No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)
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)
Theorists at the interface of medicine and the humanities have recently suggested that interpretation as a literary activity can be applied to the practice of clinical medicine. This article reviews such theories and their literary metaphors and methods. In pushing these ideas further, it is proposed that a number of guidelines can be applied to interpretation as a practical activity for clinical medicine.
Resource allocation decisions are often made on the basis of clinical and cost effectiveness at the expense of ethical inquiry into what is acceptable. This paper proposes that a more compassionate model of resource allocation would be achieved through integrating ethical awareness with clinical, financial and legal input. Where a publicly-funded healthcare system is involved, it is suggested that having an agency that focuses solely on cost-effectiveness leaving medical, legal and ethical considerations to others would help depoliticise rationing decisions and (...) command greater public acceptance. (shrink)
Although providing aid in conflict is implicitly political, involving humanitarian actors and aid in conflict resolution initiatives, as Weiss advocates, risks diluting the primary responsibility of humanitarian aid to alleviate suffering.
The ABA has adopted four model policies that address, in one way or another, the issue of foreign lawyer mobility. These policies are the ABA Model Foreign Legal Consultant Rule, which is commonly known as the FLC rule, the ABA Model Rule for Temporary Practice by Foreign Lawyers, which is commonly known as the FIFO rule, ABA Model Rule of Professional Conduct 5.5, which permits foreign lawyers to serve as in-house counsel, and the ABA Model Rule on Pro Hac Vice (...) Admission. All four of the ABA's foreign lawyer mobility recommendations include a requirement that the mobile foreign lawyer is “ subject to effective regulation and discipline by a duly constituted professional body or a public authority .” In other words, these rules set forth requirements regarding the nature of the regulatory system in the foreign lawyer's home jurisdiction. A number of US states have included this requirement in their foreign lawyer mobility provisions, but a number have not. Although the ABA model rules and a number of state rules include this requirement, neither the ABA Model Rules nor any of the state rules have defined what it means for a foreign lawyer to come from a system with “effective regulation and discipline.” Nor is there any evidence that this requirement has been enforced in those states that have included this requirement. This article suggests that the “effective regulation and discipline” requirement has been an elephant in the room that no one has been willing to talk about. The article argues that the time has come to confront this issue head-on. It asserts that either efforts should be undertaken to define and enforce this requirement or that the requirement should be abandoned. The article reviews two “threshold” issues that jurisdictions might want to consider when deciding whether to adopt or retain an “effective regulation and discipline” requirement. It also identifies cross-cultural and cross-professional resources that might be consulted for “benchmarking” purposes if and when US regulators decide to add “meat to the bones” by defining and enforcing the “effective regulation and discipline” requirement found in foreign lawyer mobility provisions. (shrink)
Medical narrative is normally assumed to be a past tense narrative. Patients’ and students’ past tense narratives should be supplemented by future tense narratives, and in particular by what we call hypothetical narratives—narratives such as those offered by a medical student in response to the instruction “Tell me a story about when you are a doctor”. These narratives are suggested to be especially useful in clinical and educational contexts because they offer greater insight into the narrator’s hopes and expectations than (...) past tense narratives, which can be helpful in planning management and teaching. The narrator’s ethical principles are also exposed more clearly than when using the past tense narrative. Some ethical concerns raised by analysing narratives offered by patients or students, as if they were literary narratives, are avoided by hypothetical narratives. This suggestion is based on Ricoeur’s account of the ethical importance of veracity in narrative, or “attestation of what has occurred”. The patient/doctor or student/teacher relationship is found to have an implicit concern for the narrator’s intention that makes the assumptions underlying literary analysis untenable. (shrink)
Laws, codes, and rules are essential for any community, public or private, to operate in an orderly and productive fashion. Without laws and codes, anarchy and chaos abound and the purpose and role of the organization is lost. However, danger is significant, and damage serious and far-reaching when individuals or organizations become so focused on rules, laws, and specifications that basic principles are ignored. This paper discusses the purpose of laws, rules, and codes, to help understand basic principles. With such (...) an understanding an increase in the level of ethical and moral behavior can be obtained without imposing detailed rules. (shrink)
Researchers in medical education have extensively studied negative reactions to gross anatomy, sometimes grouped under the term “the cadaver experience.” Although there has been disagreement about the extent and importance of such phenomena, several attempts at curricular reform have been designed to “humanize” the student-cadaver encounter. However, some obvious sources linking gross anatomy and the humanities have been consistently overlooked. Such sources—from the history of art, the history of anatomy, and autobiographical and imaginative literature—not only bear witness to the “cadaver (...) experience” for anatomists of the past, but also offer forgotten alternatives for placing present-day reactions in perspective. Former methods of teaching which used such material might serve as models for reintegrating the humanities into the study of gross anatomy as a possible humanizing force. (shrink)
This article describes a model of DNA banking that incorporates appropriate consumer influence on the design and use of DNA data banks. This model values input of consumer stakeholders in key decisions, including contracts between donors, researchers and the bank.
Aim: Patients with advanced cancer need information about end-of-life treatment options in order to make informed decisions. Clinicians vary in the frequency with which they initiate these discussions.Patients and methods: As part of a long-term longitudinal study, patients with an expected 2-year survival of less than 50% who had advanced gastrointestinal or lung cancer or amyotrophic lateral sclerosis were interviewed. Each patient’s medical record was reviewed at enrollment and at 3 months for evidence of the discussion of patient wishes concerning (...) ventilator support, artificial nutrition and hydration , resuscitation and hospice care. A Kaplan–Meier analysis was also performed and 2-year survival calculated.Results: 60 cancer and 32 ALS patients were enrolled. ALS patients were more likely than cancer patients to have evidence of discussion about their wishes for ventilator support , ANH , DNR and hospice care . At 6 months, 91% of ALS patients were alive compared with 62% of cancer patients; at 2 years, 63% of ALS patients were alive compared with 23% of cancer patients .Conclusions: Cancer patients were less likely than ALS patients to have had documented advanced care planning discussions despite worse survival. This may reflect perceptions that ALS has a more predictable course, that advanced cancer has a greater number of treatment options, or differing views about hope. Nevertheless, cancer patients may be less adequately prepared for end-of-life decision-making. (shrink)
In his 1958 seminal paper “Saints and Heroes”, J. O. Urmson argued that the then dominant tripartite deontic scheme of classifying actions as being exclusively either obligatory, or optional in the sense of being morally indifferent, or wrong, ought to be expanded to include the category of the supererogatory. Colloquially, this category includes actions that are “beyond the call of duty” and hence actions that one has no duty or obligation to perform. But it is a controversial category. Some have (...) argued that the concept of supererogation is paradoxical because on one hand, supererogatory actions are supposed to be morally good, indeed morally best, actions. But then if they are morally best, why aren't they morally required, contrary to the assumption that they are morally optional? In short: how can an action that is morally best to perform fail to be what one is morally required to do? The source of this alleged paradox has been dubbed the ‘good-ought tie-up’. In our article, we address this alleged paradox by first making a phenomenological case for the reality of instances of genuine supererogatory actions, and then, by reflecting on the relevant phenomenology, explaining why there is no genuine paradox. Our explanation appeals to the idea that moral reasons can play what we call a merit conferring role. The basic idea is that moral reasons that favor supererogatory actions function to confer merit on the actions they favor—they play a merit conferring role—and can do without also requiring the actions in question. Hence, supererogatory actions can be both good and morally meritorious to perform yet still be morally optional. Recognition of a merit conferring role unties the good-ought tie up, and there are good reasons, independent of helping to resolve the alleged paradox, for recognizing this sort of role that moral reasons may play. (shrink)
It's time to pick up your fedora and embark on a philosophical journey through Discworld! Terry Pratchett is world-famous for the narrative verve and surreal humour of his novels. But now meet another Terry Pratchett – a man of serious metaphysical ideas and sophisticated philosophical insights. In Philosophy and Terry Pratchett thirteen professional philosophers survey such key philosophical issues as personal identity, the nature of destiny, the value of individuality, the meaning of existentialism, the reality of universals (...) and the existence of alternative realities. In considering these and many other equally fascinating themes, close reference is made to more than 35 Discworld novels as well as to the ideas of some of history's greatest philosophers including Aristotle, Hobbes, Rousseau, Kant, Mill, Kierkegaard, Wittgenstein and Rawls. During your journey, you will be surprised by numerous provocative conclusions including the startling claim that the existence of Discworld is logically possible! (shrink)
In 'Jackson on physical information and qualia' Terry Horgan defended physicalism against Frank Jackson's Knowledge Argument by raising what later has been called the 'mode of presentation reply'- arguingthatthe Knowledge Argumentis fallacious because itsubtly equivocates on two different readings of 'physical information'. In 'Mary, Mary, quite contrary' however, George Graham and Terry Horgan maintain that none of the replies against Jackson has yet been successful, not even Horgan's own 1984 rejoinder.Tosubstantiate their claim, they present an allegedly improved version (...) of the Knowledge Argument, the 'Mary Mary Argument' whose default moral is property-dualism. In section 1, I will set the scene by making some clarifying remarks regarding Jackson's original argument. In section 2, I will consider several objections to the most promising physicalist rejoinder to the Knowledge Argument, the mode of presentation reply. In section 3 I will discuss the Mary Mary Argument and propose the indexical account of consciousness that, as it happens, is based on Horgan's own 1984 account as a possible solution. Finally,in section 4, I will argue that to the extent that the Mary Mary Argument exceeds the force of Jackson's original challenge it coincides with Joe Levine's Explanatory Gap Argument. (shrink)
In his review of my book, Terry Godlove raises some robust objections to the exegesis of Kant that I present in my recent book, Kant and the Creation of Freedom: a Theological Problem (Oxford/New York: Oxford University Press, 2013). I respond to these criticisms in this article. Properly to locate Godlove’s exegetical objections, I dedicate the first section to setting out the arc of the argument I trace. I then set out and treat in turn Godlove’s main objections to (...) my exegesis: that it depends upon an interpretation of transcendental idealism which makes the doctrine ‘flatly inconsistent and probably just silly’; that I neglect the most plausible account interpretation of Kant’s various statements about transcendental idealism; and that I ‘pick and choose’ supporting texts too narrowly, leading to an unbalanced presentation, which is too convenient to my thesis. I conclude with some general methodological reflections—stimulated by Godlove, but not aimed at him—about how historical philosophical texts are often treated. I express some anxieties about the principle of charity that underlies much current exegesis, and ‘rational reconstruction’ of historical texts, and I propose a case for what might be called ‘creative decomposition’ (not of the text, but of the self). (shrink)
Although the title of this book is misleading, Terry Godlove offers valuable insights into Kant’s approach to concept formation, and how this relates to conceptualizing religion.The book deliberately sets narrow limits to its discussion of a complex and far-ranging topic that spans most of Kant’s major writings. In six loosely-connected chapters, Godlove explores various aspects of the relation between Kant’s epistemology and the way we understand and classify religions, hence eschewing “the ‘official’ philosophy of religion,” including Kant’s own . (...) Godlove generally ignores the predominant approaches to Kant and religion, such as exploring “the denial of the knowledge of God in favor of a moral faith” , which unfortunately for him seems to include the crucial issue of the ethical dimension of religious concepts. He also rejects, quite rightly in my judgment, the endeavors of “those of a traditional theological bent whose views are difficult to square with Kant’s texts” (p. .. (shrink)