Several quantitative surveys have been conducted internationally to gather empirical information about physicians’ general attitudes towards health care rationing. Are physicians ready to accept and implement rationing, or are they rather reluctant? Do they prefer implicit bedside rationing that allows the physician–patient relationship broad leeway in individual decisions? Or do physicians prefer strategies that apply explicit criteria and rules?

BackgroundThe concept of evidence-based medicine has strongly influenced the appraisal and application of empirical information in health care decision-making. One principal characteristic of this concept is the distinction between "evidence" in the sense of high-quality empirical information on the one hand and rather low-quality empirical information on the other hand. In the last 5 to 10 years an increasing number of articles published in international journals have made use of the term "evidence-based ethics", making a systematic analysis and explication of (...) the term and its applicability in ethics important.DiscussionIn this article four descriptive and two normative characteristics of the general concept "evidence-based" are presented and explained systematically. These characteristics are to then serve as a framework for assessing the methodological and practical challenges of evidence-based ethics as a developing methodology. The superiority of evidence in contrast to other empirical information has several normative implications such as the legitimization of decisions in medicine and ethics. This implicit normativity poses ethical concerns if there is no formal consent on which sort of empirical information deserves the label "evidence" and which does not. In empirical ethics, which relies primarily on interview research and other methods from the social sciences, we still lack gold standards for assessing the quality of study designs and appraising their findings.ConclusionThe use of the term "evidence-based ethics" should be discouraged, unless there is enough consensus on how to differentiate between high- and low-quality information produced by empirical ethics. In the meantime, whenever empirical information plays a role, the process of ethical decision-making should make use of systematic reviews of empirical studies that involve a critical appraisal and comparative discussion of data. (shrink)

Die finanziellen Ressourcen im deutschen Gesundheitssystem sind begrenzt. Diese Mittelknappheit führt im Rahmen der ärztlichen Tätigkeit zu medizinischen, ökonomischen, juristischen und ethischen Problemen, welche sich in den kommenden Jahren weiter verschärfen dürften. Aus ethischer Perspektive sind die Probleme einer gerechten Verteilung knapper Ressourcen sowie mögliche Rollen- oder Gewissenskonflikte der ärztlichen Profession besonders relevant. Mit Hilfe von qualitativen Interviewstudien lässt sich der aktuelle ärztliche Umgang mit der Mittelknappheit in der klinischen Versorgung in seiner Komplexität und seinen ethisch relevanten Aspekten untersuchen. An (...) fünf Kliniken mit unterschiedlichem Versorgungsauftrag wurden Tiefeninterviews mit fünfzehn leitenden Ärzten in den Bereichen Intensivmedizin und Kardiologie durchgeführt. Die auf Tonband aufgezeichneten Interviews wurden nach dem Verfahren der Grounded Theory ausgewertet. Die Ärzte berichten ein heterogenes Spektrum von Einflussfaktoren, Konsequenzen und Reaktionen im Zusammenhang mit ihrem Handeln bei Mittelknappheit. Zuteilungskriterien wie der medizinische Nutzen oder die Kosteneffektivität werden von den befragten Ärzten sehr unterschiedlich interpretiert und führen damit möglicherweise zu inkonsistenten Allokationsentscheidungen. Gleichzeitig bestätigen die Untersuchungen aber auch, dass die Ärzte nicht leichtfertig mit den Allokationsentscheidungen umgehen, im Gegenteil: Die Mittelknappheit und die dadurch hervorgerufenen Verteilungsprobleme können zu Gewissenskonflikten, emotionalem Stress und Gefühlen der Überforderung führen. Um Lösungskonzepte für ethische Probleme im Umgang mit der Mittelknappheit in der klinischen Praxis entwickeln und erfolgreich implementieren zu können, müssen die in dieser Arbeit systematisch zusammengestellten Verständnisweisen, Einflussfaktoren und Konsequenzen im Zusammenhang mit dem Kostendruck berücksichtigt werden. (shrink)

Systematic reviews, which were developed to improve policy-making and clinical decision-making, answer an empirical question based on a minimally biased appraisal of all the relevant empirical studies. A model is presented here for writing systematic reviews of argument-based literature: literature that uses arguments to address conceptual questions, such as whether abortion is morally permissible or whether research participants should be legally entitled to compensation for sustaining research-related injury. Such reviews aim to improve ethically relevant decisions in healthcare, research or policy. (...) They are better tools than informal reviews or samples of literature with respect to the identification of the reasons relevant to a conceptual question, and they enable the setting of agendas for conceptual and empirical research necessary for sound policy-making. This model comprises prescriptions for writing the systematic review's review question and eligibility criteria, the identification of the relevant literature, the type of data to extract on reasons and publications, and the derivation and presentation of results. This paper explains how to adapt the model to the review question, literature reviewed and intended readers, who may be decision-makers or academics. Obstacles to the model's application are described and addressed, and limitations of the model are identified. (shrink)

Mit dem Konzept der Evidenz-basierten Medizin wurde die Verwendungsweise von empirischen Informationen in den Gesundheitswissenschaften stark verändert. Ein grundlegendes Charakteristikum dieses Konzeptes ist die Unterscheidung zwischen empirischen Informationen per se und „Evidenzen“ im Sinne von qualitativ hochwertigeren empirischen Informationen. Dieses Konzept der Evidenzbasierung findet sich zunehmend auch im Kontext der angewandten Ethik. In der internationalen Fachpresse sind in den letzten 5 bis 10 Jahren zunehmend Arbeiten publiziert worden, die den Begriff „Evidenz-basierte Ethik“ in unterschiedlicher Weise verwenden. Um die ethisch akzeptable (...) Verwendungsweise dieses neuen Konzeptes in der Ethik beurteilen zu können, bedarf es seiner systematischen und kritischen Explikation und Analyse.Der Artikel unterscheidet verschiedene deskriptive und normative Dimensionen des Konzeptes einer Evidenzbasierung und stellt diese in einer Systematik vor. Die Problembereiche im Zusammenhang mit den normativen Dimensionen werden an Praxisbeispielen der Evidenz-basierten Medizin dargestellt, um anschließend die methodischen und praxisorientierten Besonderheiten einer Evidenz-basierten Ethik herauszustellen.Die Höherwertigkeit von Evidenzen gegenüber anderen empirischen Informationen impliziert verschiedene normative Dimensionen wie die der Handlungslegitimation. Die Handlungslegitimation durch den Verweis auf Evidenzen wird dann zu einem ethischen Problem, wenn kein Konsens besteht zu der Frage, wann man bei spezifischen empirischen Informationen von Evidenz sprechen sollte und wann nicht. Durch die im Rahmen der empirischen Ethik hauptsächlich verwendeten sozialempirischen Studienansätze und die noch fehlenden Goldstandards zur Bewertung ihrer Qualität, führt die Übertragung des Evidenz-Konzeptes auf die Ethik zu weiteren methodischen und praktischen Problembereichen. Von einer Verwendung des Begriffspaares „Evidenz-basiert“ in der angewandten Ethik ist solange abzuraten, bis diese Problembereiche konsensfähig gelöst wurden. In der Zwischenzeit wäre eine „Informations-kritische“ Ethik zu fordern, deren Aufgabenspektrum in diesem Artikel vorgestellt wird. (shrink)

ZusammenfassungDie finanziellen Ressourcen im deutschen Gesundheitssystem sind begrenzt. Diese Mittelknappheit führt im Rahmen der ärztlichen Tätigkeit zu medizinischen, ökonomischen, juristischen und ethischen Problemen, welche sich in den kommenden Jahren weiter verschärfen dürften. Aus ethischer Perspektive sind die Probleme einer gerechten Verteilung knapper Ressourcen sowie mögliche Rollen- oder Gewissenskonflikte der ärztlichen Profession besonders relevant. Mit Hilfe von qualitativen Interviewstudien lässt sich der aktuelle ärztliche Umgang mit der Mittelknappheit in der klinischen Versorgung in seiner Komplexität und seinen ethisch relevanten Aspekten untersuchen. An (...) fünf Kliniken mit unterschiedlichem Versorgungsauftrag wurden Tiefeninterviews mit fünfzehn leitenden Ärzten in den Bereichen Intensivmedizin und Kardiologie durchgeführt. Die auf Tonband aufgezeichneten Interviews wurden nach dem Verfahren der Grounded Theory ausgewertet. Die Ärzte berichten ein heterogenes Spektrum von Einflussfaktoren, Konsequenzen und Reaktionen im Zusammenhang mit ihrem Handeln bei Mittelknappheit. Zuteilungskriterien wie der medizinische Nutzen oder die Kosteneffektivität werden von den befragten Ärzten sehr unterschiedlich interpretiert und führen damit möglicherweise zu inkonsistenten Allokationsentscheidungen. Gleichzeitig bestätigen die Untersuchungen aber auch, dass die Ärzte nicht leichtfertig mit den Allokationsentscheidungen umgehen, im Gegenteil: Die Mittelknappheit und die dadurch hervorgerufenen Verteilungsprobleme können zu Gewissenskonflikten, emotionalem Stress und Gefühlen der Überforderung führen. Um Lösungskonzepte für ethische Probleme im Umgang mit der Mittelknappheit in der klinischen Praxis entwickeln und erfolgreich implementieren zu können, müssen die in dieser Arbeit systematisch zusammengestellten Verständnisweisen, Einflussfaktoren und Konsequenzen im Zusammenhang mit dem Kostendruck berücksichtigt werden. (shrink)

BackgroundEmpirical research can become relevant for bioethics in at least two ways. First, by informing the development or refinement of ethical recommendations. Second, by evaluating how ethical recommendations are translated into practice. This study aims to investigate the scope and objectives of empirical studies evaluating how ethical recommendations are translated into practice. MethodsA sample of the latest 400 publications from four bioethics journals was created and screened. All publications were included if they met one of the following three criteria: (1) (...) evaluative empirical research, (2) non-evaluative empirical research and (3) borderline cases. For all publications categorized as evaluative empirical research we analyzed which objects (norms and recommendations) had been evaluated.Results234 studies were included of which 54% (n = 126) were categorized as non-evaluative empirical studies, 36% (n = 84) as evaluative empirical studies, and 10% (n = 24) as borderline cases. The object of evaluation were aspirational norms in 5 of the 84 included evaluative empirical studies, more specific norms in 14 (16%) studies and concrete best practices in 65 (77%) studies. The specific best practices can be grouped under five broader categories: ethical procedures, ethical institutions, clinical or research practices, educational programs, and legal regulations.ConclusionsThis mapping study shows that empirical evaluative studies can be found at all stages in the translational process from theory to best practices. Our study suggests two intertwined dimensions for structuring the field of evaluative/translational empirical studies in bioethics: First, three broader categories of evaluation objects and second five categories for types of best practices.Trial registration: The methodology used was described in a study protocol that was registered publicly on the Open Science Framework (https://osf.io/r6h4y/). (shrink)

Faden, R. & Shebaya, S, Public Health Ethics. The Stanford Encyclopedia of Philosophy (Summer 2010 Edition), Edward N. Zalta (ed.). Available from: htt : lato.stanford.edu archives sum2010 entries ublichealth-ethics (accessed ...

In this book, scholars with different disciplinary and national backgrounds argue for possible answers and analyse case studies on current issues of governance in biomedical research. These issues comprise among others the research-care distinction, risk evaluation in early human trials, handling of incidental findings, nocebo effects, cluster randomized trials, publication bias, or consent in biobank research. This book demonstrates how new technologies and research possibilities multiply or intensify already known governance challenges, leaving room for ethical analysis and complex moral choices. (...) Clinical researchers, research ethics committee members and research ethicists have all to deal with such challenges on a daily basis. While general reflection on core concepts of research ethics is seldom pointless, those confronted with hard moral choices do need more practical and contextualized reflection on the said issues. This book particularly provides such contextualized reflections and aims to inform all those who study, conduct, regulate, fund, or participate in biomedical research. (shrink)

Seit vielen Jahren zeigen Untersuchungen, dass die Ergebnisse klinischer Studien häufig selektiv publiziert werden mit einer statistisch signifikanten und im klinischen Ausmaß sehr bedeutenden Übervorteilung positiver Studienergebnisse. Diese selektive Publikation führt zu einer systematischen Fehlleitung verschiedener medizinischer Entscheidungen bzw. der diesen Entscheidungen zu Grunde liegenden Nutzen-Schaden-Abwägungen. Man muss davon ausgehen, dass solche Fehlleitungen die Patientenversorgung, die Patientenaufklärung, den Probandenschutz und die medizinische Lehre verschlechtern und somit in vielerlei Hinsicht ethisch unakzeptable Konsequenzen haben. Studienregister stellen die international bevorzugte Strategie dar, um (...) der selektiven Publikation entgegenzutreten. Wann und in welchem Umfang für in Deutschland durchgeführte klinische Studien eine Verpflichtung zur Studienregistrierung faktisch etabliert wird ist weiterhin offen. Der vorliegende Artikel führt unter Verweis auf zentrale internationale Literatur in die theoretischen und empirischen Hintergründe zum selektiven Publizieren und zur Studienregistrierung ein. Die ethischen Probleme des selektiven Publizierens werden systematisch dargestellt. Hierauf aufbauend wird für die Notwendigkeit einer restriktiven Regulierung der Studienregistrierung seitens der deutschen Gesundheitspolitik und der medizinischen Selbstverwaltung zur deutlichen Reduktion des selektiven Publizierens argumentiert. Abschließend diskutiert der Beitrag, inwieweit den deutschen Institutionen der medizinischen und forschenden Selbstverwaltung eine prospektive und retrospektive Verantwortung für eine effektive Regulierung der Studienregistrierung (bzw. für das Fehlen eben dieser) zugeschrieben werden kann. (shrink)

„Früh entdecken, effizienter therapieren!“ — Die innereLogik des Früherkennungskonzeptes ist äußerst öffentlichkeitswirksam und wird von den unterschiedlichsten medizinischen und gesellschaftlichen Institutionen unterstützt. In dieser Arbeit werden die vorrangig medizin-ethischen und wissenschaftstheoretischen Bedingungen untersucht, die erfüllt sein müssten, damit sich die Theorie einer Krebsfrüherkennung zum Wohl des Patienten umsetzen lässt: Wer ist kompetent, den jeweils stochastisch zu interpretierenden Nutzen und Schaden adäquat gegeneinander abzuwägen? Was sind angemessene Evaluationsparameter? Gibt es Grenzen der Informationsvermittlung in einer partnerschaftlichen Arzt-Patienten-Beziehung? Vor dem Hintergrund der früherkennungsspezifischen (...) Relativität von medizinischem Wissen und der unklaren Nutzenbestimmung stellt sich die Frage, wie verantwortungsvolles ärztliches Handeln aussehen kann. Der alleinige Hinweis auf die ärztliche Pflicht zur Aufklärung und Stärkung der Eigenverantwortung von Patienten verliert sich dabei zum Teil in paradoxen Scheinlösungen. Durch die genannten Probleme in der Krebsfrüherkennung wird deutlich, dass die Bedingungen für die Möglichkeit von patientenorientierter Informationsvermittlung nur schwer erfüllbar sind. (shrink)

Imperfect efficiency in healthcare delivery is sometimes given as a justification for refusing to ration or even discuss how to pursue fair rationing. This paper aims to clarify the relationship between inefficiency and rationing, and the conditions under which bedside rationing can be justified despite coexisting inefficiency. This paper first clarifies several assumptions that underlie the classification of a clinical practice as being inefficient. We then suggest that rationing is difficult to justify in circumstances where the rationing agent is or (...) should be aware of and contributes to clinical inefficiency. We further explain the different ethical implications of this suggestion for rationing decisions made by clinicians. We argue that rationing is more legitimate when sufficient efforts are undertaken to decrease inefficiency in parallel with efforts to pursue unavoidable but fair rationing. While the qualifier ‘sufficient’ is crucial here, we explain why ‘sufficient efforts’ should be translated into ‘benchmarks of efficiency’ that address specific healthcare activities where clinical inefficiency can be decreased. Referring to recent consensus papers, we consider some examples of specific clinical situations where improving clinical inefficiency has been recommended and consider how benchmarks for efficiency might apply. These benchmarks should state explicitly how much inefficiency shall be reduced in a reasonable time range and why these efforts are ‘sufficient’. Possible strategies for adherence to benchmarks are offered to address the possibility of non-compliance. (shrink)

Brody (2011) claims that clarifying conflict of interest (COI) is important for several reasons. Brody's paper seems to focus on the importance of raising awareness of the impact of COI and the nee...

ZusammenfassungSeit vielen Jahren zeigen Untersuchungen, dass die Ergebnisse klinischer Studien häufig selektiv publiziert werden mit einer statistisch signifikanten und im klinischen Ausmaß sehr bedeutenden Übervorteilung positiver Studienergebnisse. Diese selektive Publikation führt zu einer systematischen Fehlleitung verschiedener medizinischer Entscheidungen bzw. der diesen Entscheidungen zu Grunde liegenden Nutzen-Schaden-Abwägungen. Man muss davon ausgehen, dass solche Fehlleitungen die Patientenversorgung, die Patientenaufklärung, den Probandenschutz und die medizinische Lehre verschlechtern und somit in vielerlei Hinsicht ethisch unakzeptable Konsequenzen haben. Studienregister stellen die international bevorzugte Strategie dar, um (...) der selektiven Publikation entgegenzutreten. Wann und in welchem Umfang für in Deutschland durchgeführte klinische Studien eine Verpflichtung zur Studienregistrierung faktisch etabliert wird ist weiterhin offen. Der vorliegende Artikel führt unter Verweis auf zentrale internationale Literatur in die theoretischen und empirischen Hintergründe zum selektiven Publizieren und zur Studienregistrierung ein. Die ethischen Probleme des selektiven Publizierens werden systematisch dargestellt. Hierauf aufbauend wird für die Notwendigkeit einer restriktiven Regulierung der Studienregistrierung seitens der deutschen Gesundheitspolitik und der medizinischen Selbstverwaltung zur deutlichen Reduktion des selektiven Publizierens argumentiert. Abschließend diskutiert der Beitrag, inwieweit den deutschen Institutionen der medizinischen und forschenden Selbstverwaltung eine prospektive und retrospektive Verantwortung für eine effektive Regulierung der Studienregistrierung (bzw. für das Fehlen eben dieser) zugeschrieben werden kann. (shrink)

There are many ethical decisions in the practice of health research and care, and in the creation of policy and guidelines. We argue that those charged with making such decisions need a new genre of review. The new genre is an application of the systematic review, which was developed over decades to inform medical decision-makers about what the totality of studies that investigate links between smoking and cancer, for example, implies about whether smoking causes cancer. We argue that there is (...) a need for similarly inclusive and rigorous reviews of reason-based bioethics, which uses reasoning to address ethical questions. After presenting a brief history of the systematic review, we reject the only existing model for writing a systematic review of reason-based bioethics, which holds that such a review should address an ethical question. We argue that such a systematic review may mislead decision-makers when a literature is incomplete, or when there are mutually incompatible but individually reasonable answers to the ethical question. Furthermore, such a review can be written without identifying all the reasons given when the ethical questions are discussed, their alleged implications for the ethical question, and the attitudes taken to the reasons. The reviews we propose address instead the empirical question of which reasons have been given when addressing a specified ethical question, and present such detailed information on the reasons. We argue that this information is likely to improve decision-making, both directly and indirectly, and also the academic literature. We explain the limitations of our alternative model for systematic reviews. (shrink)

The systematic review of reasons is a new way to obtain comprehensive information about specific ethical topics. One such review was carried out for the question of why post-trial access to trial drugs should or need not be provided. The objective of this study was to empirically validate this review using an author check method. The article also reports on methodological challenges faced by our study.

BackgroundPublic involvement activities are promoted as measures for ensuring good governance in challenging fields, such as biomedical research and innovation. Proponents of public involvement activities include individual researchers as well as non-governmental and governmental organizations. However, the concept of ‘public’ in public involvement deserves more attention by researchers because it is not purely theoretical: it has important practical functions in the guidance, evaluation and translation of public involvement activities.DiscussionThis article focuses on collective agency as one property a public as a (...) small group of participants in a public involvement activity could exhibit. It introduces a prominent theoretical approach to collective agents as one specific kind of social entities and demonstrates how this approach can be applied to current practice in public involvement activities. A brief discussion of different types of representation as they are used in the existing literature on this topic is also included because representation and collective agency can be closely related to each other. Suggestions and ideas that are derived from this reasoning include the proposal to use a ‘validity check’ for the generation of collective agents as a regular element of certain types of public involvement activities, the consequences of combining collective agency and representativeness as a further property a public could exhibit, and standards for reporting the content of public involvement activities in scientific publications.SummaryThis article discusses the importance of the concept of ‘public’ in public involvement activities, with a focus on biomedical research and innovation. It introduces various practically relevant ideas that are based on a theoretical analysis of collective agency as an important property a public can possess. (shrink)

Background: For many years, studies have shown that the results of clinical trials are often published or reported selectively with a statistically significant bias in favour of positive trial results. Trial registration as a precondition for publication had only limited effects on current practice. Results of trials which were approved by research ethics committees are often published only partially, with a substantial time lag or not at all. This study examined existing procedures of RECs in the European Union to monitor (...) and prevent incomplete registration of trials and selective reporting of trial results. It further investigated opinions of REC members about the need to update current legislation on this matter. Methods: Web-based survey on members of RECs in 22 European countries. Results: Over 90 percent of respondents agreed that the incomplete publication of trial results had a strong or somewhat negative impact on public health and on healthcare professionals’ trust in the validity of clinical research, yet only 30 percent reported that their REC had some mechanism in place to check that findings of approved studies are published in some form. Less than 10 percent stated that their REC has further specific procedures in place to prevent or minimize selective reporting of study results. Respondents stated variously that their REC did not have the resources to follow up on this matter. Conclusions: The existing legislation to regulate trial registration and encourage complete publication of trial results leaves room for improvement. REC members welcome guidelines to adequately address both problems. The new Regulation EU No. 536/2014 as well as the FDA Amendment Act from 2007 require the reporting of summary results within 1 year after study end. As recent reviews demonstrated, without any systematic approach to monitor the adherence to these regulations, publication rates remain rather low. (shrink)

This paper responds to the commentaries from Stacy Carter and Alan Cribb. We pick up on two main themes in our response. First, we reflect on how the process of setting standards for empirical bioethics research entails drawing boundaries around what research counts as empirical bioethics research, and we discuss whether the standards agreed in the consensus process draw these boundaries correctly. Second, we expand on the discussion in the original paper of the role and significance of the concept of (...) ‘integrating’ empirical methods and ethical argument as a standard for research practice within empirical bioethics. (shrink)

Background In the course of the COVID-19 pandemic, the biomedical research community’s attempt to focus the attention on fighting COVID-19, led to several challenges within the field of research ethics. However, we know little about the practical relevance of these challenges for Research Ethics Committees. Methods We conducted a qualitative survey across all 52 German RECs on the challenges and potential solutions with reviewing proposals for COVID-19 studies. We de-identified the answers and applied thematic text analysis for the extraction and (...) synthesis of challenges and potential solutions that we grouped under established principles for clinical research ethics. Results We received an overall response rate of 42%. The 22 responding RECs reported that they had assessed a total of 441 study proposals on COVID-19 until 21 April 2020. For the review of these proposals the RECs indicated a broad spectrum of challenges regarding social value, scientific validity, favourable risk–benefit ratio, informed consent, independent review, fair selection of trial participants, and respect for study participants. Mentioned solutions ranged from improved local/national coordination, over guidance on modified consent procedures, to priority setting across clinical studies. Conclusions RECs are facing a broad spectrum of pressing challenges in reviewing COVID-19 studies. Some challenges for consent procedures are well known from research in intensive care settings but are further aggravated by infection measures. Other challenges such as reviewing several clinical studies at the same time that potentially compete for the recruitment of in-house COVID-19 patients are unique to the current situation. For some of the challenges the proposed solutions in our survey could relatively easy be translated into practice. Others need further conceptual and empirical research. Our findings together with the increasing body of literature on COVID-19 research ethics, and further stakeholder engagement should inform the development of hands-on guidance for researchers, funders, RECs, and further oversight bodies. (shrink)

For valid informed consent, it is crucial that patients or research participants fully understand all that their consent entails. Testing and revising informed consent documents with the assistance of their addressees can improve their understandability. In this study we aimed at further developing a method for testing and improving informed consent documents with regard to readability and test-readers’ understanding and reactions. We tested, revised, and retested template informed consent documents for biobank research by means of 11 focus group interviews with (...) members from the documents’ target population. For the analysis of focus group excerpts we used qualitative content analysis. Revisions were made based on focus group feedback in an iterative process. Focus group participants gave substantial feedback on the original and on the revised version of the tested documents. Revisions included adding and clarifying explanations, including an info-box summarizing the main points of the text and an illustrative graphic. Our results indicate positive effects on the tested and revised informed consent documents in regard to general readability and test-readers’ understanding and reactions. Participatory methods for improving informed consent should be more often applied and further evaluated for both, medical interventions and clinical research. Particular conceptual and methodological challenges need to be addressed in the future. (shrink)

Established wisdom in cognitive science holds that the everyday folk psychological abilities of humans -- our capacity to understand intentional actions performed for reasons -- are inherited from our evolutionary forebears. In _Folk Psychological Narratives_, Daniel Hutto challenges this view and argues for the sociocultural basis of this familiar ability. He makes a detailed case for the idea that the way we make sense of intentional actions essentially involves the construction of narratives about particular persons. Moreover he argues that (...) children acquire this practical skill only by being exposed to and engaging in a distinctive kind of narrative practice. Hutto calls this developmental proposal the narrative practice hypothesis. Its core claim is that direct encounters with stories about persons who act for reasons supply children with both the basic structure of folk psychology and the norm-governed possibilities for wielding it in practice. In making a strong case for the as yet underexamined idea that our understanding of reasons may be socioculturally grounded, Hutto not only advances and explicates the claims of the NPH, but he also challenges certain widely held assumptions. In this way, _Folk Psychological Narratives_ both clears conceptual space around the dominant approaches for an alternative and offers a groundbreaking proposal. (shrink)

This classic analysis of Western liberal capitalist society contends that capitalism harbors the seeds of its downfall, particularly by effecting a certain cultural tendency among its most successful subjects that is bound to corrode its very foundations. As such, it is a conservative critique employing cultural concerns precisely where Marx prioritized economic ones.

"This book is a very impressive achievement. Kennefick skillfully introduces readers to some of the most abstruse yet fascinating concepts in modern physics stemming from Einstein's gravitational theory.

This essay criticizes the proposal recently defended by a number of prominent economists that welfare economics be redirected away from the satisfaction of people's preferences and toward making people happy instead. Although information about happiness may sometimes be of use, the notion of happiness is sufficiently ambiguous and the objections to identifying welfare with happiness are sufficiently serious that welfare economists are better off using preference satisfaction as a measure of welfare. The essay also examines and criticizes the position associated (...) with Daniel Kahneman and a number of co-authors that takes welfare to be ‘objective happiness’ – that is, the sum of momentary pleasures. (shrink)

Moral philosophy is often said to be about what we owe to each other. Do we owe anything to ourselves?

In this book, Daniel Shapiro argues that the dominant positions in contemporary political philosophy - egalitarianism, positive rights theory, communitarianism, and many forms of liberalism - should converge in a rejection of central welfare state institutions. He examines how major welfare institutions, such as government-financed and -administered retirement pensions, national health insurance, and programs for the needy, actually work. Comparing them to compulsory private insurance and private charities, Shapiro argues that the dominant perspectives in political philosophy mistakenly think that (...) their principles support the welfare state. Instead, egalitarians, positive rights theorists, communitarians, and liberals have misunderstood the implications of their own principles, which in fact support more market-based or libertarian institutional conclusions than they may realize. Shapiro's book is unique in its combination of political philosophy with social science. Its focus is not limited to any particular country; rather it examines welfare states in affluent democracies and their market alternatives. (shrink)

This essay develops an account of health, the functional efficiency theory, which derives from Christopher Boorse's biostatistical theory. Like the BST, the functional efficiency theory is a nonevaluative view of health, but unlike the BST, it argues that the fundamental theoretical task is to distinguish levels of efficiency with which the parts and processes within organisms and within systems within organisms function. Which of these to label as healthy or pathological is of secondary importance. Because the statistical distributions that Boorse's (...) account relies on are distributions of functional efficiency, the functional efficiency theory arguably complements rather than challenges the BST. (shrink)

The surviving sources on the Stoic theory of division reveal that the Stoics, particularly Chrysippus, believed that bodies, places and times were such that all of their parts themselves had proper parts. That is, bodies, places and times were composed of gunk. This realisation helps solve some long-standing puzzles about the Stoic theory of mixture and the Stoic attitude to the present.

Knowing Better presents a novel solution to the problem of reconciling the seemingly conflicting perspectives of ordinary virtue and normative ethics. Normative ethics is a sophisticated, open-ended philosophical enterprise that attempts to articulate and defend highly general ethical principles. Such principles aspire to specify our reasons, and tell us what it is right to do. However, it is not plausible to suppose that virtuous people in general follow such philosophical principles. These principles are difficult to articulate and assess, and we (...) do not think that advanced philosophical expertise is a necessary requirement for virtue. At the same time, the virtuous do not only accidentally get things right; rather, they act well in a reliable fashion, and they do so by responding appropriately to genuine reasons. Daniel Star argues that the solution to this problem requires a new approach to understanding the relation between ethical theory and ordinary deliberation, a new way of thinking about the nature of practical authority and normative reasons, a new account of the nature of virtue, and a rethinking of how best to understand the role that knowledge plays in deliberation and action. (shrink)

This paper argues that radical enactivism (RE) offers a framework with the required nuance needed for understanding of the full range of the various forms of pretense. In particular, its multi-storey account of cognition, which holds that psychological attitudes can be both contentless and contentful, enables it to appropriately account for both the most basic and most advanced varieties of pretense. By comparison with other existing accounts of pretense, RE is shown to avoid the pitfalls of representationalist theories while also (...) allowing us to combine the best elements of the praxeological enactivist (Weichold & Rucińska, 2021 ) and Langland-Hassan’s ( 2020, 2021 ) proposals about pretense, while avoiding their key shortcomings. (shrink)

Predictive Processing accounts of Cognition, PPC, promise to forge productive alliances that will unite approaches that are otherwise at odds. Can it? This paper argues that it can’t—or at least not so long as it sticks with the cognitivist rendering that Clark and others favor. In making this case the argument of this paper unfolds as follows: Sect. 1 describes the basics of PPC—its attachment to the idea that we perceive the world by guessing the world. It then details the (...) reasons why so many find cognitivist interpretations to be inevitable. Section 2 examines how prominent proponents of cognitivist PPC have proposed dealing with a fundamental problem that troubles their accounts—the question of how the brain is able to get into the great guessing game in the first place. It is argued that on close inspection Clark’s solution, which he calls bootstrap heaven is—once we take a realistic look at the situation of the brain—in fact bootstrap hell. Section 3 argues that it is possible to avoid dwelling in bootstrap hell if one adopts a radically enactive take on PPC. A brief sketch of what this might look like is provided. (shrink)

The core claim of this paper is that mind minding of the sort required for the simplest and most pervasive forms of joint attentional activity is best understood and explained in non-representational, enactivist terms. In what follows I will attempt to convince the reader of its truth in three steps. The first step, section two, clarifies the target explanandum. The second step, section three, is wholly descriptive. It highlights the core features of a Radically Enactivist proposal about elementary mind minding, (...) revealing it to be at least a possible explanans. The final step is to consider the comparative virtues of the contending proposals; section four. The exercise is to decide which of the possible explanations is best. Various evidential appeals and theoretical considerations that might aid us in this choice are reviewed. The conclusion is that the scales would be tipped in favour of the Radical Enactivist option, decisively, if it should turn out that there is (1) no reason to believe that basic forms of mentality are representational (in a semantically contentful way) and (2) if no good theory is likely to explain how they could be so. It is concluded that all that we need for understanding basic forms of intentional (with a ‘t’) mentality and what it takes to attend to basic cases of mind minding. (shrink)

Impossible fictions are not just the creations of puzzle-seeking philosophers or artists experimenting with the limits of fiction. Impossibilities can be found in relatively mundane fiction as well. This article argues that the device of personification, especially of abstract entities such as death or duty, yields impossible fictions, arguing against a number of strategies that might be tried to show that these cases of personification do not yield impossibilities.

This paper explores the possibility of extending Locke’s theory with respect to tangible property so that it might offer a feasible theoretical basis for intellectual property too. The main conclusion is that such an attempt must fail. Locke’s theory comes in three parts: a general justification of property which serves to explain why assets ought to be under the exclusive control of individuals; a positive method of private appropriation whereby an individual acquires a prima facie exclusive claim to previously commonly (...) held natural resources; and third, a negative requirement that other individuals’ crucial interests are not harmed by such an appropriation. For each of these, the difficulties involved in applying that part of the theory to the sphere of ideas are discussed, and a central aspect of intellectual property that raises the problems of application is highlighted. (shrink)

Are the properties of communicative acts grounded in the intentions with which they are performed, or in the conventions that govern them? The latest round in this debate has been sparked by Ernie Lepore and Matthew Stone (2015), who argue that much more of communication is conventional than we thought, and that the rest isn’t really communication after all, but merely the initiation of open-ended imaginative thought. I argue that although Lepore and Stone may be right about many of the (...) specific cases they discuss, their big-picture, conventionalist conclusions don’t follow. My argument focuses on four phenomena that present challenges to conventionalist accounts of communication: ambiguity, indirect communication, communication by wholly unconventional means, and convention acquisition. (shrink)

Some explanations appeal to facts about the causal structure of a system in order to shed light on a particular phenomenon; these are explanations which do more than cite the causes X and Y of some state-of-affairs Z, but rather appeal to “macro-level” causal features—for example the fact that A causes B as well as C, or perhaps that D is a strong inhibitor of E—in order to explain Z. Appeals to these kinds of “macro-level” causal features appear in a (...) wide variety of social scientific and biological research; statements about features such as “patriarchy,” “healthcare infrastructure,” and “functioning DNA repair mechanism,” for instance, can be understood as claims about what would be different in a system with a different causal structure. I suggest interpreting counterfactual questions involving structural features as questions about alternative parameter settings of causal models, and propose an extension of the usual interventionist framework for causal explanation which enables scientists to explore the consequences of interventions on “macro-level” structure. (shrink)

Plagiarism is increasingly evident in business and academia. Though links between demographic, personality, and situational factors have been found, previous research has not used actual plagiarism behavior as a criterion variable. Previous research on academic dishonesty has consistently used self-report measures to establish prevalence of dishonest behavior. In this study we use actual plagiarism behavior to establish its prevalence, as well as relationships between integrity-related personal selection and workplace deviance measures. This research covers new ground in two respects: (a) That (...) the academic dishonesty literature is subject to revision using criterion variables to avoid self bias and social desirability issues and (b) we establish the relationship between actual academic dishonesty and potential workplace deviance/white-collar crime. (shrink)