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)
The confusion between cognitive states and the content of cognitive states that gives rise to psychologism also gives rise to reverse psychologism. Weak reverse psychologism says that we can study cognitive states by studying content – for instance, that we can study the mind by studying linguistics or logic. This attitude is endemic in cognitive science and linguistic theory. Strong reverse psychologism says that we can generate cognitive states by giving computers representations that express the content of cognitive states and (...) that play a role in causing appropriate behaviour. This gives us strong representational, classical AI (REPSCAI), and I argue that it cannot succeed. This is not, as Searle claims in his Chinese Room Argument, because syntactic manipulation cannot generate content. Syntactic manipulation can generate content, and this is abundantly clear in the Chinese Room scenano. REPSCAI cannot succeed because inner content is not sufficient for cognition, even when the representations that carry the content play a role in generating appropriate behaviour. (shrink)
In the formation of epistemically justified beliefs, what is the role of attention, and what is the role (if any) of non-attentional aspects of cognition? We will here argue that there is an essential role for certain nonattentional aspects. These involve epistemically relevant background information that is implicit in the standing structure of an epistemic agent’s cognitive architecture and that does not get explicitly represented during belief-forming cognitive processing. Since such “morphological content” (as we call it) does not become explicit (...) during belief formation, it cannot be information that is within the scope of attention. Nevertheless,it does exert a subtle influence on the character of conscious experience, rather than operating in a purely unconscious way. (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)
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)
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)
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)
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)
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.