As social media becomes increasingly popular, human subjects researchers are able to use these platforms to locate, track, and communicate with study participants, thereby increasing participant retention and the generalizability and validity of research. The use of social media; however, raises novel ethical and regulatory issues that have received limited attention in the literature and federal regulations. We review research ethics and regulations and outline the implications for maintaining participant privacy, respecting participant autonomy, and promoting researcher transparency when using social (...) media to locate and track participants. We offer a rubric that can be used in future studies to determine ethical and regulation-consistent use of social media platforms and illustrate the rubric using our study team’s experience with Facebook. We also offer recommendations for both researchers and institutional review boards that emphasize the importance of well-described procedures for social media use as... (shrink)

Moral or ethical questions are vital because they affect our daily lives: what is the best choice we can make, the best action to take in a given situation, and ultimately, the best way to live our lives? Health ethics has contributed to moving ethics toward a more experience-based and user-oriented theoretical and methodological stance but remains in our practice an incomplete lever for human development and flourishing. This context led us to envision and develop the stance of a “living (...) ethics”, described in this inaugural collective and programmatic paper as an effort to consolidate creative collaboration between a wide array of stakeholders. We engaged in a participatory discussion and collective writing process known as instrumentalist concept analysis. This process included initial local consultations, an exploratory literature review, the constitution of a working group of 21 co-authors, and 8 workshops supporting a collaborative thinking and writing process. First, a living ethics designates a stance attentive to human experience and the role played by morality in human existence. Second, a living ethics represents an ongoing effort to interrogate and scrutinize our moral experiences to facilitate adaptation of people and contexts. It promotes the active and inclusive engagement of both individuals and communities in envisioning and enacting scenarios which correspond to their flourishing as authentic ethical agents. Living ethics encourages meaningful participation of stakeholders because moral questions touch deeply upon who we are and who we want to be. We explain various aspects of a living ethics stance, including its theoretical, methodological, and practical implications as well as some barriers to its enactment based on the reflections resulting from the collaborative thinking and writing process. (shrink)

Individuals of many animal species are said to have a personality. It has been shown that some individuals are bolder than other individuals of the same species, or more sociable or more aggressive. In this paper, we analyse what it means to say that an animal has a personality. We clarify what an animal personality is, that is, its ontology, and how different personality concepts relate to each other, and we examine how personality traits are identified in biological practice. Our (...) analysis shows that biologists often study specific personality traits, such as boldness, sociability or aggressiveness, rather than personalities in general. We claim that personality traits are best understood as dispositions and that they are operationally defined in terms of certain sets of behaviours, which are studied in specific experimental set-ups. Furthermore, we develop an integrative philosophical account that specifies and formalises three criteria for identifying personality traits, which are used in biological practice. For an individual animal to have a personality trait it must, first, behave differently than others. Second, these behavioural differences must be stable over a certain time, and third, they must be consistent in different contexts. (shrink)

Some theories of personal identity allow some variation in what it takes for a person to survive from context to context; and sometimes this is determined by the desires of person-stages or the practices of communities.This leads to problems for decision making in contexts where what is chosen will affect personal identity.‘Temporal Phase Pluralism’ solves such problems by allowing that there can be a plurality of persons constituted by a sequence of person stages. This illuminates difficult decision making problems when (...) persons have to choose between different life-altering choices. (shrink)

Visual research methods like photography and digital storytelling are increasingly used in health and social sciences research as participatory approaches that benefit participants, researchers, and audiences. Visual methods involve a number of additional ethical considerations such as using identifiable content and ownership of creative outputs. As such, ethics committees should use different assessment frameworks to consider research protocols with visual methods. Here, we outline the limitations of ethics committees in assessing projects with a visual focus and highlight the sparse knowledge (...) on how researchers respond when they encounter ethical challenges in the practice of visual research. We propose a situated approach in relation to visual methodologies that encompasses a negotiated, flexible approach, given that ethical issues usually emerge in relation to the specific contexts of individual research projects. Drawing on available literature and two case studies, we identify and reflect on nuanced ethical implications in visual research, like tensions between aesthetics and research validity. The case studies highlight strategies developed in-situ to address the challenges two researchers encountered when using visual research methods, illustrating that some practice implications are not necessarily addressed using established ethical clearance procedures. A situated approach can ensure that visual research remains ethical, engaging, and rigorous. (shrink)

Wilfrid Sellars [1962: 1] described philosophy as an attempt to ‘understand how things in the broadest possible sense of the term hang together in the broadest possible sense of the term’. But it is distinctive of philosophy that many of us are interested not only in how the world is but in ways that it could be. That is, philosophy is concerned with facts about modality. Some of the most important arguments in philosophy hinge on modal premises, and philosophers have (...) typically assumed special expertise in evaluating these modal premises. Replicating Goldvarg and Johnson-Laird’s [2000] study of modal illusions, we show that training in mathematics and not philosophy predicts success in overcoming such illusions (n = 395). This study is the first to test the modal expertise of professional philosophers directly. Our findings undermine claims to modal expertise. Philosophical training does not inoculate expert philosophers against basic mistakes in modal judgment. (shrink)

ABSTRACTAdults perceive emotional expressions categorically, with discrimination being faster and more accurate between expressions from different emotion categories than between two stimuli from the same category. The current study sought to test whether facial expressions of happiness and fear are perceived categorically by pre-verbal infants, using a new stimulus set that was shown to yield categorical perception in adult observers. These stimuli were then used with 7-month-old infants using a habituation and visual preference paradigm. Infants were first habituated to an (...) expression of one emotion, then presented with the same expression paired with a novel expression either from the same emotion category or from a different emotion category. After habituation to fear, infants displayed a novelty preference for pairs of between-category expressions, but n... (shrink)

In this study, we evaluate how individual virtues and inter-organizational management control systems influence buyer–supplier performance through relationship quality. Results from a sample of 232 firms confirm that virtues and IOMCS relate positively to relationship quality and performance, respectively. However, IOMCS lose their positive influence on relationship quality when considered along with virtues. That is, when both variables enter the regression model simultaneously, virtues win. This interesting finding has particular resonance at a time when research on ethics still needs to (...) reinforce its positive effects on the practice of management. (shrink)

Mitochondrial donation poses the latest regulatory challenge for policy-makers in the context of assisted conception. Since 2010 the Human Genetics Commission, the Human Fertilisation and Embryology Authority and the Nuffield Council on Bioethics have all considered the policy implications of permitting use of these techniques in treatment. The Nuffield Council on Bioethics reported its recommendations in June 2012 following a consultation on the ethical issues raised by these techniques; and a separate consultation by the Human Fertilisation and Embryology Authority in (...) conjunction with Sciencewise-ERC followed in September 2012. Matters for consideration included the potential relationships created by the use of three parties’ genetic material and the associated ramifications, eg whether or not there is a need to establish records of such donations and, if so, to whom should information later be provided? Thus, mitochondrial donation poses both novel and familiar questions about the ‘genetic family’, ‘parentage’ and ‘identity’. This article explores some of the ways in which mitochondrial DNA is constructed as relatively significant in recent Parliamentary debates, policy and consultation documents. It reflects on the ways in which the role of some genetic connections, or lack thereof, are mediated in law and policy. (shrink)

Psychedelic experiences are often compared to “transformative experiences” due to their potential to change how people think and behave. This study empirically examines whether psychedelic experiences constitute transformative experiences. Given psychedelics’ prospective applications as treatments for mental health disorders, this study also explores neuroethical issues raised by the possibility of biomedically directed transformation—namely, consent and moral psychopharmacology. To achieve these aims, we used both inductive and deductive coding techniques to analyze transcripts from interviews with 26 participants in psychedelic retreats. Results (...) indicate that psychedelic experiences can constitute transformative experiences. Twenty participants reported experiences or insights that were seemingly inaccessible or impossible to attain if not for the psychoactive effects of psychedelics. All participants besides one reported some change in identity, values, beliefs, desires, and behavior—changes in behavior being the most common. Participants also reported feeling capable deciding to use psychedelics in part due to information seeking prior to their retreats. Finally, several participants reported an enhanced capacity for enacting changes in their lives. Our results underscore both the importance of subjective embodiment to transformation and the role of transformative agency in shaping outcomes of the psychedelic experience. We examine our results relative to neuroethical issues and advocate for centering the person in psychedelic research and neuroethical inquiry about psychedelics to avoid pitfalls associated with psychedelics’ potential as moral psychopharmacological agents. (shrink)

Great effort is invested in identifying ways to change people's minds on an issue. A first priority should perhaps be enriching their thinking about the issue. With a goal of enriching their thinking, we studied the views of community adults on the DACA issue—young adults who entered the United States illegally as children. A dialogic method was employed, offering dual benefits in providing participants the opportunity to further develop their own ideas and to consider differing ideas. Yet, participants engaged in (...) dialog only vicariously by observing the talk of a pair of actors who held opposing positions on DACA. The effect on participants’ thinking was greatest in the condition in which they viewed a dialog between the two actors, rather than a comparison condition in which the actors individually expressed their positions. In control conditions, no presentation was observed. Probing questions included in all conditions encouraged a participant to examine and clarify for themselves their own position, potentially enriching it. This condition proved unsuccessful in enriching thinking; participants’ justifications for their own positions in fact became simpler and less qualified. In contrast, observing a video of a like-minded and opposing other did enrich observers’ thinking, yet to a greater degree in the dialogic than nondialogic condition. The findings thus suggest observed dialog as a promising practical approach in promoting deeper thinking. (shrink)

We can think about the use of controlled substances in the treatment of anxiety disorders in two simple but diametrically opposed ways. First, we can say that anxiety disorders are trivial and require only acts of willpower, or, if anxiety disorders do require treatment, they are better treated without the use of benzodiazepines. When BZs are used to treat anxiety, they pose grave risks of addiction to the patients to whom these medicines are prescribed; they relieve patients’ symptoms, but are (...) the equivalent of a pharmacological “roach motel,” a haven into which many unsuspecting patients enter, but from which few emerge without becoming addicted. Patients must then face terrible struggles to free themselves of dependence on BZs, and this compounds the problem for which they sought treatment. Furthermore, the large number of prescriptions for BZs are a threat to the public health because these drugs are widely abused by alcoholics and drug addicts. (shrink)

We agree with Rendell and Whitehead that cetaceans acquire knowledge from caretakers and peers, and that a clear understanding of this process can provide insight into the evolution of mammalian cognition. The passive observational methods they advocate, however, are inadequate for determining what cetaceans know. Only by experimentally investigating the cognition of cetaceans can we hope to understand what they learn through social interactions.

In lieu of an abstract, here is a brief excerpt of the content:The Vagaries of Exemplarity: Distortion or Dismissal?Michel JeanneretExample is an uncertain looking-glass, all embracing, turning all ways.Montaigne 1Ancients and Moderns: Negotiating CoexistenceDo the Ancients provide the Renaissance with a repertoire of infallible examples? Do they have such absolute authority that their models, whether ethical or aesthetic, retain their relevance in every circumstance? The question is part and parcel of that thinking, which is fundamental to the sixteenth century, on (...) the status of Greco-Roman paradigms in the management of public and private life, or in the methods of science and the arts. Before analyzing two particular responses to classical exemplarity—by Erasmus and Montaigne—we shall set the problem in its general context.Whether lobbying for intense faithfulness to the models or recognizing the need for divergence, whether insisting on continuity or the need for change, on the possibility or impossibility of equaling the masters, everyone in the sixteenth century measured art, knowledge, and moral reflection according to the Greek and Roman norm. Scholars and artists together entered into this exchange on a daily basis and everybody, whatever the extent of their dependence, knew that their work could not be conceived or perceived as anything other than the more or less free modification of a particular vestige of classical heritage. To escape tradition was unthinkable, but to accept it resignedly was absurd. All room for maneuver was therefore in the shifting difference between [End Page 565] old and new, and in the extent of its transformation. 2 It is then predictable, given these conditions, that the transmission of classical examples should be subject to turbulence without, however, undergoing any violent break.The question was even more relevant given that the sense of history, the consciousness of time past being irrevocably lost took on a new resonance now. Recognizing and acknowledging the phenomenon of irreversible development—whether good or bad—counts as one of the most important intellectual acquisitions of the Renaissance. 3 The Middle Ages had been able to maintain the illusion of continuity and, by dressing Antiquity up in the manners and colors of feudal chivalry, had seen itself reflected in it as in a mirror. With the influx of new documents and the perfecting of more rigorous methods of interpretation—the techniques of philology—intellectuals had to acknowledge evident change. The past could no longer be modeled on the present; all imitation would henceforth be witness to the impossibility of any perfect match. At the same time as the classical world was coming to light, it was also getting further away, getting lost. This bereavement sometimes sparked off enough regressive nostalgia to provide matter for many an antiquarian project. In reaction to this loss, most humanists were motivated into salvaging the salvageable by injecting a dose of novelty into the rift created by their awareness of history. The intellectuals of the Renaissance would often have felt as if they were reenacting the famous encounter of the Romans and the Greeks; like the Romans they wanted to be both conquering and conquered, free and faithful, differing and deferring. For them also the antique model will be an ideal simultaneously present and lost, necessary and foreign.Two opposing solutions to this dilemma seemed to offer themselves: on the one hand an unconditional return to the sources minimizing the effects of history, and on the other an exploitation of the eclipses of the past, giving the present a chance to fight it out with the Ancients. We shall sketch out each of these two strategies: both the methods of respectful transmission and those of transformative intervention.Fine-tuned by the humanists, philology was closely linked to the advent of historical consciousness. Since classical civilization had definitively come to an end, the philologist devoted himself to reconstituting and preserving it, in all its original specificity. He removed the layers of interference accumulated over the centuries, reestablished the texts in their authentic versions, maybe even providing commentary on the meaning of the work within its context. Theoretically his intervention stopped there. Acknowledging the difference and [End Page 566] superiority of past authors, he did not touch their works except to restore them to their pristine selves. Soon... (shrink)

This study investigated the beliefs that formed teachers’ intentions to integrate STEM content into their social studies instruction. Participants were 60 elementary, middle, and high school in-service teachers who attended a summer history workshop on Abraham Lincoln. Data were collected by qualitative and quantitative instruments. Beliefs about likely outcomes of integrating STEM, and beliefs about persons who would approve, or disapprove, of STEM integration were elicited from teachers, and content analyzed. The resulting outcome and normative beliefs were used as stems (...) for items in the quantitative instrument. Quantitative data were analyzed primarily by correlation and multiple regression. This study found that attitude toward the behavior, integrating STEM, was formed by 15 outcome beliefs, subjective norm was formed by five normative beliefs, and that attitude and norm predicted behavioral intention. The theory we used enabled us to calculate the numerical contribution of each of the beliefs that were important in forming teachers’ intentions. The results have implications for theory, research, and practice in social studies education. In the realm of practice, these implications are for the initial preparation of, and the subsequent professional development of social studies teachers, both at the elementary and secondary levels. (shrink)

Despite general agreement within philosophy that peer review is indispensable, its fairness and reliability is often questioned. This article suggests that such worries can to a large extent be met by adopting the practice that reviews as well as earlier versions of papers are made publicly available when the final version of a paper is published. This suggestion combines the advantages of transparency with the merits of anonymity of reviewers. While there are obstacles to this suggestion, the article argues that (...) it would be worthwhile to implement it because it can help map patterns of conduct and secure confidence in the fairness and reliability of review procedures and journal editing within philosophy. (shrink)

Discute-se a interface entre discursos poéticos e proféticos e a área de atuação de seus respectivos especialistas, na Grécia arcaica, a partir de uma análise de certas passagens dos poemas Teogonia e Trabalhos e dias de Hesíodo. O enfoque é a afirmação, na Teogonia , que a consagração do poeta pelas Musas, ou seja, sua união com uma realidade sagrada, lhe permite celebrar o futuro. A afirmação é discutida através da interpretação de passagens em Trabalhos e dias.

Coming to Life: Philosophies of Pregnancy, Childbirth and Mothering is a superlative collection of essays that does what too few scholarly works have dared: it takes seriously the philosophical significance of women’s lived experience. Every woman, regardless of her own reproductive story, is touched by the often restrictive beliefs and norms governing discourses about pregnancy, childbirth and mothering. Thus the concerns of this anthology are relevant to all women and central to any philosophical project that takes women’s lives seriously. In (...) this volume 16 authors- including both established feminists and some of today’s most innovative new scholars- engage in sustained reflection on the experiences of pregnancy, childbirth and mothering, and on the beliefs, customs, and political institutions by which those experiences are informed. Many of the topics in this collection, though familiar, are here taken up in a new way: contributors think beyond the traditional pro-choice/pro-life dichotomy, speak to the manifold nature of mothering by considering the experiences of adoptive mothers and birthmothers, and upend the belief that childrearing practices must be uniform despite psycho-sexual differences in children. Many chapters reveal the radical shortcomings of conventional philosophical wisdom by placing trenchant assumptions about subjectivity, gender, power and virtue in dialogue with women’s experience. The volume is diverse both in its content and in its scholarly approach; certain of the essays are informed by their authors’ own experiences, others draw from extant narratives; many engage such canonical thinkers as Plato, Aristotle, Nietzsche and Heidegger, while others draw from the works of contemporary feminists including Sara Ruddick, Iris Marion Young, Virginia Held, Julia Kristeva and Luce Irigaray. All readers, regardless of their philosophical training and commitments, will find much to appreciate in this volume. (shrink)

Excerpt from Induction and Deduction: A Historical Critical Sketch of Successive Philosophical Conceptions Respecting the Relations Between Inductive and Deductive Thought and Other Essays It is a painful and pathetic task for an intimate friend of Constance Naden to be called upon to write a memoir, however brief, of her short life, instead of looking forward to years of happy and elevating intercourse, sharing in works of benevolent usefulness, and gladly watching her rise to the distinction which her intellectual gifts (...) entitled her circle of friends to anticipate. The sorrow for her loss must be lifelong. As Mrs. Browning says, "the inevitable strikes us dead," but the expression of it is unavailing. All that remains for the most devoted of her friends is to keep her memory green, by striving to let the world know what it has lost, both in promise and in fulfilment. Miss Naden's earlier life was uneventful, and almost all the details for this portion of it have been drawn from accounts published in the Birmingham papers, at the time of her death, by those associated with her school and college career. Constance Caroline Woodhill Naden was born on the 24th January, 1858, at her father's house in Edgbaston, where he still resides, and is the President of the Birmingham Architectural Association. Her mother died on the 5th February, a few days after the birth of her child. Shortly afterwards the motherless infant was domesticated with her mother's parents, Mr. and Mrs. Woodhill, of Pakenham House, Edgbaston, and here Constance lived a retired, peaceful life, adored by her grandparents, till they died, Mr. Woodhill in 1881, and his widow in 1887. About the Publisher Forgotten Books publishes hundreds of thousands of rare and classic books. Find more at www.forgottenbooks.com This book is a reproduction of an important historical work. Forgotten Books uses state-of-the-art technology to digitally reconstruct the work, preserving the original format whilst repairing imperfections present in the aged copy. In rare cases, an imperfection in the original, such as a blemish or missing page, may be replicated in our edition. We do, however, repair the vast majority of imperfections successfully; any imperfections that remain are intentionally left to preserve the state of such historical works. (shrink)

Liberals agree that free speech should be protected, where speech is understood broadly to include all forms of intentional communication, including actions and pictures, not merely the spoken or written word. A surprising view about free speech in some liberal and legal circles is that communications should be protected on free-speech grounds only if the communications are mentally mediated. By “mentally mediated communication” we mean speech which communicates its message in such a way that the message can be rationally evaluated (...) by hearers, and causes the hearers to believe it, when it does, through the mechanism of those hearers employing their rational capacity to judge that it is correct. The mental-mediation or persuasion principle, as it is sometimes called, has some important legal and public policy implications. It has been applied to argue that certain forms of expression, despite being forms of speech or expression, lack even a prima facie claim to protection on free speech grounds. -/- Our central aim is to show why the mental mediation principle is mistaken. Liberals should think that some speech which is not mentally mediated deserves protection for the very same reasons that speech which is mentally mediated is often thought to deserve protection. (shrink)

Husserlian reduction is a rigorous method for describing the foundations of psychiatric experience. With Jaspers we consider three main principles inspired by phenomenological reduction: direct givenness, absence of presuppositions, re-presentation. But with Binswanger alone we refer to eidetic and transcendental reduction: to establish a critical epistemology; to directly investigate the constitutive processes of mental phenomena and their disturbances, freed from their nosological background; to question the constitution of our own experience when facing a person with mental illness. Regarding the last (...) item, we suggest a specific kind of reduction, typically intersubjective from the start, which we call the ‘looking-glass reduction'. The schizophrenic experience -- understood as a ‘loss of taken-for-grantedness’ implying the constitutions of the body, of the other, and of internal time -- is a real ‘epochal provocation’ for the psychiatrist. As the horizon it opens seems to be both corporeal and narrative, this ‘provoking’ of an epoche in the attitude of the psychiatrist himself and the resistances it implies raise important issues regarding the general constitution of human experience. (shrink)

We can think about the use of controlled substances in the treatment of anxiety disorders in two simple but diametrically opposed ways. First, we can say that anxiety disorders are trivial and require only acts of willpower, or, if anxiety disorders do require treatment, they are better treated without the use of benzodiazepines. When BZs are used to treat anxiety, they pose grave risks of addiction to the patients to whom these medicines are prescribed; they relieve patients’ symptoms, but are (...) the equivalent of a pharmacological “roach motel,” a haven into which many unsuspecting patients enter, but from which few emerge without becoming addicted. Patients must then face terrible struggles to free themselves of dependence on BZs, and this compounds the problem for which they sought treatment. Furthermore, the large number of prescriptions for BZs are a threat to the public health because these drugs are widely abused by alcoholics and drug addicts. (shrink)

Following the distinctions proposed by Gamson and Easton the complex phenomenon of political alienation among the young was empirically subdivided in several dimensions. Within the 'input'dimension of political alienation we distinguished between the ability to process information and the ability to participate. Within the 'output'dimension we distinguished between two referents of distrust, political actors and authorities on the one hand, and the political system on the other. We succeeded in constructing reliable scales for each of these dimensions which were then (...) used as dependent variables in regression models. When turning to the explanation of the phenomenon our attention was focused first and foremost on the cultural factors. This was amply rewarded. Some of the normative aspects of culture, namely 'presenteism' and 'dionysianism', have a significant influence on various dimensions of political alienation. The impact of cognitive aspects appears to be even more significant. This means that an effective policy to counter the rise of political alienation wilt have to cope with a phenomenon solidly embedded in contemporary culture. (shrink)

Chacun s’interroge sur les effets de la séparation de couple sur l’enfant. Dans la mesure où il module les relations familiales après la séparation, le mode de garde semble être une variable centrale. Pour y voir plus clair, nous nous sommes intéressées à la période de la post-adoles-cence, qui voit le développement du second processus de séparation-individuation (Blos, 1967). Nous avons rencontré 29 jeunes femmes de 18 à 23 ans et analysé, par une série d’outils cliniques, la manière dont chaque (...) mode de garde a pu moduler l’individuation de ces sujets par rapport à leur famille. Chacun d’entre eux semble bien avoir un effet différent sur les dynamiques d’emprise et de dégagement propres à la post-adolescence, ainsi que sur la qualité des relations de l’enfant à son père et sa mère. (shrink)

Caroline New is an energetic activist who has interpolated critical realist ideas into the front-line of political activism. In this wide-ranging interview, she begins by reflecting on her life and how she became a realist and her account is illustrated with personal anecdotes recalling memories of well-known philosophers and activists from the time. She discusses how her position set her apart from other feminists and she examines the interacting threads of longstanding debates on the political left, as well as (...) longstanding debates within critical realist circles, such as the relative importance of quantitative methods in social research and the scope for agency as a source of intentional change. Finally she brings some of her ideas to bear on contemporary issues. This engaging interview notably provides some of the social context in which critical realism developed, while also pointing towards its future potential. (shrink)

Some patients awaken from their coma but only show reflex motor activity. This condition of wakeful (eyes open) unawareness is called the vegetative state. In 2002, a new clinical entity coined ‘‘minimally conscious state’’ defined patients who show more than reflex responsiveness but remain unable to communicate their thoughts and feelings. Emergence from the minimally conscious state is defined by functional recovery of verbal or nonverbal communication.1 Our empirical medical definitions aim to propose clearcut borders separating disorders of consciousness such (...) as coma, vegetative state and minimally conscious state but clinical reality shows that these boundaries can often be fuzzy (fig 1). Recent clinical, electrophysiological and neuroimaging studies are shedding light on these challenging limits of consciousness encountered following severe acute brain damage. At the patient’s bedside, it is very challenging to differentiate reflex or automatic motor behaviour from movements indicating signs of consciousness, and hence some minimally conscious patients might be misdiagnosed as being vegetative. For some motor responses (eg, blinking to visual threat, brief fixation, normal flexion response to pain, etc) it remains unclear whether they truly are voluntary or willed because we lack convincing scientific evidence. We also lack consensus on how to practically assess some of these behavioural responses. For example, there is no agreement on what stimulus to employ in the assessment of visual pursuit movements— often one of the first clinical signs heralding the transition from the vegetative to the minimally conscious state. Vanhaudenhuyse and colleagues2 recently studied visual pursuit in 51 post-comatose patients comparing eye tracking of a moving object, person or mirror. It was shown that more.. (shrink)

Background Discussions on ethical aspects of life-and-death decisions within the hospital are often made in plenary. The prehospital physician, however, may be faced with ethical dilemmas in life-and-death decisions when time-critical decisions to initiate or refrain from resuscitative efforts need to be taken without the possibility to discuss matters with colleagues. Little is known whether these considerations regarding ethical issues in crucial life-and-death decisions are documented prehospitally. This is a review of the ethical considerations documented in the prehospital medical records (...) of patients in a Danish prehospital setting for whom the decision to resuscitate or not was made at the scene. Methods The study is based on discharge summaries of all patients subjected to crucial life-and-death decisions by the Mobile Emergency Care Unit in Odense in the years 2010 to 2014. The medical records with possible documentation of ethical issues were independently reviewed by two philosophers in order to identify explicit ethical or philosophical considerations pertaining to the decision to resuscitate or not. Results In total, 1275 patients were either declared dead at the scene without exhibiting layman’s reliable signs of death or admitted to hospital following resuscitation. In a total of 62 patients, 85 specific ethical issues related to resuscitation were documented. The expressions of the ethical considerations were generally vague or unclear and almost exclusively concerned the interests of the patient and not the relatives. In the vast majority of cases where an ethical content was identified, the ethical considerations led to a decision to terminate treatment. Conclusions A strengthened practice of documenting ethical considerations in prehospital life-and-death decision-making in the patient’s medical records is required. We suggest that a template be implemented in the prehospital medical records describing the basis for any ethical decisions. This template should contain information regarding the persons involved in the deliberations and notes on ethical considerations. The documentation should include considerations concerning the patient’s end-of-life wishes, the estimations of the quality of life before and after the incident, and a summary of other ethical concerns taken into account, such as the integrity of the patient and frame of mind of relatives. (shrink)