Transplantation of vital organs has been premised ethically and legally on "the dead donor rule" (DDR)—the requirement that donors are determined to be dead before these organs are procured. Nevertheless, scholars have argued cogently that donors of vital organs, including those diagnosed as "brain dead" and those declared dead according to cardiopulmonary criteria, are not in fact dead at the time that vital organs are being procured. In this article, we challenge the normative rationale for the DDR by rejecting the (...) underlying premise that it is necessarily wrong for physicians to cause the death of patients and the claim that abandoning this rule would exploit vulnerable patients. We contend that it is ethical to procure vital organs from living patients sustained on life support prior to treatment withdrawal, provided that there is valid consent for both withdrawing treatment and organ donation. However, the conservatism of medical ethics and practical concerns make it doubtful that the DDR will be abandoned in the near future. This leaves the current practice of organ transplantation based on the "moral fiction" that donors are dead when vital organs are procured. (shrink)
Risk–benefit assessment is a routine requirement for research ethics committees that review and oversee biomedical research with human subjects. Nevertheless, it remains unclear how to weigh and balance risks to research participants against the social benefits that flow from generating biomedical knowledge. In this article, we address the question of whether there are any reasonable criteria for defining the limit of permissible risks to individuals who provide informed consent for research participation. We argue against any a priori limit to permissible (...) research risks. However, attention to the uncertainty of potential social benefit that can be derived from any particular study warrants caution in exposing prospective research participants to a substantial likelihood of serious harm. (shrink)
Despite strong growth in scientific investigation of the placebo effect, understanding of this phenomenon remains deeply confused. We investigate critically seven common conceptual distinctions that impede clear understanding of the placebo effect: (1) verum/placebo, (2) active/inactive, (3) signal/noise, (4) specific/nonspecific, (5) objective/subjective, (6) disease/illness, and (7) intervention/context. We argue that some of these should be eliminated entirely, whereas others must be used with caution to avoid bias. Clearing away the conceptual underbrush is needed to lay down a path to understanding (...) and harnessing placebo effects in clinical medicine. (shrink)
Payment for research participation has raised ethical concerns, especially with respect to its potential for coercion. We argue that characterising payment for research participation as coercive is misguided, because offers of benefit cannot constitute coercion. In this article we analyse the concept of coercion, refute mistaken conceptions of coercion and explain why the offer of payment for research participation is never coercive but in some cases may produce undue inducement.
Although established in the law and current practice, the determination of death according to neurological criteria continues to be controversial. Some scholars have advocated return to the traditional circulatory and respiratory criteria for determining death because individuals diagnosed as ‘brain dead’ display an extensive range of integrated biological functioning with the aid of mechanical ventilation. Others have attempted to refute this stance by appealing to the analogy between decapitation and brain death. Since a decapitated animal is obviously dead, and ‘brain (...) death’ represents physiological decapitation, brain dead individuals must be dead. In this article we refute this ‘decapitation gambit.’ We argue that decapitated animals are not necessarily dead, and that, moreover, the analogy between decapitation and the clinical syndrome of brain death is flawed. (shrink)
Dual-track assessment directs research ethics committees to assess the risks of research interventions based on the unclear distinction between therapeutic and non-therapeutic interventions. The net risks test, in contrast, relies on the clinically familiar method of assessing the risks and benefits of interventions in comparison to the available alternatives and also focuses attention of the RECs on the central challenge of protecting research participants.Research guidelines around the world recognise that clinical research is ethical only when the risks to participants are (...) reasonable.1 Appropriate implementation of this requirement is vital to protecting research participants and allowing research to proceed when it poses acceptable risks. Unfortunately, as the US National Bioethics Advisory Commission notes: “current regulations do not further elaborate how risks and potential benefits are to be assessed, and little additional guidance is available to IRBs.”1The NBAC, as well as numerous commentators, recommend that research ethics committees , ethics review committees and institutional review boards should adopt what may be called dual-track risk assessment.2–5 Yet, dual-track assessment unnecessarily divides research interventions into two different categories before assessing their risks and relies on the unclear distinction between therapeutic and non-therapeutic interventions. As a result, dual-track assessment provides RECs with confusing guidance and has the potential to block valuable research that poses acceptable risks. This paper describes one alternative, the net risks test, and argues that this approach offers a better method for assessing research risks, one that puts RECs in a position to protect participants without blocking appropriate research studies.BACKGROUNDClinical research exposes participants to interventions and procedures to gather systematic data that may be used to improve overall health and well-being. To ensure that research is ethical, RECs must ensure that the risks and burdens to participants are not excessive and that …. (shrink)
John McMillan's article raises numerous important points about the ethics of surgical castration of sex offenders.1 In this commentary, we focus solely on and argue against the claim that the offer of release from detention conditional upon surgical castration is a coercive offer that compromises the validity of the offender's consent. We take no view on the question as to whether castration for sex offenders is ethically permissible. But, we reject the claim that it is ethically permissible only if competing (...) ethical considerations outweigh worries about coercion. For in the situation described, the proposal is not coercive at all.McMillan states that if offenders agree to castration because they fear long-term detention, then ‘it seems, intuitively, as if agreeing to be castrated under these conditions makes the decision coerced in some way.’1 He adds that if castration is ‘the only way that they will be released back into the community, the status of this decision as a genuine expression of their autonomy is questionable.’1 In defence of his claim, he uses two analogies that he borrows from Joel Feinberg. First, if a governor offers to commute a death sentence if the prisoner agrees to participate in a medical experiment, then ‘it's clear that the governor is coercing the prisoner.’1 Second, if a millionaire offers to give a woman $1 000 000 …. (shrink)
Der Beschreibung der zeitlichen Entwicklung lebender Systeme kann eine reine Differentialanalyse nicht genügen. In solchen Fällen muss man sich an Stelle der gewöhnlichen Differentialgleichungen der integraldifferentiellen, bezw. der Integralgleichungen bedienen. Zur leichteren Veranschaulichung der mathematischen Darstellung betrachtet Verfasser zuerst diejenigen Systeme, deren innerer Zustand sich durch ein einziges Parameterc bestimmen lässt. Die zeitliche Entwicklung eines leblosen Systems dieser Klasse werde durch die Differentialgleichung dcdt=kf... dargestellt, wot=Zeit, undk eine Funktion der äusseren Parameterα, Β, γ. ist. Im Falle eines jeden Systems sind (...) die äusseren Parameterα, Β, γ. charakteristische individuelle Funktionen der Zeit. Misst manc am. Zeitpunktt, so lässt sich die Zukunft des Systems vermittelst der Gleichung berechnen, wenn die zukünftigen Werte der äusseren Parameter gegeben sind. Solche Systeme nennt Verfasser nicht-historische Systeme. Im Falle der lebenden Systeme werde die zeitliche Entwicklung durch die Integral-differentialgleichung dcdt=k1f1+∫t−λtk2f2dt........dargestellt, wof 1 undf 2 Funktionen des Zustandsparametersc, undk 1 undk 2 Funktionen der äusseren Parameter sind. Das Zeitintegral erstreckt sich auf das vergangene Zeitintervalt-λ →t, woλ einen positiven endlichen konstanten Wert besitzt. Diese Systeme nennt Verfasser historische Systeme. Setzt manH für das darin enthaltene Integralglied, so verwandelt sich die Gleichung in: dcdt=k1f1+H..........Misst man nunc am Zeitpunktt, so kann man in diesem Fall die Zukunft des Systems ohne Kenntnis des historischen GliedsH nicht berechnen. Das Vorkommen des historischen IntegralgliedsH nennt Verfasser Chronoholismus. Man kann deshalb die historischen Systeme auch chronoholistische Systeme nennen.Die biologische Interpretation dieser Betrachtungsweise wird vom Verfasser diskutiert, und die Gleichung auf Systeme mit erblichen Eigenschaften ausgedehnt. Es werden zuletzt Systeme mit vielen Zustandsparametern in gewissen einfachen Fällen kurz behandelt.L'analyse différentielle ne suffit pas, selon l'avis de de l'auteur, pour la description de l'évolution des systèmes vivants au cours des temps. Il faut utiliser dans ces cas les équations intégro-différentielles ou intégrales. Pour faciliter le traÎtement mathématique, on peut considérer d'abord les systèmes dont l'état intérieur est défini par un seul paramètrec. L'évolution d'un système inanimé de cette classe se laisse décrire par l'équation différentielle dcdt=kf,...........oùt=temps, etk est une fonction déterminée des paramètres extérieurs α,Β, γ.Si l'on connaÎtc à un temps donnét, l'état du système à un temps futurt′ se laisse prévoir au moyen de l'équation , quand les valeurs des paramètres extérieurs dans l'intervallet → t∼' sont fixées. L'auteur appelle les systèmes de cette classe des systèmes non-historiques.Pour les systèmes vivants, il faut se servir, selon l'avis de l'auteur, des équations intégro-différentielles. Pour les systèmes définis par un seul paramètrec, on peut se servir, par exemple, de l'équation dcdt=k1f1+∫t−λtk2f2dt........où k1 et k2 sont des fonctions déterminées des paramètres extérieurs. L'intégrale s'étend sur l'intervallet-λ→ t où λ est positif et constant. En indiquant le terme intégral par le symboleH, on peut écrire dcdt=k1f1+H..........La connaissance de c à un temps donnét ne laisse pas prévoir l'état du système à un temps futurt′ sans connaissance du terme historiqueH, quand mÊme les paramètres α, Β, γ,..., seraient des fonctions déterminées du temps dans l'intervallet→t′.L'auteur appelle l'existence du terme intégral historiqueH le chronoholisme. On peut appeler les systèmes de cette classe des systèmes historiques ou chronoholistiques.L'interprétation biologique de cette faÇon de traÎter les systèmes vivants est discutée par l'auteur, qui étend l'équation pour le faire représenter aussi les propriétés héréditaires des Êtres vivants.Quelques cas de systèmes dont l'état intérieur est défini par plusieurs paramètres et plusieurs phases sont traités brièvement. (shrink)
Reviewed Works:G. Priest, R. Routley, Graham Priest, Richard Routley, Jean Norman, First Historical Introduction. A Preliminary History of Paraconsistent and Dialethic Approaches.Ayda I. Arruda, Aspects of the Historical Development of Paraconsistent Logic.G. Priest, R. Routley, Systems of Paraconsistent Logic.G. Priest, R. Routley, Applications of Paraconsistent Logic.G. Priest, R. Routley, The Philosophical Significance and Inevitability of Paraconsistency.
IntroductionTourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered.Methods and ResultsWe discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a tic reduction of (...) more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects.DiscussionSpecific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication.ConclusionClinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)
Data monitoring committees often are employed to review interim findings of randomised controlled trials. Interim findings are kept confidential until the data monitoring committee finds that they provide sufficiently compelling evidence regarding efficacy, typically because they have crossed the pre-defined statistical boundaries, or they raise serious concerns about safety. While this practice is vital to maintaining the scientific integrity of controlled trials and thereby ensuring their social value, it has been criticised as unethical. Commentators argue that withholding interim findings from (...) research participants is deceptive, inconsistent with valid informed consent, and a violation of respect for participants’ autonomy. The present article examines these arguments, focusing specifically on confidential data monitoring for efficacy. This practice need not be deceptive provided its use is disclosed to prospective research participants. In addition, confidential data monitoring does not make research participants worse off than they would be in the clinical setting and represents an acceptable limitation on the options available to prospective research participants. Taken together, these considerations suggest confidential data monitoring, subject to adequate safeguards, is ethically acceptable. (shrink)
In this essay, Hegel attempted to show how Fichte’s Science of Knowledge was an advance from the position of Kant in the Critique of Pure Reason, and how Schelling (and incidentally Hegel himself) had made a further advance from the position of Fichte.
Participants are often not informed by investigators who conduct randomised, placebo-controlled acupuncture trials that they may receive a sham acupuncture intervention. Instead, they are told that one or more forms of acupuncture are being compared in the study. This deceptive disclosure practice lacks a compelling methodological rationale and violates the ethical requirement to obtain informed consent. Participants in placebo-controlled acupuncture trials should be provided an accurate disclosure regarding the use of sham acupuncture, consistent with the practice of placebo-controlled drug trials.
Ethical guidelines for conducting clinical trials have historically been based on a perceived therapeutic obligation to treat and benefit the patient-participants. The origins of this ethical framework can be traced to the Hippocratic oath originally written to guide doctors in caring for their patients, where the overriding moral obligation of doctors is strictly to do what is best for the individual patient, irrespective of other social considerations. In contrast, although medicine focuses on the health of the person, public health is (...) concerned with the health of the entire population, and thus, public health ethics is founded on the societal responsibility to protect and promote the health of the population as a whole. From a public health perspective, research ethics should be guided by giving due consideration to the risks and benefits to society in addition to the individual research participants. On the basis of a duty to protect the population as a whole, a fiduciary obligation to realise the social value of the research and the moral responsibility to distribute the benefits and burdens of research fairly across society, how a public health perspective on research ethics results in fundamental re-assessments of the proper course of action for two salient topical issues in research ethics is shown: stopping trials early for reasons of efficacy and the conduct of research on less expensive yet less effective interventions. (shrink)
This paper investigates connectionism's potential to solve the frame problem. The frame problem arises in the context of modelling the human ability to see the relevant consequences of events in a situation. It has been claimed to be unsolvable for classical cognitive science, but easily manageable for connectionism. We will focus on a representational approach to the frame problem which advocates the use of intrinsic representations. We argue that although connectionism's distributed representations may look promising from this perspective, doubts can (...) be raised about the potential of distributed representations to allow large amounts of complexly structured information to be adequately encoded and processed. It is questionable whether connectionist models that are claimed to effectively represent structured information can be scaled up to a realistic extent. We conclude that the frame problem provides a difficulty to connectionism that is no less serious than the obstacle it constitutes for classical cognitive science. (shrink)
I argue that Grafen’s formal darwinism project could profitably incorporate a gene’s-eye view, as informed by the major transitions framework. In this, instead of the individual being assumed to maximise its inclusive fitness, genes are assumed to maximise their inclusive fitness. Maximisation of fitness at the individual level is not a straightforward concept because the major transitions framework shows that there are several kinds of biological individual. In addition, individuals have a definable fitness, exhibit individual-level adaptations and arise in a (...) major transition, only to the extent that the inclusive-fitness interests of genes within them coincide. Therefore, as others have suggested, the fundamental level at which fitness is maximised is the gene level. Previous reconciliations of the concepts of gene-level fitness and individual-level fitness implicitly recognise this point. Adaptations always maximise the fitness of their causative genes, but may be simple or complex. Simple adaptations may be controlled by single genes and be maladaptive at higher levels, whereas complex adaptations are controlled by multiple genes and rely on those genes having coinciding fitness interests at a higher level, for a given trait. (shrink)
This paper attempts to assess and evaluate some of the economic implications of the Convention on Biological Diversity. After outlining the main principles and the scope of this Convention, the following issues are addressed: the determination of the 'optimal' level of biodiversity loss, the meaning of incremental costs, and monetary evaluation problems of ecological resources and the problems it poses for the funding mechanism. The paper concludes with a discussion of the issues of commercialisation and access to genetic resources.
Robotics can be seen as a cognitive technology, assisting us in understanding various aspects of autonomy. In this paper I will investigate a difference between the interpretations of autonomy that exist within robotics and philosophy. Based on a brief review of some historical developments I suggest that within robotics a technical interpretation of autonomy arose, related to the independent performance of tasks. This interpretation is far removed from philosophical analyses of autonomy focusing on the capacity to choose goals for oneself. (...) This difference in interpretation precludes a straightforward debate between philosophers and roboticists about the autonomy of artificial and organic creatures. In order to narrow the gap I will identify a third problem of autonomy, related to the issue of what makes one’s goals genuinely one’s own. I will suggest that it is the body, and the ongoing attempt to maintain its stability, that makes goals belong to the system. This issue could function as a suitable focal point for a debate in which work in robotics can be related to issues in philosophy. Such a debate could contribute to a growing awareness of the way in which our bodies matter to our autonomy. (shrink)
This volume contains the Dialogues, The Natural History of Religion, and several short essays and selections from other works. The selection is a good one, but the editor's introduction does little to explicate the principles upon which Hume's writings on religion are based or to connect them with his other philosophical work.—A. F. G.
Robotics can be seen as a cognitive technology, assisting us in understanding various aspects of autonomy. In this paper I will investigate a difference between the interpretations of autonomy that exist within robotics and philosophy. Based on a brief review of some historical developments I suggest that within robotics a technical interpretation of autonomy arose, related to the independent performance of tasks. This interpretation is far removed from philosophical analyses of autonomy focusing on the capacity to choose goals for oneself. (...) This difference in interpretation precludes a straightforward debate between philosophers and roboticists about the autonomy of artificial and organic creatures. In order to narrow the gap I will identify a third problem of autonomy, related to the issue of what makes one's goals genuinely one's own. I will suggest that it is the body, and the ongoing attempt to maintain its stability, that makes goals belong to the system. This issue could function as a suitable focal point for a debate in which work in robotics can be related to issues in philosophy. Such a debate could contribute to a growing awareness of the way in which our bodies matter to our autonomy. (shrink)
Listening to someone from some distance in a crowded room you may experience the following phenomenon: when looking at them speak, you may both hear and see where the source of the sounds is; but when your eyes are turned elsewhere, you may no longer be able to detect exactly where the voice must be coming from. With your eyes again fixed on the speaker, and the movement of her lips a clear sense of the source of the sound will (...) return. This ‘ventriloquist’ effect reflects the ways in which visual cognition can dominate auditory perception. And this phenomenological observation is one what you can verify or disconfirm in your own case just by the slightest reflection on what it is like for you to listen to someone with or without visual contact with them. (shrink)
Advances in life-saving technologies in the past few decades have challenged our traditional understandings of death. Traditionally, death was understood to occur when a person stops breathing, their heart stops beating and they are cold to the touch. Today, physicians determine death by relying on a diagnosis of ‘total brain failure’ or by waiting a short while after circulation stops. Evidence has emerged, however, that the conceptual bases for these approaches to determining death are fundamentally flawed and depart substantially from (...) the established biological conception of death. We argue that the current approach to determining death consists of two different types of unacknowledged legal fictions. These legal fictions were developed for practices that are largely ethically legitimate but need to be reconciled with the law. The considerable debate over the determination of death in the medical and scientific literature has not informed the public that vital organs are being procured from still-living donors and it seems unlikely that this information can remain hidden for long. Given the instability of the status quo and the difficulty of making the substantial legal changes required by complete transparency, we argue for a second-best policy solution: acknowledging the legal fictions involved in determining death to move in the direction of greater transparency. This may someday result in more substantial legal change to directly confront the challenges raised by life-sustaining and life-preserving technologies without the need for fictions. (shrink)