Background: Informed consent is regarded as a contract between autonomous and equal parties and requires the elements of information disclosure, understanding, voluntariness and consent. The validity of informed consent for critically ill patients has been questioned. Little is known about how these patients experience the process of consent.Objective: The aim of this study was to explore critically ill patients’ experience with the principle of informed consent in a clinical trial and their ability to give valid informed consent.Design: 11 stroke patients (...) who had been informed about thrombolytic treatment and had been through the process of deciding whether or not to participate in a thrombolysis trial went through repeated qualitative semistructured interviews.Results: None of the patients had any clear understanding of the purpose of the trial. Neither did they understand the principles of randomisation and voluntariness. Reasons for giving or not giving consent were trust, conceptions of benefits and risks and altruism. Several patients found it immoral to involve patients in the consent procedure and argued that this was the doctors’ responsibility. Others argued that it is a duty to question patients and perceived it as a sign of being treated with respect and dignity. A majority of the patients found the consent process vague and ambiguous.Conclusions: The results indicate that the principle of informed consent from critically ill patients cannot be seen as a contract between equal and autonomous parties. Further studies are needed to explore critically ill patients’ experiences with the process of informed consent. (shrink)

Background: Informed consent is regarded as a contract between autonomous and equal parties and requires the elements of information disclosure, understanding, voluntariness and consent. The validity of informed consent for critically ill patients has been questioned. Little is known about how these patients experience the process of consent.Objective: The aim of this study was to explore critically ill patients’ experience with the principle of informed consent in a clinical trial and their ability to give valid informed consent.Design: 11 stroke patients (...) who had been informed about thrombolytic treatment and had been through the process of deciding whether or not to participate in a thrombolysis trial went through repeated qualitative semistructured interviews.Results: None of the patients had any clear understanding of the purpose of the trial. Neither did they understand the principles of randomisation and voluntariness. Reasons for giving or not giving consent were trust, conceptions of benefits and risks and altruism. Several patients found it immoral to involve patients in the consent procedure and argued that this was the doctors’ responsibility. Others argued that it is a duty to question patients and perceived it as a sign of being treated with respect and dignity. A majority of the patients found the consent process vague and ambiguous.Conclusions: The results indicate that the principle of informed consent from critically ill patients cannot be seen as a contract between equal and autonomous parties. Further studies are needed to explore critically ill patients’ experiences with the process of informed consent. (shrink)

Background: Thrombolytic drugs to treat an acute ischaemic stroke reduce the risk of death or major disability. The treatment is, however, also associated with an increased risk of potentially fatal intracranial bleeding. This confronts the patient with the dilemma of whether or not to take a risk of a serious side effect in order to increase the likelihood of a favourable outcome. Objective: To explore acute stroke patients’ perception of risk and willingness to accept risks associated with thrombolytic drug treatment. (...) Design: Eleven patients who had been informed about thrombolytic drug treatment and had been through the process of deciding whether or not to participate in a thrombolytic drug trial went through repeated qualitative, semistructured interviews. Results: Many patients showed a limited perception of the risks connected with thrombolytic drug treatment. Some perceived the risk as not relevant to them and were reluctant to accept that treatment could cause harm. Others seemed to be aware that treatment would mean exposure to risk. The patients’ willingness to take a risk also varied substantially. Several statements revealed ambiguity and confusion about being involved in a decision about treatment. The patients’ reasoning about risk was put into the context of their health-related experiences and life histories. Several patients wanted the doctor to be responsible for the decisions. Conclusion: Acute stroke patients’ difficulties in perceiving and processing information about risk may reduce their ability to be involved in clinical decisions where risks are involved. (shrink)

The Global Ethics Observatory, launched by the United Nations Educational, Scientific, and Cultural Organization in December 2005, is a system of databases in the ethics of science and technology. It presents data on experts in ethics, on institutions and on teaching programmes in ethics. It has a global coverage and will be available in six major languages. Its aim is to facilitate the establishment of ethical infrastructures and international cooperation all around the world.

The Database on Ethics Related Legislation and Guidelines was launched in March 2007 as the fourth database of the UNESCO Global Ethics Observatory system of databases in ethics of science and technology. The database offers a collection of legal instruments searchable by region, country, bioethical themes, legal categories and applicability to specific articles of the UNESCO Universal Declaration on Bioethics and Human Rights and International Declaration on Human Genetic Data. This paper discusses the background and rationale for the database and (...) its role as a consultative and comparative resource hub for the study of ethics related legal instruments across the world, with the purpose of informing and inspiring relevant stakeholders on the implementation of the principles contained within the UNESCO declarations on bioethics. (shrink)

The United States, along with other nations and international organizations, has developed an elaborate system of ethical norms and legal rules to govern biomedical research using human subjects. These policies govern research that might provide direct health benefits to participants and research in which there is no prospect for participant health benefits. There has been little discussion, however, about how well these rules would apply to research designed to improve participants’ capabilities or characteristics beyond the goal of good health. When (...) mentioned at all in the literature, this so-called enhancement research, as opposed to research aimed at diagnosing, preventing, curing, or treating illnesses or medical conditions, is usually dismissed without explanation. (shrink)

I want to talk about some of the main objections that have been given to libertarian anarchism and my attempts to answer them. But before I start giving objections and trying to answer them, there is no point in trying to answer objections to a view unless you have given some positive reason to hold the view in the first place. So, I just want to say briefly what I think the positive case is for it before going on to (...) defend it against objections. (shrink)

In this paper we compare the propositional logic of Frege’s Grundgesetze der Arithmetik to modern propositional systems, and show that Frege does not have a separable propositional logic, definable in terms of primitives of Grundgesetze, that corresponds to modern formulations of the logic of “not”, “and”, “or”, and “if…then…”. Along the way we prove a number of novel results about the system of propositional logic found in Grundgesetze, and the broader system obtained by including identity. In particular, we show that (...) the propositional connectives that are definable in terms of Frege’s horizontal, negation, and conditional are exactly the connectives that fuse with the horizontal, and we show that the logical operators that are definable in terms of the horizontal, negation, the conditional, and identity are exactly the operators that are invariant with respect to permutations on the domain that leave the truth-values fixed. We conclude with some general observations regarding how Frege understood his logic, and how this understanding differs from modern views. (shrink)

The effective altruism movement (EA) is one of the most influential philosophically savvy movements to emerge in recent years. Effective Altruism has historically been dedicated to finding out what charitable giving is the most overall-effective, that is, the most effective at promoting or maximizing the impartial good. But some members of EA want the movement to be more inclusive, allowing its members to give in the way that most effectively promotes their values, even when doing so isn’t overall-effective. When we (...) examine what it means to give according to one’s values, I argue, we will see that this is both inconsistent with what EA is like now and inconsistent with its central philosophical commitment to an objective standard that can be used to critically analyze one’s giving. While EA is not merely synonymous with act utilitarianism, it cannot be much more inclusive than it is right now. (shrink)

Background Genuine uncertainty on superiority of one intervention over the other is called equipoise. Physician-investigators in randomized controlled trials need equipoise at least in studies with more than minimal risks. Ideally, this equipoise is also present in patient-participants. In pediatrics, data on equipoise are lacking. We hypothesize that 1) lack of equipoise at enrolment among parents may reduce recruitment; 2) lack of equipoise during participation may reduce retention in patients assigned to a less favoured treatment-strategy. Methods We compared preferences of (...) parents/patients at enrolment, documented by a questionnaire, with preferences developed during follow-up by an interview-study to investigate equipoise of child-participants and parents in the BeSt-for-Kids-study. This trial in new-onset Juvenile Idiopathic Arthritis-patients consists of three strategies. One strategy comprises initial treatment with a biological disease-modifying-antirheumatic-drug, currently not standard-of-care. Semi-structured interviews were conducted with 23 parents and 7 patients, median 11 months after enrolment. Results Initially most parents and children were not in equipoise. Parents/patients who refused participation, regularly declined due to specific preferences. Many participating families preferred the biological-first-strategy. They participated to have a chance for this initial treatment, and would even consider stopping trial-participation when not randomized for it. Their conviction of superiority of the biological-first strategy was based on knowledge from internet and close relations. According to four parents, the physician-investigator preferred the biological-first-strategy, but the majority stated that she had no preferred strategy. In phase 2, preferences tended to change to the treatment actually received. Conclusions Lack of equipoise during enrolment did not reduce study recruitment, mainly due to the fact that preferred treatment was only available within the study. Still, when developing a trial it is important to evaluate whether the physicians’ research question is in line with preferences of the patient-group. By exploring so-called ‘informed patient-group’-equipoise, successful recruitment may be enhanced and bias avoided. In our study, lack of equipoise during trial-participation did not reduce retention in those assigned to a less favoured option. We observed a change for preference towards treatment actually received, possibly explained by comparable outcomes in all three arms. (shrink)

Ernst Lubitsch, the great author of Hollywood comedy and pioneer of such genres as the sophisticated romantic comedy, the musical, and the screwball comedy, is a relatively overlooked figure in mainstream film theory. In this collection, renowned world thinkers and philosophers position Lubitsch as the premium director of subversive cinema, reflecting on his attitude toward love and politics which correspond to contemporary issues.Followers of the Hegelian, Marxist, Freudian, Lacanian, and Deleuzian traditions discuss thephilosophical, political, and ethical dimensions of Lubitsch's late (...) Hollywood work. They focus on love as stealing, the ethics of style, and comedy in times of austerity in the director's masterpiece, _Trouble in Paradise_ ; answer the question of why comedy is always polygamous; discuss links between masochism, melancholia, and ideology in _Ninotchka_; celebrate the ethical gesture of comedy in _To Be or Not to Be_ ; and promote the revolutionary comic spirit of Lubitsch's last directorial effort, _Cluny Brown_. These essays' witty, subversive, and provocative approaches highlight Lubitsch's unique understanding of love, sex, comedy, and politics and idiosyncratic conception of totalitarian"nightmares" and capitalistic "paradise," countering the non-dialectic and politically correct discourse of mainstream and independent cinema today. (shrink)

I introduce the reader to the character and complexity of lying, in terms of how the lie should be defined as a particular type of intentionally deceptive utterance, whether or not the deceiver succeeded in that aim, and examine how we might usefully avoid prejudging the justifiability of the lying utterance when compared to alternative forms of intentional deception and the overall outcome sought.

When we can’t live up to the ultimate standards of morality, how can moral theory give us guidance? We can distinguish between ideal and non-ideal theory to see that there are different versions of the voluntarist constraint, ‘ought implies can.’ Ideal moral theory identifies the best standard, so its demands are constrained by one version. Non-ideal theory tells us what to do given our psychological and motivational shortcomings and so is constrained by others. Moral theory can now both provide an (...) ultimate standard and give us guidance; this view also gives us new insights into demandingness and blame. (shrink)

1. Sentences have implicatures. (11, 14, 19)** 2. Implicatures are inferences. (12. 14) 3. Implicatures can’t be entailments. 4. Gricean maxims apply only to implicatures. (16, 17) 5. For what is implicated to be figured out, what is said must be determined first. (12, 13) 6. All pragmatic implications are implicatures. 7. Implicatures are not part of the truth-conditional contents of utterances. (20) 8. If something is meant but unsaid, it must be implicated. (20) 9. Scalar “implicatures” are implicatures. (11) (...) 10. Conventional “implicatures” are implicatures. (shrink)

Chervenak and McCullough, authors of the most acknowledged ethical framework for maternal–fetal surgery, rely on the ‘ethical–obstetrical’ concept of the fetus as a patient in order to determine what is morally owed to fetuses by both physicians and the women who gestate them in the context of prenatal surgery. In this article, we reconstruct the argumentative structure of their framework and present an internal criticism. First, we analyse the justificatory arguments put forward by the authors regarding the moral status of (...) the fetus qua patient. Second, we discuss the internal coherence and consistency of the moral obligations those authors derive from that concept. We claim that some of the dilemmas their approach is purported to avoid, such as the debate about the independent moral status of the fetus, and the foundation of the moral obligations of pregnant women (towards the fetuses they gestate) are not, all things considered, avoided. Chervenak and McCullough construct the obligations of physicians as obligations towards entities with equal moral status. But, at the same time, they assume that the woman has an independent moral status while the moral status of the fetus is dependent on the decision of the woman to present it to a physician for care. According to the logic of their own argumentation, Chervenak and McCullough implicitly admit a different moral status of the woman and the fetus, which will lead to different ascription of duties of the physician than those they ascribed. (shrink)

The apolipoprotein E gene plays an important role in the pathogenesis of Alzheimer's disease , and amyloid plaque comprised mostly of the amyloid-beta peptide ) is one of the major hallmarks of AD. However, the relationship between these two important molecules is poorly understood. We examined how A treatment affects APOE expression in cultured cells and tested the role of the transcription factor NF-B in APOE gene regulation. To delineate NF-B's role, we have characterized a 1098 nucleotide segment containing the (...) 5'-flanking region of the human APOE gene . Sequence analysis of this region suggests the presence of two potential NF-B elements. To demonstrate promoter activity, the region was cloned upstream of a promoterless luciferase gene. This segment was able to drive expression of luciferase in transient transfections of human fetal glial cells. Promoter activity was stimulated twofold by A treatment. Pretreatment with double-stranded DNA decoy oligonucleotides against NF-B reduced A stimulation. Deletion and mutagenetic analyses demonstrated that the distal NF-B element was functional and showed a strong DNA-protein complex band in gel shift analysis, similar to that from control NF-B consensus element. An anti-inflammatory and anti-NF-B drug, sodium salicylate, significantly blocked A-induced APOE promoter function. Our data provide evidence that upregulation of APOE by A in astroglial cells is mediated by an NF-B-element present in the 5'-flanking region of the APOE gene. (shrink)

The following points, which represent a path to a semiotics of being, are pertinent to various sub-fields at the conjunction of semiotics of nature (biosemiotics, ecosemiotics, zoosemiotics) and semiotics of culture—semioethics and existential semiotics included. 1) Semiotics of being entails inquiry at all levels of biological organization, albeit, wherever there are individuals, with emphasis on the living qua individuals (integrated biological individualism). 2) An Umwelt is the public aspect (cf. the Innenwelt, the private aspect) of a phenomenal/experienced world that is (...) organism-specific (rather than species-specific) and ultimately refers to an existential realm. 3) Existential universals at work on Earth include seeking out the edible, dwelling in a medium, holding a phenomenal world (possibly an Umwelt) and being endowed with life, and consequently being mortal. 4) Human Umwelten include speechless Umwelten, spoken Umwelten and alphabetic Umwelten. 5) An Uexküllian phenomenology—stating that semiotic states represent the general class to which all mental/cognitive states belong—can draw on the works of the phenomenologists David Abram and Ted Toadvine (The notion of semiotic states is treated in Tønnessen 2009a: 62–63. For an introduction to eco-phenomenology, see Brown and Toadvine (eds.) 2003). 6) A task for such a phenomenology is to portray the natural history of the phenomenal world. 7) An imperative task in our contemporary world of faltering biological diversity is that of Umwelt mapping, i.e. a mapping of ontological niches. 8) The ecological crisis is an ontological crisis with historical roots in humankind’s domestication of animals and plants, which can be taken as archetypical for our attempted planet-scale taming of the wild. 9) The process of globalization is expressed by correlated trends of depletion of semiotic diversity and semiotic diversification. 10) Semiotic economy is a field which task it is to map the human ontological niche insofar as its semiotic relations are of an economic nature. All ten points will be commented (explicitly or implicitly) in due time. (shrink)

About one third of patients with epilepsy have seizures refractory to the medical treatment. Electrical stimulation mapping is the gold standard for the identification of “eloquent” areas prior to resection of epileptogenic tissue. However, it is time-consuming and may cause undesired side effects. Broadband gamma activity recorded with extraoperative electrocorticography during cognitive tasks may be an alternative to ESM but until now has not proven of definitive clinical value. Considering their role in cognition, the alpha and beta bands could further (...) improve the identification of eloquent cortex. We compared gamma, alpha and beta activity, and their combinations for the identification of eloquent cortical areas defined by ESM. Ten patients with intractable focal epilepsy participated in a delayed-match-to-sample task, where syllable sounds were compared to visually presented letters. We used a generalized linear model approach to find the optimal weighting of each band for predicting ESM-defined categories and estimated the diagnostic ability by calculating the area under the receiver operating characteristic curve. Gamma activity increased more in eloquent than in non-eloquent areas, whereas alpha and beta power decreased more in eloquent areas. Diagnostic ability of each band was close to 0.7 for all bands but depended on multiple factors including the time period of the cognitive task, the location of the electrodes and the patient’s degree of attention to the stimulus. We show that diagnostic ability can be increased by 3–5% by combining gamma and alpha and by 7.5–11% when gamma and beta were combined. We then show how ECoG power modulation from cognitive testing can be used to map the probability of eloquence in individual patients and how this probability map can be used in clinical settings to optimize ESM planning. We conclude that the combination of gamma and beta power modulation during cognitive testing can contribute to the identification of eloquent areas prior to ESM in patients with refractory focal epilepsy. (shrink)

SummaryThe apparent conflict between first person authority and externalism arises only from needlessly thinking of first person authority in terms of “knowing what.”.

This research study sought to identify and categorize international marketing ethical problems that confront business managers in Australia and Canada. The study focused on ten major ethical problems developed from previous exploratory research. Managers from both countries indicate that the most frequently cited ethical problem is "gifts/ favors/entertainment" and the most important ethical problem is "large-scale bribery". However, there exist significant differences in terms of rankings and mean values of frequency and importance ratings for other ethical problems.

Context: There is a growing recognition in consciousness science of the need for rigorous methods for obtaining accurate and detailed phenomenological reports of lived experience, i.e., descriptions of experience provided by the subject living them in the “first-person.” Problem: At the moment although introspection and debriefing interviews are sometimes used to guide the design of scientific studies of the mind, explicit description and evaluation of these methods and their results rarely appear in formal scientific discourse. Method: The recent publication of (...) an edited book of papers dedicated to the exploration of first-and second-person methods, Ten Years of Viewing from Within: The Legacy of Francisco Varela, serves as a starting point for a discussion of how these methods could be integrated into the growing discipline of consciousness science. We complement a brief review of the book with a critical analysis of the major pilot studies in Varela’s neurophenomenology, a research program that was explicitly devised to integrate disciplined experiential methods with the latest advances in neuroscience. Results: The book is a valuable resource for those who are interested in impressive recent advances in first- and second-person methods, as applied to the phenomenology of lived experience. However, our review of the neurophenomenology literature concludes that there is as yet no convincing example of these specialized techniques being used in combination with standard behavioral and neuroscientific approaches in consciousness science to produce results that could not have also been achieved by simpler methods of introspective reporting. Implications: The end of behaviorism and the acceptance of verbal reports of conscious experience have already enabled the beginning of a science of consciousness. It can only be of benefit if new first- and second-person methods become well-known across disciplines. Constructivist content: Constructivism has long been interested in the role of the observer in the constitution of our sense of reality, so these developments in the science of consciousness may open new avenues of constructivist research. More specifically, one of the ways in which the insights from first- and second-person methods are being validated is by recursively applying the methods to themselves; a practical application of an epistemological move that will be familiar to constructivists from the second-order cybernetics tradition. (shrink)