Stem cells are likely to be used as an alternate source of biological material for neural transplantation to treat Parkinson’s disease in the not too distant future. Among the several ethical criteria that must be fulfilled before proceeding with clinical research, a favourable benefit to risk ratio must be obtained. The potential benefits to the participant and to society are evaluated relative to the risks in an attempt to offer the participants a reasonable choice. Through examination of preclinical studies transplanting (...) stem cells in animals and the transplantation of fetal tissue in patients with Parkinson’s disease, a current set of potential benefits and risks for neural transplantation of stem cells in clinical research of Parkinson’s disease are derived. The potential benefits to research participants undergoing stem cell transplantation are relief of parkinsonian symptoms and decreasing doses of parkinsonian drugs. Transplantation of stem cells as a treatment for Parkinson’s disease may benefit society by providing knowledge that can be used to help determine better treatments in the future. The risks to research participants undergoing stem cell transplantation include tumour formation, inappropriate stem cell migration, immune rejection of transplanted stem cells, haemorrhage during neurosurgery and postoperative infection. Although some of these risks are general to neurosurgical transplantation and may not be reduced for participants, the potential risk of tumour formation and inappropriate stem cell migration must be minimised before obtaining a favourable potential benefit to risk calculus and to provide participants with a reasonable choice before they enrol in clinical studies. (shrink)

In this paper we discuss the epistemological positions of evolution theories. A sharp distinction is made between the theory that species evolved from common ancestors along specified lines of descent (here called the theory of common descent), and the theories intended as causal explanations of evolution (e.g. Lamarck's and Darwin's theory). The theory of common descent permits a large number of predictions of new results that would be improbable without evolution. For instance, (a) phylogenetic trees have been validated now; (b) (...) the observed order in fossils of new species discovered since Darwin's time could be predicted from the theory of common descent; (c) owing to the theory of common descent, the degrees of similarity and difference in newly discovered properties of more or less related species could be predicted. Such observations can be regarded as attempts to falsify the theory of common descent. We conclude that the theory of common descent is an easily-falsifiable & often-tested & still-not-falsified theory, which is the strongest predicate a theory in an empirical science can obtain. Theories intended as causal explanations of evolution can be falsified essentially, and Lamarck's theory has been falsified actually. Several elements of Darwin's theory have been modified or falsified: new versions of a theory of evolution by natural selection are now the leading scientific theories on evolution. We have argued that the theory of common descent and Darwinism are ordinary, falsifiable scientific theories. (shrink)

This paper offers a particular intuitionistic negation completion of Urquhart's system C resulting in a super-intuitionistic contractionless propositional logic equivalent to Dummett's LC without contraction.

The legalization of euthanasia, both in the Netherlands and in other countries is usually justified in reference to the right to autonomy of patients. Utilizing recent Dutch jurisprudence, this article intends to show that the judicial proceedings on euthanasia in the Netherlands have not so much enhanced the autonomy of patients, as the autonomy of the medical profession. Keywords: allowing to die, criminal law, euthanasia, law enforcement, legal aspects, legislation, medical ethics, medical profession, self determination, the Netherlands, voluntary euthanasia, withholding (...) treatment CiteULike Connotea Del.icio.us What's this? (shrink)

This paper seeks to define and delimit the scope of the social responsibilities of health professionals in reference to the concept of a social contract. While drawing on both historical data and current empirical information, this paper will primarily proceed analytically and examine the theoretical feasibility of deriving social responsibilities from the phenomenon of professionalism via the concept of a social contract.

Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to (...) autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous. (shrink)

This article provides a summary overview of the ideas on medical anthropology and anthropological medicine of the German philosopher-psychiatrist Viktor Emil von Gebsattel (1883–1974), and discusses in more detail his views on the doctor-patient relationship. It is argued that Von Gebsattel''s warning against a dehumanization of medicine when the person of both patient and physician are not explicitly present in their relationship remains valid notwithstanding the modern emphasis on respect for patient (and provider) autonomy.

One of the main challenges in medicine is to guarantee an appropriate drug supply according to the real needs of patients. Closed-loop strategies have been widely used to develop automatic solutions based on feedback variables. However, when the variable of interest cannot be directly measured or there is a lack of knowledge behind the process, it turns into a difficult issue to solve. In this research, a novel algorithm to approach this problem is presented. The main objective of this study (...) is to provide a new general algorithm capable of determining the influence of a certain clinical variable in the decision making process for drug supply and then defining an automatic system able to guide the process considering this information. Thus, this new technique will provide a way to validate a given physiological signal as a feedback variable for drug titration. In addition, the result of the algorithm in terms of fuzzy rules and membership functions will define a fuzzy-based decision system for the drug delivery process. The method proposed is based on a Fuzzy Inference System whose structure is obtained through a decision tree algorithm. A four-step methodology is then developed: data collection, preprocessing, Fuzzy Inference System generation, and the validation of results. To test this methodology, the analgesia control scenario was analysed. Specifically, the viability of the Analgesia Nociception Index as a guiding variable for the analgesic process during surgical interventions was studied. Real data was obtained from fifteen patients undergoing cholecystectomy surgery. (shrink)

In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate (who may or may not hold the power of attorney ), and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of (...) best interest judgments entails a risk that health care providers withdraw from the decision-making process, abandoning patients (or their family members) to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit. (shrink)

In the face of managed care and market economies infringing on the practice of medicine, reducing its autonomy and determining the moral guidelines for medical practice, many physicians are calling out for a return to what is perceived as a traditional medical ethic. Many religiously motivated critics of certain modern developments in medicine have made similar appeals. These calls are best understood as an attempt to define medicine as a practice that is necessarily ethical in nature, a practice the moral (...) basis of which is internal to that practice. This article examines and assesses this definition of medicine in reference to Aristotle's division of human undertakings into three distinct categories: theory, poieisis (i.e., production), and praxis. It is concluded that medicine can be understood as a praxis (as opposed to a theory or production, both of which are morally neutral), because the practice of medicine, and all of its constitutive acts, can only be explained and assessed in reference to health, which is itself a final good and hence of moral value. Such an understanding would immunize medicine against usurpation by the free market. However, by the same token it would also dissociate medicine from all other moralities external to it, including those grounded in faith and religion. (shrink)

This article examines whether cosmetic interventions by dentists and plastic surgeons are medically indicated and, hence, qualify as medical interventions proper. Cosmetic interventions (and the business strategies used to market them) are often frowned upon by dentists and physicians. However, if those interventions do not qualify as medical interventions proper, they should not be evaluated using medical-ethical norms. On the other hand, if they are to be considered medical practice proper, the medical-ethical principles of nonmaleficence, beneficence, justice and others hold (...) true for cosmetic interventions as much as they do for other medical and dental interventions. It is concluded that most cosmetic interventions do not qualify as medical interventions proper because they do not restore or maintain the patient's health (defined as the patient's integrity) by any objective standards. Rather, cosmetic interventions are intended to enhance a person's physical appearance; more specifically, they intend to fulfill the client's subjective perception of an enhanced appearance. (shrink)

There are at present 28 Jesuit colleges and universities in the United States, which together offer more than 50 health sciences degree programs. But as the Society's membership is shrinking and the financial risks involved in sponsoring health sciences education are rising, the question arises whether the Society should continue to sponsor health sciences degree programs. In fact, at least eight Jesuit health sciences schools have already closed their doors. This paper attempts to contribute to the resolution of this urgent (...) question by reexamining Ignatius' own views on health sciences education and, more specifically, his prohibition of the Society's sponsoring medical education. It concludes on the basis of an historical analysis of Ignatius' views that there is insufficient support for today's ,Jesuits to maintain their engagement in medical and health care education. (shrink)

Este documento busca revisar el estado actual del pensamiento católico sobre el respeto al agenciamiento del paciente, a la autonomía y al consentimiento. Sin embargo, no se pretende llegar a una revisión definitiva. De hecho, encontraremos un amplio apoyo de estos conceptos dentro de la bioética católica, a pesar de que persiste un importante disenso sobre aspectos específicos. En primer lugar, el artículo ofrece una descripción resumida de algunas diferencias importantes entre el entendimiento prevaleciente de la autonomía del paciente en (...) la bioética secular y en la bioética católica. En la primera, se suele entender que el respeto a la autonomía del paciente considera las necesidades y deseos subjetivos de éste, incluso cuando, o tal vez precisamente, porque quedan fuera del ámbito de comprensión del profesional de la salud. En la segunda, este respeto se fundamenta en la dignidad delpaciente individual, que abarca los deseos y necesidades subjetivas del paciente, pero que es esencialmente un concepto objetivo y, por lo tanto, intersubjetivamente accesible. Para explicar con más detalle cómo puede respetarse el agenciamiento del paciente dentro de ese marco de referencia objetivo, en el documento se examinan diferentes tipos de agenciamiento del paciente dentro de la relación terapéutica. Para que la atención de la salud sea clínicamente óptima y éticamente sólida –como exigen los principios éticos de beneficencia y no maleficencia–, el paciente debe participar activamente en: 1) la evaluación y el diagnóstico; 2) la planificación del tratamiento, y 3) la terapia propiamente dicha. Además –como exige el principio ético del respeto a la autonomía–el proveedor de atención sanitaria debe: 4) proteger la confidencialidad del paciente; 5) proporcionarle información adecuada, y 6) obtener el consentimiento del paciente para cualquier intervención. A continuación, se examinan diferentes tipos de consentimiento. En una sección final, se revisará la cuestión de si es moralmente permisible que los proveedores de atención de la salud obliguen a los pacientes a rechazar los tratamientos que se consideren inmorales. (shrink)

This article starts with a brief historical account of the ongoing debate about the status of clinical ethics: theory of practice. The author goes on to argue that clinical ethics is best understood as a practice. However, its practicality should not be measured by the extent to which clinical-ethical consultants manage to mediate or negotiate resolutions to ethical conflicts. Rather, clinical ethics is practical because it is characterized by a profound concern for the well-being of individual patients as well as (...) the moral parameters of swift and urgent medical action in the face of limited supportive information. (shrink)

The aim of this paper is to introduce an alternative to Łukasiewicz’s 4-valued modal logic Ł. As it is known, Ł is afflicted by “Łukasiewicz type paradoxes”. The logic we define, PŁ4, is a strong paraconsistent and paracomplete 4-valued modal logic free from this type of paradoxes. PŁ4 is determined by the degree of truth-preserving consequence relation defined on the ordered set of values of a modification of the matrix MŁ characteristic for the logic Ł. On the other hand, PŁ4 (...) is a rich logic in which a number of connectives can be defined. It also has a simple bivalent semantics of the Belnap–Dunn type. (shrink)

The logic TM is the result of adding the mingle axiom, M to Ticket Entailment logic, T. In the present study, it is proved that TM has the variable-sharing property . Ternary relational semantics for TM is provided. Finally, an interesting extension of TM with the vsp is briefly discussed.

A simple, bivalent semantics is defined for Łukasiewicz’s 4-valued modal logic Łm4. It is shown that according to this semantics, the essential presupposition underlying Łm4 is the following: A is a theorem iff A is true conforming to both the reductionist and possibilist theses defined as follows: rt: the value of modal formulas is equivalent to the value of their respective argument iff A is true, etc.); pt: everything is possible. This presupposition highlights and explains all oddities arising in Łm4.

ABSTRACTA conditional is natural if it fulfils the three following conditions. It coincides with the classical conditional when restricted to the classical values T and F; it satisfies the Modus Ponens; and it is assigned a designated value whenever the value assigned to its antecedent is less than or equal to the value assigned to its consequent. The aim of this paper is to provide a ‘bivalent’ Belnap-Dunn semantics for all natural implicative expansions of Kleene's strong 3-valued matrix with two (...) designated elements. (shrink)

BackgroundThe interRAI 0–3 Early Years was recently developed to support intervention efforts based on the needs of young children and their families. One aspect of child development assessed by the Early Years instrument are motor skills, which are integral for the maturity of cognition, language, social-emotional and other developmental outcomes. Gross motor development, however, is negatively impacted by pre-term birth and low birth weight. For the purpose of known-groups validation, an at-risk sample of preterm children using the interRAI 0–3 Early (...) Years was included to examine correlates of preterm risk and the degree of gross motor delay.MethodsParticipant data included children and families from 17 health agencies in Ontario, Canada. Data were collected as part of a pilot study using the full interRAI 0–3 Early Years assessment. Correlational analyses were used to determine relationships between prenatal risk and preterm birth and bivariate analyses examined successful and failed performance of at-risk children on gross motor items. A Kruskal-Wallis test was used to determine the mean difference in gross motor scores for children born at various weeks gestation.ResultsCorrelational analysis indicated that prenatal and perinatal factors such as maternal nicotine use during pregnancy did not have significant influence over gross motor achievement for the full sample, however, gross motor scores were lower for children born pre-term or low birth weight based on bivariate analysis. Gross motor scores decreased from 40 weeks’ gestation, to moderate to late preterm, and to very preterm, however extremely preterm performed comparably to very preterm.InterpretationThe interRAI 0–3 was evaluated to determine its efficacy and report findings which confirm the literature regarding delay in gross motor performance for preterm children. Findings confirm that pre-term and low birth weight children are at greater risk for motor delay via the interRAI 0–3 Early Years gross motor domain. (shrink)

As is well known, the variable-sharing property (vsp) is, according to Anderson and Belnap, a necessary property of any relevant logic. In this paper, we shall consider two versions of the vsp, what we label the "weak vsp" (wvsp) and the "strong vsp" (svsp). In addition, the "no loose pieces property," a property related to the wvsp and the svsp, will be defined. Each one of these properties shall generally be characterized by means of a class of logical matrices. In (...) this way, any logic verified by an actual matrix in one of these classes has the property the class generally represents. Particular matrices (and so, logics) in each class are provided. (shrink)

In this article, I argue that the relationship between patients and their health care providers need not be construed as a contract between moral strangers. Contrary to the (American) legal presumption that health care providers are not obligated to assist others in need unless the latter are already contracted patients of record, I submit that the presence of a suffering human being constitutes an immediate moral commandment to try to relieve such suffering. This thesis is developed in reference to the (...) French philosopher Levinas and the Dutch theologian Schillebeeckx. An expanded version of the biblical parable of the Good Samaritan serves as test case. (shrink)

Łukasiewicz presented two different analyses of modal notions by means of many-valued logics: the linearly ordered systems Ł3,..., Open image in new window,..., \; the 4-valued logic Ł he defined in the last years of his career. Unfortunately, all these systems contain “Łukasiewicz type paradoxes”. On the other hand, Brady’s 4-valued logic BN4 is the basic 4-valued bilattice logic. The aim of this paper is to show that BN4 can be strengthened with modal operators following Łukasiewicz’s strategy for defining truth-functional (...) modal logics. The systems we define lack “Łukasiewicz type paradoxes”. Following Brady, we endow them with Belnap–Dunn type bivalent semantics. (shrink)

The aim of this paper is to define the logical system Sm4 characterised by the degree of truth-preserving consequence relation defined on the ordered set of values of Smiley’s four-element matrix MSm4. The matrix MSm4 has been of considerable importance in the development of relevant logics and it is at the origin of bilattice logics. It will be shown that Sm4 is a most interesting paraconsistent logic which encloses a sound theory of logical necessity similar to that of Anderson and (...) Belnap’s logic of entailment E. Intuitively, Sm4 can be described as a four-valued expansion of the positive fragment of Lewis’ S5 or, alternatively, as a four-valued version of S5. (shrink)

This paper explores the relationship between individual work values and unethical decision-making and actual behavior at work through two complementary studies. Specifically, we use a robust and comprehensive model of individual work values to predict unethical decision-making in a sample of working professionals and accounting students enrolled in ethics courses, and IT employees working in sales and customer service. Study 1 demonstrates that young professionals who rate power as a relatively important value are more likely to violate professional conduct guidelines (...) despite receiving training regarding ethical professional principles. Study 2, which examines a group of employees from an IT firm, demonstrates that those rating power as an important value are more likely to engage in non-work-related computing even when they are aware of a monitoring software that tracks their computer usage and an explicit policy prohibiting the use of these computers for personal reasons. (shrink)

The logic E4 is related to Brady’s BN4 in a similar way to which Anderson and Belnap’s logic of entailment E is related to their logic of the relevant implication R. In ‘A companion to Brady’s 4-valued relevant logic: the 4-valued logic of entailment E4’, quoted in this paper, three alternatives to BN4 and another three to E4 are summarily introduced in a couple of pages as the only alternatives containing Routley and Meyer’s basic logic B, provided some conditions are (...) fulfilled. The aim of this note is to prove BN4 and its three alternatives are the same logic up to some point, since they are functionally equivalent to each other, as it is the case with E4 and its three alternatives, which are also functionally equivalent to each other; to some extent, E4 is superior to BN4, since the latter is functionally included in the former, but not conversely. (shrink)

A classical result by Słupecki states that a logic L is functionally complete for the 3-element set of truth-values THREE if, in addition to functionally including Łukasiewicz’s 3-valued logic Ł3, what he names the ‘$T$-function’ is definable in L. By leaning upon this classical result, we prove a general theorem for defining binary expansions of Kleene’s strong logic that are functionally complete for THREE.