The ethical treatment of cancer patientsparticipating in clinical trials requiresthat patients are well-informed about thepotential benefits and risks associated withparticipation. When patients enrolled in phaseI clinical trials report that their chance ofbenefit is very high, this is often taken as evidence of a failure of the informed consent process. We argue, however, that some simple themes from the philosophy of language may make such a conclusion less certain. First, the patient may receive conflicting statements from multiple speakers about the expected (...) outcome of the trial. Patients may be reporting the message they like best. Second, there is a potential problem of multivocality. Expressions of uncertainty of the frequency type can be confused with expressionsof uncertainty of the belief type. Patients may be informed using frequency-type statements and respond using belief-type statements. Third, each speech episode involving the investigator and the patient regarding outcomes may subservemultiple speech acts, some of which may beindirect. For example, a patient reporting ahigh expected benefit may be reporting a beliefabout the future, reassuring family members,and/or attempting to improve his or her outcome by apublic assertion of optimism. These sources oflinguistic confusion should be considered injudging whether the patient's reported expectation isgrounds for a bioethical concern that there hasbeen a failure in the informed consent process. (shrink)
Current UK legislation is impacting upon the feasibility and cost-effectiveness of medical record-based research aimed at benefiting the NHS and the public heath. Whereas previous commentators have focused on the Data Protection Act 1998, the Health and Social Care Act 2001 is the key legislation for public health researchers wishing to access medical records without written consent. The Act requires researchers to apply to the Patient Information Advisory Group for permission to access medical records without written permission. We present a (...) case study of the work required to obtain the necessary permissions from PIAG in order to conduct a large scale public health research project. In our experience it took eight months to receive permission to access basic identifying information on individuals registered at general practices, and a decision on whether we could access clinical information in medical records without consent took 18 months. Such delays pose near insurmountable difficulties to grant funded research, and in our case £560 000 of public and charitable money was spent on research staff while a large part of their work was prohibited until the third year of a three year grant. We conclude by arguing that many of the current problems could be avoided by returning PIAG’s responsibilities to research ethics committees, and by allowing “opt-out” consent for many public health research projects. (shrink)
Palliative laser therapy for gastrointestinal tumors is now well established. Its use however may be associated with complications not directly attributable to the laser therapy. These complications potentially decrease the quality of life which opposes the aim of treatment.
: To say that a work of fine art is beautiful because it has been produced by a genius introduces a determinate concept precluding a judgment of the work’s beauty by way of a pure judgment of taste. What Kant in fact proposes is that we judge a work to be the product of genius as a consequence of our judgment of its beauty. As Kant explains in KU §58, when we judge the beautiful in fine art it is the (...) indeterminacy of the mode of mental activity in which aesthetic ideas arise which permits us to interpret idealistically the purposiveness in the work, on which account we regard it as the product of genius. This article examines in particular KU §50 concerning the combination of genius and taste, and the puzzling assertion in KU §51 that all beauty is the expression of aesthetic ideas. (shrink)
Counterfactual thinking may be described as disciplined, realistic, and rational, but we move a step further to describe a theoretical perspective centering on behavior regulation. According to this perspective, counterfactual thinking primarily centers on coordination of ongoing behavior. In short, most thoughts in daily life center on the acquisition of goals; hence, counterfactual thinking may be illuminated by considering the large literature on goal cognition.