Fundamental questions in value sensitive design include whether and how high-tech products/artefacts could embody values and ethical ideals, and how plural and incommensurable values of ethical and social importance could be chosen rationally and objectively at a collective level. By using a humanitarian cargo drone study as a starting point, this paper tackles the challenges that VSD’s lack of commitment to a specific ethical theory generates in practical applications. Besides, it highlights how mainstream ethical approaches usually related to VSD are (...) incapable of solving main ethical dilemmas raised by technological design for well-being in democratic settings. Accordingly, it is argued that VSD’s ethical-democratic import would substantially be enhanced by the espousal of a procedural ethics stance and the deliberative approach to value and welfare entailed by Amartya Sen’s capability approach. Differently from rival ethical–political theories, its normative and meta-ethical foundations better handle human diversity, value-goal pluralism, conflicting vested interests as well as the epistemic-moral disagreements typical of contemporary complex democracies. Particularly, Sen’s capability approach procedural-deliberative tenets result in an “objective-impartial” choice procedure selecting a “hierarchy” of plural incommensurable values and rational goals thus, suitable to validate an applied science such as welfare-oriented technological design in concrete social environments. Conclusions suggest that refining VSD with a capability-based procedural approach to ethics fosters the concern for democracy and social justice while preserving vital scientific-technical standards. Major advantages are at an applied level to delivering ethically and socially justified, but yet highly functional technologies and high-tech products/artefacts. (shrink)

Suppose a committee or a jury confronts a complex question, the answer to which requires attending to several sub-questions. Two different voting procedures can be used. On one, the committee members vote on each sub-question and the voting results are used as premises for the committee’s conclusion on the main issue. This premise-based procedure can be contrasted with the conclusion-based approach, which requires the members to directly vote on the conclusion, with the vote of (...) each member being guided by her views on the relevant sub-questions. The two procedures are not equivalent: There may be a majority of voters supporting each of the premises, but if these majorities do not significantly overlap, there will be a majority against the conclusion. Pettit (2001) connects the choice between the two procedures with the discussion of deliberative democracy. The problem we want to examine instead concerns the relative advantages and disadvantages of the two procedures from the epistemic point of view. Which of them is better when it comes to tracking truth? As it turns out, the answer is not univocal. On the basis of Condorcet’s jury theorem, the premise-based procedure can be shown to be superior if the objective is reach truth for the right reasons, without making any mistakes on the way. However, if the goal instead is to reach truth for whatever reasons, right or wrong, there will be cases in which using the conclusion-based procedure turns out to be more reliable, even though, for the most part, the premise-based procedure will retain its superiority. (shrink)

The aggregation of individual judgments on logically connected issues often leads to collective inconsistency. This study examines two collective decision-making procedures designed to avoid such inconsistency—one premise-based and the other conclusion-based. While the relative desirability of the two procedures has been studied extensively from a theoretical perspective, the preference of individuals regarding the two procedures has been less studied empirically. In the present study, a scenario-based questionnaire survey of participant preferences for the two procedures was conducted, (...) taking into consideration prevailing social norms in the society to which the participants belong and the heterogeneity of the participants’ past experiences. Results show that a minority opinion not matching a prevailing social norm is more likely to be supported when the conclusion-based procedure is used. This can be explained by a basic property of the conclusion-based procedure: The procedure does not require voters to reveal their reasons for reaching a particular conclusion. This property proves appealing for participants who have a minority opinion. Such a finding is highly relevant to future studies on strategic behaviors in choosing a collective decision-making procedure. (shrink)

The aggregation of individual judgments on logically interconnected propositions into a collective decision on the same propositions is called judgment aggregation. Literature in social choice and political theory has claimed that judgment aggregation raises serious concerns. For example, consider a set of premises and a conclusion where the latter is logically equivalent to the former. When majority voting is applied to some propositions (the premises) it may give a different outcome than majority voting applied to another set of propositions (...) (the conclusion). This problem is known as the discursive dilemma (or paradox). The discursive dilemma is a serious problem since it is not clear whether a collective outcome exists in these cases, and if it does, what it is like. Moreover, the two suggested escape-routes from the paradox—the so-called premise-based procedure and the conclusion-based procedure—are not, as I will show, satisfactory methods for group decision-making. In this paper I introduce a new aggregation procedure inspired by an operator defined in artificial intelligence in order to merge belief bases. The result is that we do not need to worry about paradoxical outcomes, since these arise only when inconsistent collective judgments are not ruled out from the set of possible solutions. (shrink)

Background: Individual, comprehensive, and written informed consent is broadly considered an ethical obligation in research involving the sampling of human material. In developing countries, however, local conditions, such as widespread illiteracy, low levels of education, and hierarchical social structures, complicate compliance with these standards. As a result, researchers may modify the consent process to secure participation. To evaluate the ethical status of such modified consent strategies it is necessary to assess the extent to which local practices accord with the values (...) underlying informed consent. Methods: Over a 2-week period in April 2014 we conducted semistructured interviews with researchers from a genetic research institute in rural Pakistan and families who had given blood samples for their research. Interviews with researchers focused on the institute’s requirements for consent, and the researchers’ strategies for and experiences with obtaining consent in the field. Interviews with donors focused on their motivation for donating samples, their experience of consent and donation, and what factors were central in their decisions to give consent. Results: Researchers often reported modifications to consent procedures suited to the local context, standardly employing oral and elder consent, and tailoring information to the social education level of donor families. Central themes in donors’ accounts of their decision to consent were the hope of getting something out of their participation and their remarkably high levels of trust in the researchers. Several donor accounts indicated a degree of confusion about participation and diagnosis, resulting in misconceived expectations of therapeutic benefits. Conclusions: We argue that while building and maintaining trusting relationships in research is important—not least in developing countries—strategies that serve this endeavor should be supplemented with efforts to ensure proper provision and understanding of relevant information, specifically about the nature of research and measures for individual consent and opt-out. (shrink)

The objective of the paper is to create a concept of what securing the claim is, based on the positive legislation of Kosovo’s law, comparing its regulation with laws of somewhat similar legislations of neighbouring regions, understanding its implementation in practice, to achieve conclusions and remarks based on law, facts, practice, and the comparative aspect. The Civil Procedure Law in the Republic of Kosovo is regulated with contested, non-contested or enforcement procedure. Securing the claim is an (...) institute expressively regulated by the “Law on Contested Procedure of the Republic of Kosovo” on its XXI Chapter that defines its means and types. Considering securing the claim measures are present in civil law to prevent any possible threat of protected rights until the final verdict is given, this paper tends to achieve a realization of how these measures practically succeed in actual cases, if they meet the criteria set in the law, or if securing the claim proposal is approved by the court, if they unintentionally restrain the respondent from using their rights. Moving forward, how one distinguishes claim security and interim measures from one-another although they describe the main concept, is strictly reviewed under this article, to finally achieve conclusions and remarks based on questions raised as above. (shrink)

Background: Medical decision making is based on patient autonomy and informed consent, which is an integral part of medical ethics, risk management and clinical governance. Consent to treatment has been extensively discussed, but the viewpoint of patients is not well represented. A new consent form was introduced by the Department of Health in 2001.Aims: To determine the information most important to patients, to facilitate evidence-based guidelines and to provide a valid and reliable consent-procedure-satisfaction questionnaire.Methods: An anonymous quantitative (...) survey was carried out, asking 100 patients 15 questions regarding procedures they may need to undergo, using a Visual Analogue Scale to test the importance of each question.Results and discussion: In total there were 77 respondents and the mean age was 48.8 years. There were 52% women and 48% men. Major complications, such as not undergoing the procedure, future management and long-term effect on work, all scored a median of 95%. Least concerns were related to technical details of the procedure and minor complications . All other questions were still considered important . No significant differences were observed between sex, age and professional groups, but a significant difference was observed between the education groups. Qualifications of the doctor did not correlate to any other question.Conclusions: This questionnaire is proposed as a basis for informed consent guidelines to health workers and for measures of satisfaction with the consent procedure. (shrink)

Evidence-Based Medicine (EBM) is defined as the conscious, and judicious use of current best evidence in making decisions about the care of individual patients. The greater the level of evidence the greater the grade of recommendation. This pioneering explicit concept of EBM is embedded in a particular view of medical practice namely the singular nature of the patient-physician relation and the commitment of the latter towards a specific goal: the treatment and the well being of his or her client. (...) Nevertheless, in many European countries as well as the United States, this integration of the best evidence from systematic research with clinical expertise and patient values appears to be re-interpreted in light of the scarcity of healthcare resources. The purpose of this paper is double. First, to claim that from an ethical perspective EBM should be a guideline to clinical practice; and second, that in specific circumstances EBM might be a useful tool in macro-allocation of healthcare resources. Methodologically the author follows Norman Daniels' theory of democratic accountability to justify this assumption. That is, choices in healthcare must be accountable by democratic procedures. This perspective of distributive justice is responsible for the scope and limits of healthcare services. It follows that particular entitlements to healthcare — namely expensive innovative treatments and medicines —may be fairly restricted as long as this decision is socially and democratically accountable and imposed by financial restrictions of the system. In conclusion, the implementation of EBM, as long as it limits the access to drugs and treatments of unproven scientific results is in accordance with this perspective. The use of EBM is regarded as an instrument to facilitate the access of all citizens to a reasonable level of healthcare and to promote the efficiency of the system. (shrink)

Which rules for aggregating judgments on logically connected propositions are manipulable and which not? In this paper, we introduce a preference-free concept of non-manipulability and contrast it with a preference-theoretic concept of strategy-proofness. We characterize all non-manipulable and all strategy-proof judgment aggregation rules and prove an impossibility theorem similar to the Gibbard--Satterthwaite theorem. We also discuss weaker forms of non-manipulability and strategy-proofness. Comparing two frequently discussed aggregation rules, we show that “conclusion-based voting” is less vulnerable to manipulation than (...) “premise-based voting”, which is strategy-proof only for “reason-oriented” individuals. Surprisingly, for “outcome-oriented” individuals, the two rules are strategically equivalent, generating identical judgments in equilibrium. Our results introduce game-theoretic considerations into judgment aggregation and have implications for debates on deliberative democracy. (shrink)

Over the past 50 years, technical advances have taken place in medicine that have greatly increased the possibilities of life-prolonging intervention. The increased possibilities of intervening have brought along new ethical questions. Not everything that is technically possible is appropriate in a specific case: not everything that could be done should be done. In the 1980s, a new term was coined to indicate a class of inappropriate interventions: “medically futile treatment”. A debate followed, with contributions from the USA and several (...) western European countries. A similar debate later took place in Mediterranean countries, although with a different terminology. The purpose of this article is to provide an up-to-date and systematic analysis of the concept of futility, and to draw some conclusions on its operationalisation in medical practice. While the concept of “medical futility” in theory applies to all kinds of medical intervention that might be performed without being medically indicated—things such as certain medical screenings and cosmetic surgery—in practice the literature on “futility” deals only with life-saving and life-sustaining medical interventions. This article deals with this more limited application of the concept of “futility”. (shrink)

Background The ideal basis of age estimation is considered to be a combination of clinical, skeletal and dental examinations. It is not easy to determine how forensic physicians take account of evidence-based data obtained from medical journals in their medical decision-making. The question of what is an ethically acceptable probability that adolescents are incorrectly considered to be over 18 has not been answered. Methods In a retrospective study over 1 year (2007), 498 files (for 141 female subjects and 357 (...) male subjects) regarding age assessment requested by the public prosecutor's office for purposes of criminal or asylum proceedings were reviewed. Chronological age was estimated from a combination of physical examination, radiographic examination of the left hand and determination of dental status. Results Estimates of chronological age in 498 subjects claiming to be 9–14 years old were incompatible with the alleged age in 356 (71%) when made by the forensic physician but in only 17 (3%) when based on data from published studies on age estimation in adolescents. Conclusions The present study suggests that in most cases the forensic physician ignores the adolescent's word. Medical mission and ethics imply a need to listen to the claims of persons in custody, whatever the risk of false claims. This situation should prompt forensic physicians to keep up with published data on estimating the age of adolescents. (shrink)

If definitive evidence concerning treatment effectiveness becomes available from an ongoing randomized clinical trial, then the trial could be stopped early, with the public release of results benefiting current and future patients. However, stopping an ongoing trial based on accruing outcome data requires methodological rigor to preserve validity of the trial conclusions. This has led to the use of formal interim monitoring procedures, which include inefficacy monitoring that will stop a trial early when the experimental treatment appears not to (...) be working. For participants, inefficacy monitoring is especially important as it ensures that they are not being treated worse than if they had not enrolled on the trial. We discuss the importance of reporting with trial results the formal interim inefficacy monitoring guidelines that were utilized, and, if none were used, the reasons for their absence. A survey of two leading medical journals suggests that this is not current practice. (shrink)

Argumentative indicators of discourse relations constitute crucial cues for the mining of arguments. However, a comprehensive lexicon of these linguistic devices is so far lacking due to the scarcity of corpora argumentatively annotated and the absence of an empirically validated analytic methodology. Recent studies have shown that modals, that express that things might be otherwise, and evidentials, that point to the presence of information sources, are good candidates to work as argumentative indicators. On these grounds, we propose a systematic, non-language (...) specific corpus-based procedure to identify indicators of argumentative discourse relations. We test the design of a multi-level annotation through the analysis of the English and Italian epistential adverbs evidently and evidentemente in comparable corpora of newspaper articles. We show that the annotation guidelines achieve consistent analytical results with expert annotators. Data analysis reveals that the two adverbs work as argumentative indicator both at the structural and at the inferential level: besides pointing to the presence of premises-conclusion relations, they recurrently pattern with causal argument schemes from the effect to the cause. The Italian adverb evidentemente is less polysemous and more frequent, thus working as a more reliable indicator. (shrink)

Argumentative indicators of discourse relations constitute crucial cues for the mining of arguments. However, a comprehensive lexicon of these linguistic devices is so far lacking due to the scarcity of corpora argumentatively annotated and the absence of an empirically validated analytic methodology. Recent studies have shown that modals, that express that things might be otherwise, and evidentials, that point to the presence of information sources, are good candidates to work as argumentative indicators. On these grounds, we propose a systematic, non-language (...) specific corpus-based procedure to identify indicators of argumentative discourse relations. We test the design of a multi-level annotation through the analysis of the English and Italian epistential adverbs evidently and evidentemente in comparable corpora of newspaper articles. We show that the annotation guidelines achieve consistent analytical results with expert annotators. Data analysis reveals that the two adverbs work as argumentative indicator both at the structural and at the inferential level: besides pointing to the presence of premises-conclusion relations, they recurrently pattern with causal argument schemes from the effect to the cause. The Italian adverb evidentemente is less polysemous and more frequent, thus working as a more reliable indicator. (shrink)

Natural theology is still practiced as though substantive theological conclusions can be derived by a quasi-deductive process. Perhaps relevant "evidence" may lead to interesting theological conclusions -- the fact of natural evil, or the cosmic fine-tuning we hear about in contemporary cosmology, both cry out for theological explanation. I remain a skeptic, however, about the value of "a priori" methods in natural theology. The case study in this short discussion is the well known attempt to establish the logical incoherence of (...) the divine command theory of moral objectivity. If skeptics can make good on this charge, they will have gone a long way toward undercutting a central tenant of western theism. I will argue, however, that the case against theologically based moral absolutism is not as simple as showing some internal paradox or logical tension. (shrink)

According to Sperber and Wilson, relevance theory’s comprehension/interpretation procedure for metaphorical utterances does not require details specific to metaphor (or nonliteral discourse); instead, the same type of comprehension procedure as that in place for literal utterances covers metaphors as well. One of Sperber and Wilson’s central reasons for holding this is that metaphorical utterances occupy one end of a continuum that includes literal, loose and hyperbolic utterances with no sharp boundaries in between them. Call this the continuum argument (...) about interpreting metaphors. My aim is to show that this continuum argument doesn’t work. For if it were to work, it would have an unwanted consequence: it could be converted into a continuum argument about interpreting linguistic errors, including slips of the tongue, of which malaprops are a special case. In particular, based on the premise that the literal–loose–metaphorical continuum extends to malaprops also, we could conclude that the relevance theoretic comprehension procedure for malaprops does not require details specific to linguistic errors, that is, details beyond those already in place for interpreting literal utterances. Given that we have good reason to reject this conclusion, we also have good reason to rethink the conclusion of the continuum argument about interpreting metaphors. (shrink)

In the following review essay I explore the limitations of effective and constructive critique of Tony Lawson’s realism in economics as articulated in Ontology and Economics. In the first section I summarize the different framing procedures that shape the different critiques. In the second section I illustrate the limitations this creates using Caldwell’s contribution and in the third section I explore the way Lawson is conditioned to respond in terms of contestation, clarification and restatement. In the fourth section I add (...) some additional detail based on Samuelson’s approach to modelling in order to illustrate what is at issue between Caldwell and Lawson and to emphasize what this suggests in terms of a common pattern across the contributions to the text. In the fifth section and in the conclusion I link the limitations of the various critiques found in Ontology and Economics to a basic issue of the vulnerability of realism to critique in order to make some suggestions regarding constructive critique and development for realism in economics. (shrink)

Many groups make decisions over multiple interconnected propositions. The “doctrinal paradox” or “discursive dilemma” shows that propositionwise majority voting can generate inconsistent collective sets of judgments, even when individual sets of judgments are all consistent. I develop a simple model for determining the probability of the paradox, given various assumptions about the probability distribution of individual sets of judgments, including impartial culture and impartial anonymous culture assumptions. I prove several convergence results, identifying when the probability of the paradox converges to (...) 1, and when it converges to 0, as the number of individuals increases. Drawing on the Condorcet jury theorem and work by Bovens and Rabinowicz , I use the model to assess the “truth-tracking” performance of two decision procedures, the premise- and conclusion-based procedures. I compare the present results with existing results on the probability of Condorcet’s paradox. I suggest that the doctrinal paradox is likely to occur under plausible conditions. (shrink)

Withdrawal is an act by which a member state of an international organization willingly terminates its membership. The right to withdraw from international organizations is explicitly mentioned in the constitutions of most of them and the circumstances regarding to the right of withdrawal vary depending on the organization. The purpose of this paper is to explain the right and procedures of withdrawal, and the reasons that result with the will of states to withdraw from international organizations. For the realization of (...) this research are used qualitative methods, based on the bibliography that is related to international organizations, with special emphasis with the right and procedures of the withdrawal of states from international organizations. Furthermore, some informations are also collected from the credible internet sources, which have valuable data about the withdrawals of states from international organizations and the reasons that result with such decisions. The results of the research have shown that since the appearance of international organizations until today, there were and there are decisions of states to withdraw from international organizations, coming from the reluctance of states to hand over to international organizations parts of their sovereignty. The conclusions of this paper aim to increase knowledge about the real meaning of the processes of withdrawals of states from international organizations. (shrink)

Topological relations such as inside, outside, or intersection are ubiquitous to our spatial thinking. Here, we examined how people reason deductively with topological relations between points, lines, and circles in geometric diagrams. We hypothesized in particular that a counterexample search generally underlies this type of reasoning. We first verified that educated adults without specific math training were able to produce correct diagrammatic representations contained in the premisses of an inference. Our first experiment then revealed that subjects who correctly judged an (...) inference as invalid almost always produced a counterexample to support their answer. Noticeably, even if the counterexample always bore a certain level of similarity to the initial diagram, we observed that an object was more likely to be varied between the two drawings if it was present in the conclusion of the inference. Experiments 2 and 3 then directly probed counterexample search. While participants were asked to evaluate a conclusion on the basis of a given diagram and some premisses, we modulated the difficulty of reaching a counterexample from the diagram. Our results indicate that both decreasing the counterexample density and increasing the counterexample distance impaired reasoning performance. Taken together, our results suggest that a search procedure for counterexamples, which proceeds object‐wise, could underlie diagram‐based geometric reasoning. Transposing points, lines, and circles to our spatial environment, the present study may ultimately provide insights on how humans reason about topological relations between positions, paths, and regions. (shrink)

There are several reasons, according to which it is worth analyzing European administrative law. First, this is a rather new branch of law. Second, the European administrative law is treated in different countries from different legal traditions positions, consequently, any effort to unify the approach to it can provide a basis for a unified European administrative law model. Third, there are no works dedicated to the analysis of the phenomenon of the European administrative law in Lithuania. Therefore, this article deals (...) with the concepts of the European administrative law. It is stated that the comprehensive image of the European administrative law reveals three European administrative law concepts. The first concept of the European administrative law characterizes it as the European Union (hereinafter – EU) administrative law, the validity of boundaries of which can be based on three aspects – functional, institutional and procedural. The second concept of the European administrative law identifies it as the law of administrative cooperation., whereas the third concept allows the European administrative law to be seen as the law common to various public administrations of European countries – ius commune. The article focuses on the analysis of the above-mentioned three approaches and the EU set of administrative procedures as an instrument to promote the development of the EU administrative law. The author comes to the conclusion that the concept of the ‘European Administrative Law’ is broader than the concept of the ‘EU Administrative Law’. The European administrative law can be perceived not only as a part of law that establishes the EU administration’s administrative legal status, its’ activity principles, forms and methods, but also as a law of administrative cooperation between states, governmental and non-governmental organizations and various corporations, based on a wide range of multilateral treaties or conventions, which cross the limits of the EU. Moreover, the European administrative law can be understood as a law with common concepts, general principles characteristic to different European countries’ public administrations as well as a science, with the help of which diverse administrative legal systems of various countries could be compared. Taking into account the content of various working documents, the author draws the conclusion that for the further development of the EU administrative law the establishment of uniform operating rules for the EU administration in its’ relations with the society is of exceptional importance. There are a number of important reasons to develop the Law on administrative procedure of the EU. First, it is generally recognized that the EU needs common binding legislation that sets out clear operating rules of the EU administration in its’ relations with legal and natural persons, and that would increase the transparency of the EU administration and its’ accessibility to citizens. Second, the drafting of the law on administrative procedure of the EU lies in the legal framework as well; the importance of the article 298 of the Treaty of the Functioning of the European Union, the articles 41 and 42 of the Charter of Fundamental Rights of the EU as well as “soft” law (i.e. codes of good administrative behavior) are obvious here. (shrink)

The combination of individual judgments on logically interconnected propositions into a collective decision on the same propositions is called judgment aggregation. Literature in social choice and political theory has claimed that judgment aggregation raises serious concerns. For example, consider a set of premises and a conclusion in which the latter is logically equivalent to the former. When majority voting is applied to some propositions (the premises) it may give a different outcome than majority voting applied to another set of (...) propositions (the conclusion). This problem is known as the doctrinal paradox. The doctrinal paradox is a serious problem since it is not clear whether a collective outcome exists in these cases, and if it does, what it is like. Moreover, the two suggested escape-routes from the paradox - the so-called premise-based procedure and the conclusion-based procedure - are not, as I will show, satisfactory methods for group decision-making. In this paper I introduce a new aggregation procedure inspired by an operator defined in artificial intelligence in order to merge knowledge bases. The result is that we do not need to worry about paradoxical outcomes, since these arise only when inconsistent collective judgments are not ruled out from the set of possible solutions. (shrink)

The problem of the aggregation of consistent individual judgments on logically interconnected propositions into a collective judgment on the same propositions has recently drawn much attention. The dificulty lies in the fact that a seemingly reasonable aggregation procedure, such as propositionwise majority voting, cannot ensure an equally consistent collective outcome. The literature on judgment aggregation refers to such dilemmas as the discursive paradox. So far, three procedures have been proposed to overcome the paradox: the premise-based and conclusion- (...) class='Hi'>based procedures on the one hand, and the merging approach on the other hand. In this paper we assume that the decision which the group is trying to reach is factually right or wrong. Hence, the question is how good the merging approach is in tracking the truth, and how it compares with the premise-based and conclusion-based procedures. (shrink)

Suppose a committee or a jury confronts a complex question, the answer to which requires attending to several sub-questions. Two different voting procedures can be used. On one, the committee members vote on each sub-question and the voting results are used as premises for the committee’s conclusion on the main issue. This premise-based procedure can be contrasted with the conclusion-based approach, which requires the members to directly vote on the conclusion, with the vote of (...) each member being guided by her views on the relevant sub-questions. The two procedures are not equivalent: There may be a majority of voters supporting each of the premises, but if these majorities do not significantly overlap, there will be a majority against the conclusion. Pettit (2001) connects the choice between the two procedures with the discussion of deliberative democracy. The problem we want to examine instead concerns the relative advantages and disadvantages of the two procedures from the epistemic point of view. Which of them is better when it comes to tracking truth? As it turns out, the answer is not univocal. On the basis of Condorcet’s jury theorem, the premise-based procedure can be shown to be superior if the objective is reach truth for the right reasons, without making any mistakes on the way. However, if the goal instead is to reach truth for whatever reasons, right or wrong, there will be cases in which using the conclusion-based procedure turns out to be more reliable, even though, for the most part, the premise-based procedure will retain its superiority. (shrink)

Suppose a committee or a jury confronts a complex question, the answer to which requires attending to several sub-questions. Two different voting procedures can be used. On one, the committee members vote on each sub-question and the voting results are used as premises for the committee’s conclusion on the main issue. This premise-based procedure can be contrasted with the conclusion-based approach, which requires the members to directly vote on the conclusion, with the vote of (...) each member being guided by her views on the relevant sub-questions. The two procedures are not equivalent: There may be a majority of voters supporting each of the premises, but if these majorities do not significantly overlap, there will be a majority against the conclusion. Pettit (2001) connects the choice between the two procedures with the discussion of deliberative democracy. The problem we want to examine instead concerns the relative advantages and disadvantages of the two procedures from the epistemic point of view. Which of them is better when it comes to tracking truth? As it turns out, the answer is not univocal. On the basis of Condorcet’s jury theorem, the premise-based procedure can be shown to be superior if the objective is reach truth for the right reasons, without making any mistakes on the way. However, if the goal instead is to reach truth for whatever reasons, right or wrong, there will be cases in which using the conclusion-based procedure turns out to be more reliable, even though, for the most part, the premise-based procedure will retain its superiority. (shrink)

Suppose a committee has to take a stand on a complex issue, where the decision presupposes answering a number of sub-questions. There is an agreement within the committee which sub-questions should be posed. All questions are of the ”yes or no?”-type and the main question is to be given the yes-answer if and only if each sub-question is answered with “yes”. Two different voting procedures can be used. On one procedure, the committee members vote on each sub-question and the (...) voting results then determine the committee’s conclusion on the main issue. This premise-based procedure (or pbp, for short) can be contrasted with the conclusion-based procedure (cbp), on which the members directly vote on the conclusion, with the vote of each member being guided by her views on the relevant sub-questions. The problem we want to examine concerns the relative advantages and disadvantages of the two procedures from the epistemic point of view. In some cases one can assume that the question before the committee has a right answer, which the committee is trying to reach. Is one of the two procedures better when it comes to tracking the truth? As it turns out, the answer to this query is not univocal: On the basis of Condorcet’s jury theorem we shall show that the premise-based procedure is clearly superior if we want to reach truth for the right reasons, i.e. without making any mistakes on the road to the conclusion. However, if the goal instead is to reach truth for whatever reasons, right or wrong, there will be special cases in which using the conclusion-based procedure turns out to be more reliable. But for the most part, the premise-based procedure will still retain its superiority. In this respect, our results disconfirm the tentative conjectures that have been put forward in Pettit and Rabinowicz (2001). (shrink)

A committee has to address a complex question, the answer to which requires answering several sub-questions. Two different voting procedures can be used. On one procedure, the committee members vote on each sub-question and the voting results then are used as premises for the committee’s conclusion on the main issue. This premise-based procedure can be contrasted with the conclusion-based procedure. On that procedure, the members directly vote on the conclusion, with the (...) vote of each member being guided by her views on the relevant sub-questions. These procedures are by no means equivalent, which has been pointed out in legal theory in connection with jury votes. There may be a majority of voters supporting each premise, but if these majorities do not significantly overlap, there will be a majority against the conclusion. Pettit connects the choice between the two procedures with general political theory, in particular, with the discussion of deliberative democracy. However, the problem we want to examine concerns the relative advantages and disadvantages of the two procedures from the epistemic point of view. In some cases one can assume that the question before the committee has the right answer. In cases like this, is one of the two procedures better when it comes to tracking the truth? As it turns out, the answer to this query is not univocal. On the basis of Condorcet’s jury theorem, we show that the premise-based procedure is clearly superior if the objective is reach truth for the right reasons, i.e. without making any mistakes on the way. However, if the goal instead is to reach truth for whatever reasons, right or wrong, there will be cases in which using the conclusion-based procedure turns out to be more reliable, even though, for the most part, the premise-based procedure will retain its superiority. Our results partly confirm and partly disconfirm the tentative conjectures that have been put forward in Pettit and Rabinowicz. (shrink)

Introduction: There is significant overlap in the type of structural language impairments exhibited by children with autism spectrum disorder and children with attention deficit hyperactivity disorder. This similarity suggests that the cognitive impairment contributing to the structural language deficits in ASD and ADHD may be shared. Previous studies have speculated that procedural memory deficits may be the shared cognitive impairment. The procedural deficit hypothesis argues that language deficits can be explained by differences in the neural structures underlying the procedural memory (...) network. This hypothesis is based on the premise that the neural structures comprising the procedural network support language learning. In this study, we aimed to test the PDH in children with ASD, ADHD, and typical development.Methods: One hundred and sixty-three participants : 91 with ASD, 26 with ADHD, and 46 with TD, completed standardized measures of cognitive and language ability as well as structural magnetic resonance imaging. We compared the structural language abilities, the neural structures underlying the procedural memory network, and the relationship between structural language and neural structure across diagnostic groups.Results: Our analyses revealed that while the structural language abilities differed across ASD, ADHD, and TD groups, the thickness, area, and volume of the structures supporting the procedural memory network were not significantly different between diagnostic groups. Also, several neural structures were associated with structural language abilities across diagnostic groups. Only two of these structures, the inferior frontal gyrus, and the left superior parietal gyrus, are known to be linked to the procedural memory network.Conclusions: The inferior frontal gyrus and the left superior parietal gyrus, have well-established roles in language learning independent of their role as part of the procedural memory system. Other structures such as the caudate and cerebellum, with critical roles in the procedural memory network, were not associated with structural language abilities across diagnostic groups. It is unclear whether the procedural memory network plays a fundamental role in language learning in ASD, ADHD, and TD. (shrink)

Background Triage in the emergency department (ED) is a crucial procedure that establishes the urgency of patient care based on symptoms at presentation. Although the efficacy of triage nurse training programs varies, their goal is to increase the precision and efficiency of their decision-making. Aim With a focus on research done between 2019 and 2024, the systematic review attempts to evaluate the effect of training programs on the accuracy and efficiency of triage nurses in emergency departments. Method We (...) conducted a thorough search of the PubMed, EMBASE, and Web of Science databases to find pertinent research. Studies assessing training treatments for triage nurses and reporting accuracy and efficiency-related results were included in the inclusion criteria. Both the quality assessment and data extraction were carried out separately by two reviewers. Result Ten studies that used a range of triage training techniques and covered a variety of geographic areas satisfied the inclusion criteria. Research findings consistently showed that, despite variations in study designs and outcome measures, training programs increased triage accuracy and efficiency. Interventions included clinical decision support system integration, training based on simulation, and conventional classroom-based instruction. Conclusion By increasing decision-making efficiency and accuracy in patient evaluation, training programs greatly improve the performance of triage nurses in emergency departments. To improve comparability and support evidence-based policies, future research must standardize training methodologies and outcome measurements. (shrink)

Recently, there has been increasing interest in methodological aspects of advanced imaging, including the role of guidelines, recommendations, and experts’ consensus, the practice of self-referral, and the risk of diagnostic procedure overuse. In a recent Delphi study of the European Association for Nuclear Medicine (EANM), panelists were asked to give their opinion on 47 scientific questions about imaging in prostate cancer. Nine additional questions exploring the experts’ attitudes and opinions relating to the procedure of consensus building itself were (...) also included. The purpose was to provide insights into the mechanism of recommendation choice and consensus building as seen from the experts’ point of view. Results: Regarding the factors likely to influence the willingness to refer a patient for imaging, the most voted were incorporation into guidelines and data from scientific literature, while personal experience and personal relationship were chosen by a small minority. Regarding the recommendations more relevant to prescribe an imaging procedure, it resulted the incorporation into guidelines promoted by scientific societies (59% of votes); these guidelines also resulted the more trusted. With respect to patients’ preferences considered when prescribing an imaging procedure, the most voted was accuracy, resulted more important than easy access and time to access to the procedure. The majority of the experts expressed the opinion that there is a scarce use of imaging procedures in prostate cancer. With respect to the most relevant factor to build consensus, it resulted the transparency of the process (52% of votes), followed by multidisciplinarity of contributors. The main obstacle to incorporation of modern imaging procedures into guidelines resulted the lack of primary literature on clinical impact. Conclusions: Firstly, the panelists portray themselves as having Evidence-Based Medicine oriented and scientifically inclined attitudes and preferences. Secondly, guidelines and recommendations from scientific societies, especially clinical ones, are positively taken into account as factors influencing decisions, but panelists tend to consider their own appraisal of the scientific literature as more relevant. Thirdly, in respect of overuse, panelists do not think that advanced diagnostic procedures are overutilized in the specific case of Prostate Cancer, but rather they are underutilized. (shrink)

Background In the context of limited health care budgets in countries where Neglected Tropical Diseases are endemic, scaling up disease control interventions entails the setting of priorities. However, solutions based solely on cost-effectiveness analyses may lead to biased and insufficiently justified priorities. Objectives The objectives of this paper are to 1) demonstrate how a range of equity concerns can be used to identify feasible priority setting criteria, 2) show how these criteria can be fed into a multi-criteria decision-making matrix, (...) and 3) discuss the conditions under which this decision-making procedure should be carried out in a real-world decision-making context. Methods This paper draws on elements from theories of decision analysis and ethical theories of fair resource allocation. We explore six typical NTD interventions by employing a modified multi-criteria decision analysis model with predefined criteria, drawn from a priority setting guide under development by the WHO. To identify relevant evidence for the six chosen interventions, we searched the PubMed and Cochrane databases. Discussion Our in vitro multi-criteria decision analysis suggested that case management for visceral leishmaniasis should be given a higher priority than mass campaigns to prevent soil-transmitted helminthic infections. This seems to contradict current health care priorities and recommendations in the literature. We also consider procedural conditions that should be met in a contextualised decision-making process and we stress the limitations of this study exercise. Conclusion By exploring how several criteria relevant to the multi-facetted characteristics of NTDs can be taken into account simultaneously, we are able to suggest how improved priority settings among NTDs can be realised. (shrink)

BackgroundRespect for autonomy is a key concept in contemporary bioethics and end-of-life ethics in particular. Despite this status, an individualistic interpretation of autonomy is being challenged from the perspective of different theoretical traditions. Many authors claim that the principle of respect for autonomy needs to be reconceptualised starting from a relational viewpoint. Along these lines, the notion of relational autonomy is attracting increasing attention in medical ethics. Yet, others argue that relational autonomy needs further clarification in order to be adequately (...) operationalised for medical practice. To this end, we examined the meaning, foundations, and uses of relational autonomy in the specific literature of end-of-life care ethics.MethodsUsing PRESS and PRISMA procedures, we conducted a systematic review of argument-based ethics publications in 8 major databases of biomedical, philosophy, and theology literature that focused on relational autonomy in end-of-life care. Full articles were screened. All included articles were critically appraised, and a synthesis was produced.ResultsFifty publications met our inclusion criteria. Twenty-eight articles were published in the last 5 years; publications were originating from 18 different countries. Results are organized according to: (a) an individualistic interpretation of autonomy; (b) critiques of this individualistic interpretation of autonomy; (c) relational autonomy as theoretically conceptualised; (d) relational autonomy as applied to clinical practice and moral judgment in end-of-life situations.ConclusionsThree main conclusions were reached. First, literature on relational autonomy tends to be more a ‘reaction against’ an individualistic interpretation of autonomy rather than be a positive concept itself. Dichotomic thinking can be overcome by a deeper development of the philosophical foundations of autonomy. Second, relational autonomy is a rich and complex concept, formulated in complementary ways from different philosophical sources. New dialogue among traditionally divergent standpoints will clarify the meaning. Third, our analysis stresses the need for dialogical developments in decision making in end-of-life situations. Integration of these three elements will likely lead to a clearer conceptualisation of relational autonomy in end-of-life care ethics. This should in turn lead to better decision-making in real-life situations. (shrink)

Background The intervention reported in this paper was a follow up to an empirical study conducted in Malawi with the aim of assessing trial participants’ understanding of randomisation, double-blinding and placebo use. In the empirical study, the majority of respondents (61.1%; n= 124) obtained low scores (lower than 75%) on understanding of all three concepts under study. Based on these findings, an intervention based on a narrative which included all three concepts and their personal implications was designed. The (...) narrative used daily examples from the field of Agriculture because Malawi has an agro-based economy. Methods The intervention was tested using a sample of 36 women who had been identified as low scorers during the empirical study. The 36 low scorers were randomly assigned to control (n=18) and intervention arms ( n =18). The control arm went through a session in which they were provided with standard informed consent information for the microbicide trial. The intervention arm went through a session in which they were provided with a narrative in ChiChewa, the local language, with the assistance of a power point presentation which included pictures as well as discussions on justification and personal implications of the concepts under study. Results The findings on the efficacy of the intervention suggest that the 3 scientific concepts and their personal implications can be understood by low literacy populations using simple language and everyday local examples. The findings also suggest that the intervention positively impacted on understanding of trial procedures under study, as 13 of the 18 women in the intervention arm, obtained high scores (above 75%) during the post intervention assessment and none of the 18 in the control arm obtained a high score. Using Fischer’s exact test, it was confirmed that the effect of the intervention on understanding of the three procedures was statistically significant (p=0.0001). Conclusions Potential trial participants can be assisted to understand key clinical trial procedures, their justification and personal implications by using innovative tailored local narratives. (shrink)

In certain contexts reasoners reject instances of the valid Modus Ponens and Modus Tollens inference form in conditional arguments. Byrne (1989) observed this suppression effect when a conditional premise is accompanied by a conditional containing an additional requirement. In an earlier study, Rumain, Connell, and Braine (1983) observed suppression of the invalid inferences "the denial of the antecedent" and "the affirmation of the consequent" when a conditional premise is accompanied by a conditional containing an alternative requirement. Here we present three (...) experiments showing that the results of Byrne (1989) and Rumain et al. (1983) are influenced by the answer procedure. When reasoners have to evaluate answer alternatives that only deal with the inferences that can be made with respect to the first conditional, then suppression is observed (Experiment 1). However, when reasoners are also given answer alternatives about the second conditional (Experiment 2) no suppression is observed. Moreover, contrary to the hypothesis of Byrne (1989), at least some of the reasoners do not combine the information of the two conditionals and do not give a conclusion based on the combined premise. Instead, we hypothesise that some of the reasoners have reasoned in two stages. In the first stage, they form a putative conclusion on the basis of the first conditional and the categorical premise, and in the second stage, they amend the putative conclusion in the light of the information in the second premise. This hypothesis was confirmed in Experiment 3. Finally, the results are discussed with respect to the mental model theory and reasoning research in general. (shrink)

Objective: Population based cohort studies involving genetic research have been initiated in several countries. However, research published to date provides little information on the willingness of the general population to participate in such studies. Furthermore, there is a need to discover the optimal methods for acquiring fully informed consent from the general population. We therefore examined the results of a population based genetic cohort study to identify the factors affecting the participation rate by members of the general public (...) and also specifically to examine the impact of different consent procedures on the rate of participation by prospective candidates and their subsequent withdrawal rate from the study.Design: Descriptive analyses.Setting and participants: The study evaluated two non-genetic subcohorts comprising 3166 people attending for a health checkup during 2002, and two genetic subcohorts comprising 2195 people who underwent a checkup during 2003.Main outcome measurements: Analysis endpoints were differences in participation rates between the non-genetic and genetic subcohorts, differences between providing non-extensive and extensive preliminary information, and changes in participation status between baseline and at 6 months.Results: Participation rates in the genetic subcohorts were 4·7–9·3% lower than those in the non-genetic subcohorts. The odds ratios of participation in genetic research were between 0·60 and 0·77, and the OR for withdrawal from the research was over 7·70; providing preliminary extensive information about genetic research reduced the withdrawal risks but worsened participation rates .Conclusions: The general population responded sceptically towards genetic research. It is crucial that genetic researchers utilise an informative and educational consent process worthy of public trust. (shrink)

ABSTRACT This paper reports on an empirical performance analysis of four modal theorem provers on benchmark suites of randomly generated formulae. The theorem provers tested are the Davis-Putnam-based procedure KSAT, the tableaux-based system KRZIS, the sequent-based Logics Workbench, and a translation approach combined with the first-order theorem prover SPASS. Our benchmark suites are sets of multi-modal formulae in a certain normal form randomly generated according to the scheme of Giunchiglia and Sebastiani [GS 96a, GS 96b]. We (...) investigate the quality of the random modal formulae and show that the scheme has some shortcomings, which may lead to mistaken conclusions. We propose improvements to the evaluation method and show that the translation approach provides a viable alternative to the other approaches. (shrink)

Even though researchers regularly use neutral affect induction procedures as a control condition in their work, there is little consensus on what is neutral affect. This article reviews five approaches that researchers have used to operationalize neutral AIPs: to produce a minimal affective state, in-the-middle state, deactivated state, typical state, or indifferent state. For each view, the article delineates the theoretical basis for the neutral AIP, how to assess it, and provides recommendations for when and how to use it. The (...) goal of the article is to encourage researchers to state their theoretical assumptions about neutral affect, to validate those assumptions, and to make appropriate conclusions based on them. (shrink)

OBJECTIVE: (a) To measure the effect of a guideline-based training on the performance of ontology developers compared with the performance after unspecific training by a competency question based evaluation; and (b) to provide empirical evidence for the applicability of competency questions in formal ontology evaluation in general. BACKGROUND: A close connection between ontology development and ontology evaluation as quality management procedure can been attained with the use of competency questions. Competency questions are often used as a semi-formal (...) specification of requirements for an ontology under development. Hence they can also be used as evaluation instruments, in order to check how far an ontology fulfills these requirements. METHODS: A randomized controlled trial was conducted with two groups of 12 students each. The intervention consisted in a differential guideline-based training on ontology development vs. unspecific training. After a group-specific training focusing on three topics per group, performance of students was assessed with 12 exercises (2 exercises per topic), in which the students had to apply their skills. Different types of competency questions were elaborated for the analysis of the students' ontologies. We used the proportion of correct answers as a measure of ontology quality. RESULTS: On single topic level, the performance of ontology developers increased after guideline-based training for two out of the six topics: it increased from a proportion of 0.46 to 0.63 for the topic Process \& Participation and from 0.44 to 0.53 for the topic Collective Material Entity. In regression analysis, a positive correlation was shown between the performance of students on untrained topics and the performance after specific guideline-based training. Moreover, in multiple regression analysis an overall effect of specific training of 0.09 was calculated (p < 0.1). CONCLUSION: The results show an effect of a specific guideline-based training on the performance of ontology developers compared to the performance after unspecific training by an increase of about 10 \% on the rate of correct competency questions. In addition, this study has shown the general applicability of competency questions in a formal ontology evaluation scenario. However, the study also shows that the training of ontology developers and their performance evaluation is a tedious task. The resulting performance of ontology developers is more dependent on the a priori individual competencies than on the specific acquired skills after training. (shrink)

Background The principles of dynamic consent are based on the idea of safeguarding the autonomy of individuals by providing them with personalized options to choose from regarding the sharing and utilization of personal health data. To facilitate the widespread introduction of dynamic consent concepts in practice, individuals must perceive these procedures as useful and easy to use. This study examines the user experience of a dynamic consent-based application, in particular focusing on personalized options, and explores whether this approach (...) may be useful in terms of ensuring the autonomy of data subjects in personal health data usage. Methods This study investigated the user experience of MyHealthHub, a dynamic consent-based application, among adults aged 18 years or older living in South Korea. Eight tasks exploring the primary aspects of dynamic consent principles–including providing consent, monitoring consent history, and managing personalized options were provided to participants. Feedback on the experiences of testing MyHealthHub was gathered via multiple-choice and open-ended questionnaire items. Results A total of 30 participants provided dynamic consent through the MyHealthHub application. Most participants successfully completed all the provided tasks without assistance and regarded the personalized options favourably. Concerns about the security and reliability of the digital-based consent system were raised, in contrast to positive responses elicited in other aspects, such as perceived usefulness and ease of use. Conclusions Dynamic consent is an ethically advantageous approach for the sharing and utilization of personal health data. Personalized options have the potential to serve as pragmatic safeguards for the autonomy of individuals in the sharing and utilization of personal health data. Incorporating the principles of dynamic consent into real-world scenarios requires remaining issues, such as the need for powerful authentication mechanisms that bolster privacy and security, to be addressed. This would enhance the trustworthiness of dynamic consent-based applications while preserving their ethical advantages. (shrink)

This paper proposes an argumentation-based procedure for legal interpretation, by reinterpreting the traditional canons of textual interpretation in terms of argumentation schemes, which are then classified, formalized, and represented through argument visualization and evaluation tools. The problem of statutory interpretation is framed as one of weighing contested interpretations as pro and con arguments. The paper builds an interpretation procedure by formulating a set of argumentation schemes that can be used to comparatively evaluate the types of arguments used (...) in cases of contested statutory interpretation in law. A simplified version of the Carneades Argumentation System is applied in a case analysis showing how the procedure works. A logical model for statutory interpretation is finally presented, covering pro-tanto and all-things-considered interpretive conclusions. (shrink)

The aggregation of consistent individual judgments on logically interconnected propositions into a collective judgment on those propositions has recently drawn much attention. Seemingly reasonable aggregation procedures, such as propositionwise majority voting, cannot ensure an equally consistent collective conclusion. The literature on judgment aggregation refers to that problem as the discursive dilemma. In this paper, we motivate that many groups do not only want to reach a factually right conclusion, but also want to correctly evaluate the reasons for that (...) conclusion. In other words, we address the problem of tracking the true situation instead of merely selecting the right outcome. We set up a probabilistic model analogous to Bovens and Rabinowicz (2006) and compare several aggregation procedures by means of theoretical results, numerical simulations and practical considerations. Among them are the premise-based, the situation-based and the distance-based procedure. Our findings confirm the conjecture in Hartmann, Pigozzi and Sprenger (2008) that the premise-based procedure is a crude, but reliable and sometimes even optimal form of judgment aggregation. (shrink)

Advanced medical imaging, such as CT, fMRI and PET, has undergone enormous progress in recent years, both in accuracy and utilization. Such techniques often bring with them an illusion of immediacy, the idea that the body and its diseases can be directly inspected. In this paper we target this illusion and address the issue of the reliability of advanced imaging tests as knowledge procedures, taking positron emission tomography in oncology as paradigmatic case study. After individuating a suitable notion of reliability, (...) we argue that PET is a highly theory-laden and non-immediate knowledge procedure, in spite of the photographic-like quality of the images it delivers; the diagnostic conclusions based on the interpretation of PET images are population-dependent; PET images require interpretation, which is inherently observer-dependent and therefore variable. We conclude with a three-step methodological proposal for enhancing the reliability of advanced medical imaging. (shrink)

The article aims to analyze the relationship between the concept of intent defined by the theory of will in the context of criminal law and the conception of will be developed by Hans Kelsen's theory of legal positivism. The study explores the norm through an analysis of the Pure Theory of Law, emphasizing the distinction between "being" and "ought" in the legal context. From this distinction, the placement of law and the role of the fundamental hypothetical norm, used by Kelsen (...) as an epistemological assumption and to ensure the validity of the entire legal system, will be investigated. In this theoretical context, using the deductive approach and monographic procedure, the concept of will in Kelsen's philosophy is brought closer to the concept of intent, seeking to infer whether the philosophy contributes characteristics that define intent as will, as defined by the theory of will. In conclusion, the characteristics of the concepts inherited from the philosophy of law in defining intent are found, especially through the relationship established between will and arbitrariness. (shrink)

The aggregation of consistent individual judgments on logically interconnected propositions into a collective judgment on the same propositions has recently drawn much attention. Seemingly reasonable aggregation procedures, such as propositionwise majority voting, cannot ensure an equally consistent collective conclusion. The literature on judgment aggregation refers to such a problem as the \textit{discursive dilemma}. In this paper we assume that the decision which the group is trying to reach is factually right or wrong. Hence, we address the question of how (...) good the various approaches are at selecting the right conclusion. We focus on two approaches: distance-based procedures and a Bayesian analysis. They correspond to group-internal and group-external decision-making, respectively. We compare those methods in a probabilistic model, demonstrate the robustness of our results over various generalizations and discuss their applicability in different situations. The findings vindicate (i) that in judgment aggregation problems, reasons should carry higher weight than conclusions and (ii) that considering members of an advisory board to be highly competent is a better strategy than to underestimate their advice.". (shrink)

Abductive reasoning involves finding the missing premise of an “unsaturated” deductive inference, thereby selecting a possible _explanans_ for a conclusion based on a set of previously accepted premises. In this paper, we explore abductive reasoning from a structural proof-theory perspective. We present a hybrid sequent calculus for classical propositional logic that uses sequents and antisequents to define a procedure for identifying the set of analytic hypotheses that a rational agent would be expected to select as _explanans_ when (...) presented with an abductive problem. Specifically, we show that this set may not include the deductively minimal hypothesis due to the presence of redundant information. We also establish that the set of all analytic hypotheses exhausts all possible solutions to the given problem. Finally, we propose a deductive criterion for differentiating between the best _explanans_ candidates and other hypotheses. (shrink)

Purpose/Significance. This study aims to explore the differences in the effectiveness of rumor refutation dissemination on government micro-blogs and to identify factors that may lead to such differences, so as to provide reference for the management of emergencies and to improve the effectiveness of rumor refutation. Methodology/Procedure. Using Octopus software to collect data from thirty government micro-blogs, the number of retweets, likes, and comments were used as indicators of the effectiveness of refutation dissemination and different levels of government micro-blogs (...) were used as moderating variables to construct a regression model of the effect of content features and text features on refutation dissemination. The regression model was constructed to test the moderating effects of micro-blog content and text features on the effectiveness of micro-blog refutation. Results/Conclusions. The empirical results show that whether a micro-blog is from the region or not and whether a micro-blog has a title or not have a significant effect on the effectiveness of micro-blog refutation dissemination. Therefore, refutation strategies such as combining layers, giving equal importance to content and form, and focusing on originality can be adopted to enhance the refutation effect of government micro-blogs. (shrink)

Researchers currently working on relational reasoning typically argue that mental model theory (MMT) is a better account than the inference rule approach (IRA). They predict and observe that determinate (or one-model) problems are easier than indeterminate (or two-model) problems, whereas according to them, IRA should lead to the opposite prediction. However, the predictions attributed to IRA are based on a mistaken argument. The IRA is generally presented in such a way that inference rules only deal with determinate relations and (...) not with indeterminate ones. However, (a) there is no reason to presuppose that a rule-based procedure could not deal with indeterminate relations, and (b) applying a rule-based procedure to indeterminate relations should result in greater difficulty. Hence, none of the recent articles devoted to relational reasoning currently presents a conclusive case for discarding IRA by using the well-known determinate vs indeterminate problems comparison. (shrink)

Photo ID 71252867© Stepan Popov| Dreamstime.com Abstract While Medical Assistance in Dying (MAiD) has been legalized in Canada since 2016, it still excludes eligibility for persons who have mental illness as a sole underlying medical condition. This temporary exclusion was set to expire on March 17th, 2024, but was set 3 years further back by the Government of Canada to March 17th, 2027. This paper presents a critical appraisal of the case of MAiD for individuals with mental illness as the (...) sole underlying medical condition through the analysis of three ethical theories: principlism, deontology, and utilitarianism. Through evidence and discussion, it will be demonstrated that MAiD, in this context, may be ethically justifiable on the grounds of upholding human rights, protecting dignity, and minimizing suffering. Introduction In June of 2016, Medical Assistance in Dying (MAiD) was legalized in Canada.[1] Throughout the first six years, a temporary exclusion of eligibility for persons suffering solely from mental illness was extended.[2] The exclusion of mental illness as a sole underlying medical condition was set to expire on March 17, 2024.[3] However, on February 1, 2024, just over a month before the set expiration, the Government of Canada once again extended the exclusion, this time setting it back three years to March 17, 2027. There are currently several countries that allow MAiD for mental illness, including Belgium, the Netherlands, and Luxembourg.[4] Some countries, like Spain,[5] do not give specific guidance, leaving the matter under discussion by ethicists and courts. In these countries, there are specific (although different) requirements for the process; overall, for mental illness, the illness must be verifiable and not simply related to a perception of satisfaction with the length of life. This extension ignited discussion on whether MAiD for persons who have mental illness as a sole underlying medical condition in Canada is ethically acceptable. As a complex, multi-faceted, and interdisciplinary issue, ethicists assessing MAiD must take into account various moral obligations and considerations. This paper analyses MAiD in this context through the application of three ethical theories: principlism, deontology, and utilitarianism. This paper concludes that, based on the current evidence and knowledge of this developing situation, MAiD for persons with mental illness in Canada may be ethically justified on the grounds of upholding human rights, labour obligations, and dignity. Through the exploration of research and discussions, it will be demonstrated that society at large ought to protect liberty and act towards relieving suffering, thereby supporting the potential eligibility of MAiD for persons who have mental illness. Principlism: The Capacity and Ability to Assess and Decide for One’s Own Life Principlism is the application of four principles: autonomy, beneficence, non-maleficence, and justice. Principlism supports permitting MAiD for mental illness due to the importance of autonomy in decision-making, equitable and just practices for MAiD assessors, and reducing suffering for patients and their family member(s) and/or friend(s). Carter v. Canada, the Canadian Supreme Court ruling of 2015—which changed Canadian law to allow for MAiD—held that the prohibition of MAiD infringed on Canadians’ right to “life, liberty, and the security of the person.” In a unanimous decision, the Supreme Court of Canada decided that the criminal prohibition of MAiD violates the Canadian Charter of Rights and Freedoms.[6] The Court concluded that the criminal law prohibiting MAiD interfered with people’s autonomy and dignity, which are protected by the rights of liberty and security of the person.[7] The ruling emphasized that Canada’s constitution reflects the fundamental importance of individual autonomy in personal decision-making. Research provides evidence that MAiD improves autonomy: A study among psychiatric patients found that 8 of 48 psychiatric patients said the mere option of accessing MAiD was enough to assess their future options for living wholly.[8] These findings complement a study entailing interviews with 30 adults who have mental illness, which emphasized that the ability to access MAiD allows individuals to analyze their quality of life, envision their desired future, and make decisions accordingly.[9] Although not all participants agreed that mental illness as the only underlying medical condition was appropriate for MAiD eligibility, many participants agreed that patient autonomy in decision-making was paramount and should be respected. However, autonomy as an ethical principle does not immediately grant all persons with mental illness the option to access MAiD. There are multiple eligibility criteria for those who wish to receive MAiD, which still must be approved and assessed. Currently, eligibility criteria for MAiD states that individuals must “give informed consent to receive MAiD, meaning that the person has consented to receiving MAiD after they have received all information needed to make this decision.”[10] Consent requires capability or capacity, which is the ability to understand relevant information, appreciate its potential consequences, and make an informed decision for oneself.[11] Like for many other diseases, disabilities, and conditions, patient capability is determined on a case-by-case basis.[12] Given the stigma surrounding those struggling with mental health, this thorough case-by-case examination of an individual patient’s capability and capacity without prejudice or partiality should lead to equitable and fair treatment. Without appropriate testing, those with mental illness could be wrongly stripped of their decision-making power. Arguments against MAiD for those with mental illness have raised concerns about the potential for individuals to harm themselves and others. A survey of MAiD providers demonstrated that physicians believed that the bereavement experience following MAiD is challenging and profoundly distinct and that bereavement support for all members involved should be required.[13] However, while watching one die (of MAiD) may cause harm to their families, friends, and support system at large, it is also important to recognize that watching someone suffer and struggle through their mental health journey also poses significant harm. Qualitative studies in Ontario, Canada, have interviewed family members of persons with mental illness as a sole medical condition, and interviewees shared that witnessing the illness and its impacts on their close one's lives was a very difficult experience.[14] As it relates to MAiD, participants emphasized that those living with mental illness are in the best position to understand their own pain and suffering and, in turn, make their own decisions about relief.[15] In an interview, a MAiD provider stated that MAiD may provide less suffering and more peace, and that, although it “depends on the family,... usually the family is more prepared and at peace.”[16] On the contrary, a person who has mental illness may perceive choosing MAiD as beneficial to their family member(s) and/or friend(s). Among those who died by MAiD in 2021, 35.7 percent reported that they perceived themselves as a burden on their family and friends.[17] While some authors report their concerns regarding such social burden as a potential driving factor for MAiD requests, others report that there are other additional burdens associated with requesting MAiD that may be financial, societal, and personal.[18] As such, the extension of MAiD eligibility to those with mental illness will likely only allow a small number of people to be granted MAiD.[19] Many others will be diverted to appropriate services and treatments. Patients’ decision to choose MAID noted their ability to make choices about their own care, reflecting the value of autonomy.[20] Although it is difficult to determine what is good for families in individual cases, MAiD presents an option that is both beneficent and non-maleficent. Therefore, these arguments satisfy the principles which do not necessarily conflict with MAiD. Deontology: The Duty to Recognize Vulnerability and Relieve Suffering The argument here begins with the fundamental focus of deontology—that moral duty lies in an action rather than in its consequences. Further discussion is required to analyze the impact of MAiD on healthcare workers. The Canadian Medical Association (CMA) Code of Ethics and Professionalism requires physicians to abide by virtues, commitments, and responsibilities in delivering health care and service.[21] The code states that “a compassionate physician recognizes suffering and vulnerability, … and alleviate[s] the patient’s suffering.”[22] In the context of MAiD for persons with mental illness as a sole underlying medical condition, vulnerabilities could be wide in range. Many Canadians are concerned with the interaction between mental health and other social determinants of health, such as the lack of medical, disability, financial, housing, and social support and resources.[23] As a result, another layer to the ethical issue arises: Does permitting MAiD for mental illness treat the symptoms of the issue rather than the root problem itself (social, economic, and systemic inequities)? Some argue against MAiD, stating that the nation should first focus on developing better quality care and service.[24] Others support MAiD as a potential harm reduction approach, given that most of these unjust conditions require a higher level of long-term structural and public policy overhaul.[25] The CMA Code also calls upon physicians to recognize and alleviate patients’ suffering. Some argue that while physicians and medical professionals do work to relieve suffering, they are trained to do so through a primary care-based diagnose-and-treat approach.[26] Studies that have captured Canadian physicians’ experiences providing MAiD report that, although physicians stated that the work was rewarding, it came with many challenges, including strained relationships with coworkers, increased workload, and inadequate compensation.[27] Physicians report that a part of the problem is that MAiD rules are written by lawyers and experts who are removed from its reality in medical practice. As a result, there is a lack of clarity surrounding practice norms and a lack of support for physicians.[28] Thus, while healthcare practitioners have a duty to relieve patients’ suffering, they should feel adequately trained and supported in doing so. If physicians and healthcare professionals recognize vulnerability and relieve suffering, then they should act accordingly, regardless of potential associations or outcomes. Making persons with mental illness eligible for MAiD ensures that treatment to relieve their suffering is available. However, it is imperative that there are sufficient resources and support available to healthcare professionals to ensure that they feel prepared and supported to provide MAiD, should they wish to do so. Utilitarianism: Minimizing Intolerable Suffering and Dying with Dignity Overall, utilitarianism is largely concerned with the greatest happiness principle—to increase the amount of happiness for the greatest number of people. So far, this paper has analyzed individual, family, and practitioner-based ethical considerations. But if MAiD were to be extended to those with mental illness as a singular underlying medical condition, what implications would this have for the world and society at large? There is a global drive toward authorizing organized ending of life, with an increasing number of countries legalizing MAiD.[29] The medical system is generally seen as a safe and appropriate system to carry out MAiD, especially when suicide and self-harm are regarded as “alternatives.” Yet despite these worldwide efforts, many argue through the theory of utilitarianism that the inability to see long-term consequences renders MAiD a premature solution, particularly for those who are unable or unwilling to seek other forms of potentially healing treatment or for those who may undergo MAiD only for a technological innovation or biomedical advancement to later come along as a potential cure.[30] While it is true that MAiD does not prevent these “premature deaths,” it is also true that it does not claim to.[31] MAiD provides an option to alleviate intolerable suffering. Some individuals with severe mental illness do describe their condition as intolerable suffering. MAiD is seen as an option to minimize suffering. It can also be seen as a way to die with dignity and relief.[32] While predicting outcomes is difficult, extending MAiD eligibility for persons experiencing mental illness does not undermine its ability to end suffering. It allows eligible individuals to take charge of their health, their life, and their future. Conclusion Based on the current evidence, allowing MAiD for persons with mental illness as their sole underlying medical condition presents as an ethically justifiable action. The right to self-determination and fair accessibility demonstrates that there is more harm done by prohibiting MAiD for mental illness than allowing it. Such liberty is a right, and in the context of relieving suffering, it is a duty that healthcare workers must uphold, although the ability to opt out of providing MAiD is well established. Thus, to recognize vulnerability and relieve suffering means to provide methods, such as MAiD, for those deeply impacted by mental illness. These justifications stand at both the individual level and for society at large. Nevertheless, it remains imperative to take an upstream approach that addresses the social determinants of health and aims to prevent mental illness and promote long-term, beneficial social change for those suffering, struggling, and vulnerable in our communities. - [1] Jaro Kotalik and David W. Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives, 1st ed. 2023., The International Library of Bioethics, 104 (Cham: Springer International Publishing, 2023), https://doi.org/10.1007/978-3-031-30002-8. [2] Department of Justice Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law,” February 21, 2024, https://www.justice.gc.ca/eng/cj-jp/ad-am/bk-di.html. [3] Health Canada, “Final Report of the Expert Panel on MAiD and Mental Illness,” transparency - other, May 13, 2022, https://www.canada.ca/en/health-canada/corporate/about-health-canada/public-engagement/external-advi sory-bodies/expert-panel-maid-mental-illness/final-report-expert-panel-maid-mental-illness.html. [4] Federal Public Service (FPS) Health Belgium, “Federal Commission for the Control and Evaluation of Euthanasia,” n.d., https://consultativebodies.health.belgium.be/en/advisory-and-consultative-bodies/federal-commission- control-and-evaluation-euthanasia.; Government of Netherlands, “Is Euthanasia Allowed in the Netherlands?,” n.d., https://www.government.nl/topics/euthanasia/is-euthanasia-allowed.; “Information on Requesting Euthanasia or Assisted Suicide,” n.d., https://guichet.public.lu/en/citoyens/sante/fin-vie/euthanasie/euthanasie-assistance-suicide.html. [5] Luis Espericueta, First official report on euthanasia in Spain: A comparison with the Canadian and New Zealand experiences, Medicina Clínica (English Edition), Volume 161, Issue 10, 2023, Pages 445-447, ISSN 2387-0206, https://doi.org/10.1016/j.medcle.2023.06.021. [6] Government of Canada, “The Canadian Charter of Rights and Freedoms,” March 15, 2021, https://www.justice.gc.ca/eng/csj-sjc/rfc-dlc/ccrf-ccdl/. [7] Supreme Court of Canada, “Carter v. Canada,” Constitutional Law, 2015, https://scc-csc.lexum.com/scc-csc/scc-csc/en/item/14637/index.do.; Kotalik and Shannon, Medical Assistance in Dying (MAID) in Canada Key Multidisciplinary Perspectives. [8] Karandeep Sonu Gaind, “What Does ‘Irremediability’ in Mental Illness Mean?,” Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie 65, no. 9 (September 2020): 604–6, https://doi.org/10.1177/0706743720928656; Lieve Thienpont et al., “Euthanasia Requests, Procedures and Outcomes for 100 Belgian Patients Suffering from Psychiatric Disorders: A Retrospective, Descriptive Study,” BMJ Open 5, no. 7 (July 27, 2015): e007454, https://doi.org/10.1136/bmjopen-2014-007454. [9] Hamer Bastidas-Bilbao et al., “Walking Alongside: Views of Family Members on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Qualitative Health Research 33 (September 29, 2023), https://doi.org/10.1177/10497323231197365. [10] Government of Canada, “Canada’s Medical Assistance in Dying (MAID) Law.” [11] Commission sur les soins de fin de vie, “Les conditions de l’admissibilité à l’aide médicale à mourir au Québec: la constance dans l’évolution de la loi concernant les soins de fin de vie,” June 9, 2023, https://csfv.gouv.qc.ca/ fileadmin/docs/autres_rapports/csfv_lcsfv_conditions_ amm_2023-06-29.pdf.; Trudo Lemmens, “When Death Becomes Therapy: Canada’s Troubling Normalization of Health Care Provider Ending of Life,” The American Journal of Bioethics 23, no. 11 (November 2, 2023): 79–84, https://doi.org/10.1080/15265161.2023.2265265. [12] Justine Dembo, Udo Schuklenk, and Jonathan Reggler, “‘For Their Own Good’: A Response to Popular Arguments Against Permitting Medical Assistance in Dying (MAID) Where Mental Illness Is the Sole Underlying Condition,” Canadian Journal of Psychiatry. Revue Canadienne De Psychiatrie 63, no. 7 (July 2018): 451–56, https://doi.org/10.1177/0706743718766055. [13] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020). [14] Bastidas-Bilbao et al., “Walking Alongside.” [15] Bastidas-Bilbao et al. [16] Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” 2020. [17] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025; Health Canada, “Third Annual Report on Medical Assistance in Dying in Canada 2021,” report on plans and priorities;transparency - other, July 26, 2022, https://www.canada.ca/en/health-canada/services/publications/health-system-services/annual-report-me dical-assistance-dying-2021.html; Lemmens, “When Death Becomes Therapy.” [18] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023.; Bastidas-Bilbao et al., “Walking Alongside.” [19] Olivia Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News,” Canadian Broadcasting Corporation, January 28, 2024, https://www.cbc.ca/news/politics/special-joint-committee-maid-mental-illness-report-1.7095679; Benjamin Lopez Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News,” Canadian Broadcasting Corporation, October 27, 2023, https://www.cbc.ca/news/politics/maid-canada-report-2022-1.7009704. [20] Hamer Bastidas-Bilbao et al., “Searching for Relief from Suffering: A Patient-Oriented Qualitative Study on Medical Assistance in Dying for Mental Illness as the Sole Underlying Medical Condition,” Social Science & Medicine 331 (August 1, 2023): 116075, https://doi.org/10.1016/j.socscimed.2023.116075. [21] Canadian Medical Association, “Canadian Medical Association Code of Ethics and Professionalism” (Canada: Canadian Medical Association, December 8, 2018), https://policybase.cma.ca/link/policy13937. [22] Canadian Medical Association. [23] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Stefanovich, “Opposition Parties Call for Indefinite Pause to MAID Expansion for Mental Illness | CBC News.” [24] John Paul Tasker, “Liberal Government Promoting a ‘culture of Death’ with Medical Assistance in Dying Law, Conservative MP Says | CBC News,” Canadian Broadcasting Corporation, March 6, 2023, https://www.cbc.ca/news/politics/culture-of-death-medical-assistance-in-dying-mental-illness-1.67695 04. [25] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023; Kayla Wiebe and Amy Mullin, “Choosing Death in Unjust Conditions: Hope, Autonomy and Harm Reduction,” Journal of Medical Ethics, April 26, 2023, https://doi.org/10.1136/jme-2022-108871. [26] Ramona Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” Palliative & Supportive Care 21, no. 5 (October 2023): 871–78, https://doi.org/10.1017/S1478951523001025. [27] Konia Trouton et al., “Attitudes and Expectations Regarding Bereavement Support for Patients, Family Members, and Friends: Findings from a Survey of MAID Providers,” British Columbia Medical Journal 62, no. 1 (2020), https://bcmj.org/articles/attitudes-and-expectations-regarding-bereavement-support-patients-family-m embers-and.; William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 9, 2021): 93–98, https://doi.org/10.7202/1084456ar. [28] Coelho et al., “The Realities of Medical Assistance in Dying in Canada,” October 2023. [29] Lemmens, “When Death Becomes Therapy.” [30] William Robert Nielsen, “MAiD in Canada: Ethical Considerations in Medical Assistance in Dying,” Canadian Journal of Bioethics 4, no. 2 (December 1, 2021): 93–98, https://doi.org/10.7202/1084456ar. [31] Steven, “Number of Assisted Deaths Jumped More than 30 per Cent in 2022, Report Says | CBC News.” [32] A. Plaisance et al., “Quebec Population Highly Supportive of Extending Medical Aid in Dying to Incapacitated Persons and People Suffering Only from a Mental Illness: Content Analysis of Attitudes and Representations,” Ethics, Medicine and Public Health 21 (April 1, 2022): 100759, https://doi.org/10.1016/j.jemep.2022.100759. (shrink)

Introduction Informed consent is a body of shared decision-making process and voluntary authorization of patients to receive medical or surgical intervention. There are limited studies conducted so far to examine the practice of informed consent in Ethiopia. This study aimed to assess the practice of informed consent process for surgery and Anesthesia. Method A cross-sectional study was conducted from March to May 2019. The data were collected using interviewer-administered structured questionnaire and analyzed in SPSS version 23. Results A total of (...) 139 patients were interviewed in this study. Most 42(30.2%) of patients were in the age group of 29–38 years. Nearly half 68 (48.9%) of the patients were informed the benefits of the surgical procedure and 78(56.1%) of the patients were informed on the type of anesthesia to be administered while 65 (46.8%) were not informed on any complication related to the anesthesia. About 66 (47.5%) of patients were informed on alternatives to the surgery. Of these patients, 39(59%) were not informed of any benefits and possible risks associated with the alternative modes of treatment. About half (54%) of the patients were reported as they were understood the information provided during the pre-operative informed consent process. Conclusion This research revealed that patients were inadequately informed on the complications of proposed procedure, alternative forms of treatment, risks and benefits of the proposed procedure. Therefore, healthcare providers should provide adequate information regarding the proposed procedure and make sure whether patients understood the risks and benefits before the consent. (shrink)

According to the judgement of the European Court of Justice in 2014, human parthenogenetic stem cells are excluded from the patenting prohibition of procedures based on hESC by the European Biopatent Directive, because human parthenotes are not human embryos. This article is based on the thesis that in light of the technological advances in the field of stem cell research, the attribution of the term ‘human embryo’ to certain entities on a descriptive level as well as the attribution (...) of a normative protection status to certain entities based on the criterion of totipotency, are becoming increasingly unclear. The example of human parthenotes in particular demonstrates that totipotency is not at all a necessary condition for the attribution of the term ‘human embryo’. Furthermore, the example of hiPSC and somatic cells particularly shows that totipotency is also not a sufficient condition for the attribution of a normative protection status to certain entities. Therefore, it is not a suitable criterion for distinguishing between human embryos worthy of protection and human non-embryos not worthy of protection. Consequently, this conclusion has repercussions for the patenting question. The strict delineation between an ethically problematic commercial use of human embryos and the concomitant patenting prohibition of hESC-based procedures and an ethically unproblematic commercial use of human non-embryos and the therefore either unrestrictedly permitted or even unregulated patenting of procedures based on these alleged alternatives becomes increasingly blurred. (shrink)