We claim that if a complete philosophy of evidence-based practice is intended, then attention to the nature of causation in health science is necessary. We identify how health science currently conceptualises causation by the way it prioritises some research methods over others. We then show how the current understanding of what causation is serves to constrain scientific progress. An alternative account of causation is offered. This is one of dispositionalism. We claim that by understanding causation from a dispositionalist stance, many (...) of the processes within an evidence-based practice framework are better accounted for. Further, some of the problems associated with the health research, e.g. external validity of causal findings, dissolve. (shrink)
What is the connection between dispositions and ethics? Some might think very little and those who are interested in dispositions tend to be metaphysicians whose interests are far from value. However, we argue in this paper that dispositions and dispositionality are central to ethics, indeed a precondition. Ethics rests on a number of notions that are either dispositional in nature or involve real dispositions or powers at work. We argue for a dispositional account of value that offers an alternative to (...) the traditional fact-value dichotomy. We explain the place of value within a structure that explains the possibility of ethics. Elsewhere in this structure, we argue that moral responsibility is a precondition for ethics and that it is a dispositional notion depending critically on what Mumford and Anjum have called the dispositional modality. Moral responsibility in turn depends on there being both agency and normativity. We argue that intentionality and agency are preconditions for agency and that value is a precondition of normativity. All these notions are dispositional and make best sense if there are real dispositions or causal powers of agents. (shrink)
Introduction Stored human samples and the establishment of biobanks are increasing in the world. Along with this there are the questions of ethics that arise such as the correct method of obtaining informed consent for research on stored samples and the policies involved in collaborative research using collected samples. This study is an attempt to evaluate the researchers, academics and policy makers' views on these ethical aspects. Methods This was an anonymised study involving a Sri Lankan population of researchers, ethics (...) committee members, and policy makers. A self administered questionnaire was utilised as the study instrument. The questionnaire captured four major areas of interest: demographic characteristics of respondents, their attitudes on informed consent policy, their opinion on rights of collaborating researchers, their attitudes on dealing with international differences in regulatory frameworks. Results The study included 55 responders with 40/55 agreeing that donors should receive the option of giving informed consent for future research, with 31/55 considering multiple- type consent options most appropriate. Regarding the issue of shared samples in collaborative research majority agreed that source country ethics review committee approval was necessary 53/55. Conclusion The study concludes that sample donors should be given the option of giving advance consent to unspecified future research provided that future research is approved by an ethics committee. In collaborative research, it is necessary to involve ethics committees from donor countries in the research approval process. (shrink)
Medically unexplained symptoms (MUS) remain recalcitrant to the medical profession, proving less suitable for homogenic treatment with respect to their aetiology, taxonomy and diagnosis. While the majority of existing medical research methods are designed for large scale population data and sufficiently homogenous groups, MUS are characterised by their heterogenic and complex nature. As a result, MUS seem to resist medical scrutiny in a way that other conditions do not. This paper approaches the problem of MUS from a philosophical point of (...) view. The aim is to first consider the epistemological problem of MUS in a wider ontological and phenomenological context, particularly in relation to causation. Second, the paper links current medical practice to certain ontological assumptions. Finally, the outlines of an alternative ontology of causation are offered which place characteristic features of MUS, such as genuine complexity, context-sensitivity, holism and medical uniqueness at the centre of any causal set-up, and not only for MUS. This alternative ontology provides a framework in which to better understand complex medical conditions in relation to both their nature and their associated research activity. (shrink)
The application of genetic technologies in China, especially in the area of prenatal genetic testing, is rapidly increasing in China. In the wealthy regions of China, prenatal genetic testing is already very widely adopted. We argue that the government should actively promote prenatal genetic testing to the poor areas of the country. In fact, the government should prioritize resources first to make prenatal genetic testing a standard routine care with an opt-out model in these area. Healthcare professions would be required (...) to inform pregnant women about the availability of genetic testing and provide free testing on a routine basis unless the parents choose not to do so. We argue that this proposal will allow parents to make a more informed decision about their reproductive choices. Secondarily, this proposal will attract more healthcare professionals and other healthcare resources to improve the healthcare infrastructures in the less-developed regions of the country. This will help to reduce the inequity of accessing healthcare services between in different regions of China. We further argue that this policy proposal is not practicing eugenics. (shrink)
This paper gives an account of theory structure in the biomedical sciences with particular emphasis on cardiology. Rather than regarding theories as axiomatizable sets of statements (the so-called received view), theories are regarded as answers to questions which are accepted as legitimate and interesting by scientists within a field of investigation at a given time. This account of theory structure is used to distinguish between theories which are quite liable to be revised during the course of scientific investigation, here called (...) theories within the field, and theories which are more securely established, here called theories of the field. These latter theories can also be regarded as patterns of reasoning which are applied again and again to answer the questions of the field. It is argued that the distinction proposed in this paper fits our intuitive understanding of what it means for a theory to be securely established within a field of research. Several examples are given which show the problems of justifying clinical intervention solely on the basis of theories within the field. (shrink)
Decision analysts sometimes use the results of clinical trials in order to evaluate treatment alternatives. I discuss some problems associated with this, and in particular I point out that it is not valid to use the estimates from clinical trials as the probabilities of events which are needed for decision analysis. I also attempt to show that an approach based on objective statistical theory may have advantages over commonly used methods based on decision theory. These advantages include the recognition of (...) uncertain data, the introduction of a third alternative, namely suspension of judgement, and the possibility of modifying the choice of probabilities based on a clinical trial with reference to other available knowledge. I have not, however, shown in detail how this modification is done, but I think the concept is sufficiently promising to be applied to an actual clinical decision problem. (shrink)
This article presents a case study from the history of cardiology, namely, the development towards the acceptance of the coronary theory of angina pectoris. I show that the arguments which were considered decisive against the theory were not answered at the time the theory was accepted. I also point out that the experimental and practical success of the theory cannot be used to support the initial choice because, in the subsequent development, the field researchers became preoccupied with new questions and (...) problems. In spite of this, there is a sense in which the field of angina research has progressed, but it remains a challenge to exactly characterise in what sense this is the case. (shrink)
In rapidly evolving medical fields where the standard of care or prevention changes frequently, guidelines are increasingly likely to conflict with what participants receive in research. Although guidelines typically set the standard of care, there are some cases in which research can justifiably deviate from guidelines. When guidelines conflict with research, an ethical issue only arises if guidelines are rigorous and should be followed. Next, it is important that the cumulative evidence and the conclusions reached by the guidelines do not (...) eliminate the need for further research. Even when guidelines are rigorous and the study still asks an important question, we argue that there may be good reasons for deviations in three cases: (1) when research poses no greater net risk than the standard of care; (2) when there is a continued need for additional evidence, for example, when subpopulations are not covered by the guidelines; and (3) less frequently, when clinical practice guidelines can be justified by the evidence, but practitioners disagree about the guidelines, and the guidelines are not consistently followed as a result. We suggest that procedural protections may be especially useful in deciding when studies in the third category can proceed. (shrink)
There is a growing interest in comparison of international health care data with the hope that such studies will enable individual systems to learn from other systems. Such comparisons, however, presuppose that there exist common criteria for evaluating health care systems. The main thesis of this paper is that these comparative studies are misleading because they employ inappropriate operationalizations of these criteria because the operarionalizations are based upon mistaken global conceptualizations of the criteria in question. The essay provides a methodological (...) critique of what has been done and sets a new agenda for future research. (shrink)
"The moral principle stating that it is a duty to tell the truth would make any society impossible if that principle were taken singly and unconditionally. We have proof of this in the very direct consequences which a German philosopher has drawn from this principle. This philosopher goes as far as to assert that it would be a crime to tell a lie to a murderer who asked whether our friend who is being pursued by the murderer had taken refuge (...) in our house.". (shrink)
Kant’s strict views on lying have been regularly cited as a reason for thinking there is something fundamentally wrong with Kantian ethics. Some of Kant’s statements here seem so excessive that most Kantians who have dealt with the topic have tried to distance themselves from them, usually claiming that they do not (or need not) follow from Kant’s own principles. In this chapter, I will do a little of that, partly by questioning whether the famous example of the “murderer at (...) the door” really fits the principles Kant applies to it. By and large, however, I will argue Kant’s views about veracity are reasonable or at least defensible, if not selfevident. This is mainly because I also think some of them –especially his position in the brief, late and famous (or notorious) essay On a Supposed Right to Lie from Philanthropy (1797)– have been badly misunderstood. My principal aim here will be to correct that misunderstanding. (shrink)
Kant’s strict views on lying have been regularly cited as a reason for thinking there is something fundamentally wrong with Kantian ethics. Some of Kant’s statements here seem so excessive that most Kantians who have dealt with the topic have tried to distance themselves from them, usually claiming that they do not follow from Kant’s own principles. In this chapter, I will do a little of that, partly by questioning whether the famous example of the “murderer at the door” really (...) fits the principles Kant applies to it. By and large, however, I will argue Kant’s views about veracity are reasonable or at least defensible, if not selfevident. This is mainly because I also think some of them –especially his position in the brief, late and famous essay On a Supposed Right to Lie from Philanthropy – have been badly misunderstood. My principal aim here will be to correct that misunderstanding. (shrink)
The present article covers the first part of our constructive-axiomatic approach to general spacetime, guided by Ludwig's conception of an axiomatic base. The leading idea of axiomatization is a generalized version of the equivalence principle—the principle of approximative reproducibility. As fundamental concepts we use processes and reproductions of processes. On the universe of processes the point space of events is founded which carries the familiar properties of spacetime topology. A general contact relation for reproductions is the key structure to build (...) up a group of tangential germs (pre-jets). Finally, using Yamabe's characterization we obtain the Lie structure. (shrink)
In this paper, we develop the beginning of Lie-differential algebra, in the sense of Kolchin by using tools introduced by Hubert in [E. Hubert, Differential algebra for derivations with nontrivial commutation rules, J. Pure Appl. Algebra 200 163–190]. In particular it allows us to adapt the results of Tressl 3933–3951]) by showing the existence of a theory of Lie-differential fields of characteristic zero. This theory will serve as a model companion for every theory of large and Lie-differential fields extending a (...) model complete theory of pure fields. As an application, we introduce the Lie counterpart of classical theories of differential fields in several commuting derivations. (shrink)
The manuscript by Baruch Brody and Reider Lie presents a distorted image of cost comparisons and social accounts. They presuppose a static view of health systems. While there is methodological uncertainty in international comparisons, such uncertainty should not be used to justify a failure to act. Keywords: accounting, efficiency, social accounts CiteULike Connotea Del.icio.us What's this?
The article describes the evolution of Ockham's theory of mental language and its impact on three of his dominican contemporaries at oxford: Hugh Lawton, William Crathorn and Robert Holcot, and its impact at Paris on the works of Gregory of Rimini and Pierre d'Ailly. Hugh Lawton's critical response to Ockham relied on a liar-like paradox to show that mental language would preclude the ability to lie. Crathorn devised an alternative to Ockham's theory in reaction, whereas Holcot defended Ockham's views. At (...) Paris, the debate suggested a solution to the liar paradox to Gregory of Rimini. (shrink)
This expanded edition of James Ellington’s preeminent translation includes Ellington’s new translation of Kant’s essay Of a Supposed Right to Lie Because of Philanthropic Concerns in which Kant replies to one of the standard objections to his moral theory as presented in the main text: that it requires us to tell the truth even in the face of disastrous consequences.
This expanded edition of James Ellington's preeminent translations of _Grounding for the Metaphysics of Morals and Metaphysical Principles of Virtue_ includes his new translation of Kant's essay On a Supposed Right to Lie Because of Philanthropic Concerns, in which Kant replies to one of the standard objections to his moral theory, as presented in the main text of _Grounding_, that it requires us to tell the truth even in the face of harmful consequences.
In this paper, I argue that companies who use functional Magnetic Resonance Imaging (fMRI) scans for lie detection encounter the same basic ethical stumbling blocks as commercial companies that market traditional polygraphs. Markets in traditional voluntary polygraphs are common and fail to elicit much uproar among ethicists. Thus, for consistency, if markets in polygraphs are ethically unproblematic, markets using fMRIs for lie detection are equally as acceptable. Furthermore, while I acknowledge two substantial differences between the ethical concerns involving polygraphs and (...) fMRI lie detection, I argue that these concerns can be overcome and do not lead to the conclusion that markets in fMRI lie detection are ethically dubious. It is my conclusion that voluntary markets in fMRI lie detection can be justified by consumer autonomy and should be allowed to persist. (shrink)
The biological function of human reasoning abilities cannot be to improve shared knowledge. This is at best a side effect. A more plausible function of argumentation, and thus of reasoning, is to advertise one's ability to detect lies and errors. Such selfish behavior is closer to what we should expect from a naturally selected competence.
In his well-known piece ‘Autonomy and Benevolent Lies’ Thomas Hill argues that out of respect for people's autonomy, we ought not to tell benevolent lies. He argues that we are obligated to tell the truth, especially when asked directly for it, even if we know it will cause a person more pain. This is because truth-telling is tied to respecting autonomy, which involves giving people a realistic picture of their situation, however rosy or bleak, and letting them decide what to (...) do with the information given. Telling people benevolent lies, because one thinks they will be happier believing something else, is an instance of paternalism, which Hill wants to resist. In this paper I will raise a case that seems at first glance to be an objection to Hill's theory i.e. a case in which the right information to give someone is not what he has requested. In offering an explanation for how Hill can respond, I will suggest that a revision to his view would allow him to justify certain benevolent lies, while still avoiding his worry that benevolent lies are necessarily paternalistic. (shrink)
The problem of human language is studied in the context of the definition “civilization” on the basis of Darwin’s theory. The author defines civilization as “survival of the unfit”. The author supposes that language was invented by the men to describe their heroic deeds for the women in order to be selected by them for reproduction. In other words, language became a selection criterion together with beauty and presents.
There are three main categories of rationale for withholding information or telling lies: if overwhelming harm can only be averted through deceit; complete triviality such that it is irrelevant whether the truth is told; a duty to protect the interests of others. Public health authorities are frequently having to form judgements about the public interest, whether to release information or issue warnings. In June 1992, routine surveillance detected patulin levels (a known carcinogen) in samples of apple juice exceeding safety threshold. (...) Remedial actions were promptly taken and it was planned to subsequently publish the information in the routine way. However, the media portrayed the handling of the problem as a conspiracy and there was a short term reduction in juice sales. In October 1995, the UK Committee on Safety of Medicines issued a warning about certain brands of the contraceptive pill, based on the interim results of three unpublished studies. The increased risk of thromboembolism was small, but the resulting scare led to an increase in unwanted pregnancies. The handling of the B.S.E. crisis in the U.K. also led to accusations of incompetence or conspiracy. Public health authorities have to handle uncertainty and frequently have to form judgements for public safety on the basis of evidence of poor quantity and quality. Their task is not helped by the sometimes conflicting agenda of scientists and media. The public also have differing perceptions and interpretations of risk. The series of scares and crises are having a detrimental effect on public confidence in public health authorities. (shrink)
In this paper I give an account of self-deception by situating it within the theory of human conduct advanced by American pragmatists John Dewey and George Herbert Mead. After examining and rejecting the two most prevalent explanations of self-deception - namely, Sigmund Freud's psychoanalytic interpretation and Jean-Paul Sartre's phenomenological one - I provide a brief sketch of some of Dewey's and Mead's fundamental insights into the inherently social nature of mind.I argue that one of the main forms of self-deception involves (...) unreflective acceptance of a belief that impartial inspection would readily expose as spurious. In this instance lying to oneself arises from the failure to analyze an appealing idea from the perspective of the generalized other which we acquire through participation in the universe of rational discourse. I conclude by pointing to certain features of contemporary social life that may indirectly promote such self-dissimulation. (shrink)
Le philosophe, que caractérise selon Nietzsche la vertu d’indépendance, se trouve par là condamné à la solitude. Celle-ci toutefois ne doit pas être conçue de manière négative, comme un simple retrait hors du monde, ou comme un refus de toute relation et de toute altérité. L’individu n’est pas une substance, mais un complexe de forces, c’est-à-dire un « corps » qui est non seulement structuré à la manière d ’une communauté, mais aussi par les relations sociales externes dans lesquelles l’individu (...) se trouve d’abord engagé. La solitude ne doit pas en conséquence être confondue avec un simple état d’ isolement . Elle consiste en une épreuve , en un mouvement de conquête de la singularité, contre les valeurs du « troupeau » qui ont été incorporées. Une telle conquête requiert que soient considérés et questionnés les autres hommes et valeurs dans leur diversité. Et elle fait surgir l’exigence d’une communauté qui apparaît comme la condition paradoxale d’une solitude authentique. (shrink)