to power: "The question is," said Alice, "whether you can make words mean so many different things.""The question is," said Humpty Dumpty, "which is to be master—that's all." But of course I don't believe that such deconstructive claims are, in Humpty Dumpty fashion, simply dogmatic assertions. Instead, they are conclusions which are derived from particular linguistic premises. I want, in the time remaining, to present what I make out to be the elected linguistic premises, first of Jacques Derrida, then of Hillis Miller, in the confidence that if I misinterpret these theories, my errors will soon be challenged and corrected. Let me eliminate suspense by saying at the beginning that I don't think that their radically skeptical conclusions from these premises are wrong. On the contrary, I believe that their conclusions are right—in fact, they are infallibly right, and that's where the trouble lies. · 1. "Tradition and Difference," Diacritics 2 : 8, 12.· 2. Ibid. M. H. Abrams’s contributions to Critical Inquiry include "Rationality and Imagination in Cultural History: A Reply to Wayne Booth" and "Behaviorism and Deconstruction: A Comment on Morse Peckham's 'The Infinitude of Pluralism'". (shrink)
We analysed research ethics committee (REC) letters. We found that RECs frequently identify process errors in applications from researchers that are not deemed “favourable” at first review. Errors include procedural violations (identified in 74% of all applications), missing information (68%), slip-ups (44%) and discrepancies (25%). Important questions arise about why the level of error identified by RECs is so high, and about how errors of different types should be handled.
Recently there has been an outpouring of consumer frustration over rising food and energy prices. Many politicians railed against “speculators” who allegedly drove up the prices of key necessities. Is speculation unethical? This article reviews the traditional arguments against speculation. Many of the standard criticisms confuse speculation with gambling. In much the same way as ethicists now draw distinctions between usury and normal business interest, we draw a distinction between socially useful speculation and gambling. Gambling involves taking on risk with (...) no plausible expectation of making a profit. Gambling may provide entertainment value to some people, but like other addictive activities causes grave harm to a subset of users. Speculation involves taking on a business risk with a plausible expectation that a profit will result. Speculators provide an important risk bearing service by taking on risks that others do not want. They help markets to function better by helping to incorporate information into prices as well as providing liquidity. Speculators may actually reduce shortages by causing quicker price increases that motivate producers to increase production and consumers to conserve. But even socially useful speculation may have an ethical dark side. Does such speculation cause damage by adding excess volatility to prices? Speculators may contribute to price bubbles. At what point does legitimate speculation become odious “price gouging?” We also draw an ethical distinction between speculation, which seeks to benefit from changing prices, and manipulation, actions taken to push prices away from their economically appropriate levels. (shrink)
In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges (...) on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence. (shrink)
Robots should be able to represent emotional states to interact with people as social agents. There are cases where robots cannot have bio-inspired bodies, for instance because the task to be performed requires a special shape, as in the case of home cleaners, package carriers, and many others. In these cases, emotional states have to be represented by exploiting movements of the body. In this paper, we present a set of case studies aimed at identifying speciﬁc values to convey emotion (...) trough changes in linear and angular velocities, which might be applied on different non-anthropomorphic bodies. This work originates from some of the most considered emotion expression theories and from emotion coding for people. We show that people can recognize some emotional expressions better than others, and we propose some directions to express emotions exploiting only bio-neutral movement. (shrink)
This paper examines the ethics of contemporary managerial compensation in the context of executive stock options. Economic considerations would dictate that executive stock options should be adjusted to eliminate the effect of overall stock market movements which are beyond the control of the executive. However, in practice, most executive stock options are not adjusted to control for these outside factors. Agency considerations are the most likely culprit. Adjusting for the influence of outside factors, such as a generally rising stock market, (...) from executive stock options sets a higher bar for managers to reach. Furthermore, traditional accounting standards permitted firms that did not adjust options to avoid reporting options as expenses. This presents CEOs and boards of directors with a major ethical dilemma. On the one hand, their duty to their shareholders and stakeholders dictates that executive stock options should be adjusted to eliminate outside noise from unrelated movements in the overall stock market. However, financial statements are presented in the language of accounting. If the overwhelming majority of the users of a language define a particular item in one way, then to deviate from the norm implies that the recipient of such a deviant statement may not properly interpret the statement. Likewise, if the standard practice is for firms to use unadjusted options and thus under-report expenses, to deviate from this industry norm risks that users of financial statements would not properly interpret the financial statements, with perhaps negative consequences for the shareholders. In short, if "everyone else does it," then it could be wrong for an individual firm to deviate from the norm as that would harm the shareholders. (shrink)