The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants (empathy focused). The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols (analytic focused). Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire (...) for information, hopes about participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics. (shrink)

The effects of research ethics training on medical students' attitudes about clinical research are examined. A preliminary randomized controlled trial evaluated 2 didactic approaches to ethics training compared to a no-intervention control. The participant-oriented intervention emphasized subjective experiences of research participants. The criteria-oriented intervention emphasized specific ethical criteria for analyzing protocols. Compared to controls, those in the participant-oriented intervention group exhibited greater attunement to research participants' attitudes related to altruism, trust, quality of relationships with researchers, desire for information, hopes about (...) participation and possible therapeutic misconception, importance of consent forms, and deciding quickly about participation. The participant-oriented group also agreed more strongly that seriously ill people are capable of making their own research participation decisions. The criteria-oriented intervention did not affect learners' attitudes about clinical research, ethical duties of investigators, or research participants' decision making. An empathy-focused approach affected medical students' attunement to research volunteer perspectives, preferences, and attributes, but an analytically oriented approach had no influence. These findings underscore the need to further examine the differential effects of empathy-versus analytic-focused approaches to the teaching of ethics. (shrink)

In this paper, I consider a variety of objections against the covering-law model of scientific explanation, show that Aristotle was already aware of them and had solutions for them, and argue that these solutions are correct. These solutions involve the notions of nonHumean causality and of essential properties. There are a great many familiar objections, both methodological and epistemological, to introducing these concepts into the methodology of science, but I show that these objections are based upon misunderstandings of these concepts.

The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

This paper distinguishes four major types of futility (physiological, imminent demise, lethal condition, and qualitative) that have been advocated in the literature either in a patient dependent or a patient independent fashion. It proposes five criteria (precision, prospective, social acceptability, significant number, and non-agreement) that any definition of futility must satisfy if it is to serve as the basis for unilaterally limiting futile care. It then argues that none of the definitions that have been advocated meet the criteria, primarily because (...) their proponents have not paid sufficient attention to the problematic nature of the data supporting the use of their definitions. (shrink)

Until a few years ago, the works of Thomas Reid were known only by specialists in the history of philosophy, and, insofar as people did think at all about Reid and his school of common sense philosophy, it was generally thought that Kant had been right in dismissing them as naive thinkers who did not really understand what philosophical skepticism was all about. This attitude about Reid changed very rapidly in recent years. More and more people now realize that Reid (...) was one of the most important British philosophers, and that his works are full of deep insights that have only recently been rediscovered. (shrink)

There is a growing interest in comparison of international health care data with the hope that such studies will enable individual systems to learn from other systems. Such comparisons, however, presuppose that there exist common criteria for evaluating health care systems. The main thesis of this paper is that these comparative studies are misleading because they employ inappropriate operationalizations of these criteria because the operarionalizations are based upon mistaken global conceptualizations of the criteria in question. The essay provides a methodological (...) critique of what has been done and sets a new agenda for future research. (shrink)

This is the first textbook of surgical ethics. It is a practical, clinically comprehenive, well-organized guide to ethical issues in surgical practice, research, and education written by leading figures in surgery and bioethics. The authors cover the surgeon-patient relationship, the full range of surgical patients, surgical education and research, and surgery and managed care. Their chapters are not abstract discussions of ethical principles; rather, they connect directly with the everyday concerns of practicing surgeons.

The European patent system allows for the introduction of moral issues into decisions about the granting of patents. This feature has.

The first book to be devoted to the logic behind the application of ethical theories, this collection of essays explores the question of how many different moral traditions (utilitarianism, natural rights theory, Marxism, Christian moral theology, and Kantianism among others) view the relation between theory and concrete judgments. By considering many applications of moral theory in medical ethics the authors illustrate their point.

Background If trials of therapeutic interventions are to serve society's interests, they must be of high methodological quality and must satisfy moral commitments to human subjects. The authors set out to develop a clinical - trials compendium in which standards for the ethical treatment of human subjects are integrated with standards for research methods. Methods The authors rank-ordered the world's nations and chose the 31 with >700 active trials as of 24 July 2008. Governmental and other authoritative entities of the (...) 31 countries were searched, and 1004 English-language documents containing ethical and/or methodological standards for clinical trials were identified. The authors extracted standards from 144 of those: 50 designated as ‘core’, 39 addressing trials of invasive procedures and a 5% sample of the remainder. As the integrating framework for the standards we developed a coherent taxonomy encompassing all elements of a trial's stages. Findings Review of the 144 documents yielded nearly 15 000 discrete standards. After duplicates were removed, 5903 substantive standards remained, distributed in the taxonomy as follows: initiation, 1401 standards, 8 divisions; design, 1869 standards, 16 divisions; conduct, 1473 standards, 8 divisions; analysing and reporting results, 997 standards, four divisions; and post-trial standards, 168 standards, 5 divisions. Conclusions The overwhelming number of source documents and standards uncovered in this study was not anticipated beforehand and confirms the extraordinary complexity of the clinical trials enterprise. This taxonomy of multinational ethical and methodological standards may help trialists and overseers improve the quality of clinical trials, particularly given the globalisation of clinical research. (shrink)

Lou Goble proposed powerful conditional deontic logics (CDPM) that are able to deal with deontic conflicts by means of restricting the inheritance principle. One of the central problems for dyadic deontic logics is to properly treat the restricted applicability of the principle “strengthening the antecedent”. In most cases it is desirable to derive from an obligation A under condition B, that A is also obliged under condition B and C. However, there are important counterexamples. Goble proposed a weakened rational monotonicity (...) principle to tackle this problem. This solution is suboptimal as it is for some examples counter-intuitive or even leads to explosion. The paper identifies also other problems of Goble’s systems. For instance, to make optimal use of the restricted inheritance principle, in many cases the user has to manually add certain statements to the premises. An adaptive logic framework based on CDPM is proposed which is able to tackle these problems. It allows for certain rules to be applied as much as possible. In this way counter-intuitive consequences as well as explosion can be prohibited and no user interference is required. Furthermore, for non-conflicting premise sets the adaptive logics are equivalent to Goble’s dyadic version of standard deontic logic. (shrink)

Huddle (2010) claims that the Association of American Medical Colleges (AAMC), in advocating the exclusion of pharmaceutical detail representatives from academic medical centers, erred in placing t...

Morality based upon categorical imperatives. On a supposed right to tell lies from benevolent motives, by I. Kant.--Utilitarian morality, by H. Sidgwick.--What makes right acts right? by Sir D. Ross.--Utilitarianism, universalisation, and our duty to be just, by J. Harrison.--Extreme and restricted utilitarianism, by J. J. C. Smart.--What if everyone did that? by C. Strang.--Toward a credible form of utilitarianism, by R. B. Brandt.

This paper argues, contrary to what has sometimes been claimed, that public commissions need to be more philosophical than they have been in analyzing crucial bioethical issues. It argues (a) that the failure of the President's Commission to develop and use even simple distinctions between life and personhood led to flaws in both its discussion of death and its discussion of persistent vegetative patients, and (b) that its treatment of access to health care fails to develop a coherent approach precisely (...) because it is based on no serious philosophical reflections about justice in health care. Keywords: justice in health care, life, persistent vegetative patients, personhood, President's Commission on Bioethics CiteULike Connotea Del.icio.us What's this? (shrink)

In this paper questions are raised about the use of Halakhic material discussions of medical ethics. Three ways in which one might use Halakhic material in such discussions are distinguishes: (a) as a source for ideas about medical ethics which can be defended independently of their origin; (b) as a basis for mandating certain forms of behaviour for members of the Jewish faith; (c) as the basis for claims about the Jewish view on disputed topics in medical ethics. The first (...) two raise no methodical problems. The third use raises a number of theoretical and practical issues, with which the paper is concerned. Several problems stem from the fact that Halakhah distinguishes between obligations, fulfilment of which is required for all people. With rare exceptions, the obligations imposed up on the Jewish people are more stringent. The pitfall lurking the in third of the three uses is that authors using Halakhic material may correctly conclude that obligations that are supposed to fall only upon the Jewish people fall upon all people. An analysis of this problem follows, along with a plea for a responsible use of Halakhic material in the third way, so as to avoid certain real pitfalls. CiteULike Connotea Del.icio.us What's this? (shrink)

Autophagy functions in both selective and non‐selective ways to maintain cellular homeostasis. Endoplasmic reticulum autophagy (ER‐phagy) is a subclass of autophagy responsible for the degradation of the endoplasmic reticulum through selective encapsulation into autophagosomes. ER‐phagy occurs both under physiological conditions and in response to stress cues, and plays a crucial role in maintaining the homeostatic control of the organelle. Although specific receptors that target parts of the ER membrane, as well as, internal proteins for lysosomal degradation have been identified, the (...) molecular regulation of ER‐phagy has been elusive. Recent work has uncovered novel regulators of ER‐phagy that involve post‐translational modifications of ER‐resident proteins and functional cross‐talk with other cellular processes. Herein, we discuss how morphology affects the function of the peripheral ER, and how ER‐phagy modulates the turnover of this organelle. We also address how ER‐phagy is regulated at the molecular level, considering implications relevant to human diseases. (shrink)

Our goal in this paper is two-fold. First, we aim to clarify two ways in which contemporary Christian bioethicists have erred, on Engelhardt’s account, in their attempts to do bioethics within a distinctively non-Christian idiom, namely, either (1) by rejecting a principal metaethical thesis or (2) by misrepresenting a principal moral-epistemological thesis of natural-law ethics, properly construed. Second, we intend to show not only that Engelhardt can and should endorse the Christian bioethicists’ use of non-Christian moral idioms in the public (...) square but also—perhaps to the surprise both of his critics and of his supporters—that he does, in fact, do so. (shrink)

The aim of this paper is to offer an account of epistemic justification suitable for the context of theory pursuit, that is, for the context in which new scientific ideas, possibly incompatible with the already established theories, emerge and are pursued by scientists. We will frame our account paradigmatically on the basis of one of the influential systems of epistemic justification: Laurence Bonjour’s coherence theory of justification. The idea underlying our approach is to develop a set of criteria which indicate (...) that the pursued system is promising of contributing to the epistemic goal of robustness of scientific knowledge and of developing into a candidate for acceptance. In order to realize this we will (a) adjust the scope of Bonjour’s standards—consistency, inferential density, and explanatory power, and (b) complement them by the requirement of a programmatic character. In this way we allow for the evaluation of the “potential coherence” of the given epistemic system. (shrink)

Med hjemmel i de lovfestede spesielle god skikk-reglene har flere yrker utformet yrkesetiske regler med en lovmessig forankring. Denne artikkelen tar utgangspunkt i fem yrker og gir en juridisk analyse av god revisorskikk, god advokatskikk, god regnskapsføringsskikk, god meglerskikk og god landmålerskikk. Formålet er å sammenligne den rettslige betydningen av disse SGS-reglene. De sammenlignes ut fra hjemmelsgrunnlaget og hvilken bransjeorganisasjon som har utformet de yrkesetiske reglene, autorisasjonsordning og en hypotese om at de yrkesetiske reglene inneholder følgende elementer: profesjonsansvar, integritet, objektivitet, (...) taushetsplikt og kompetansekrav.Sammenligningen viser at lovfestede SGS-regler har ført til at de aktuelle bransjeorganisasjonene har tatt ansvar for å utforme de yrkesetiske reglene. Når det gjelder autorisasjonsordningen, har Finanstilsynet ansvaret for autorisasjonene til revisorer, regnskapsførere og eiendomsmeglere. For advokater har Tilsynsrådet for advokatvirksomhet ansvaret for å føre tilsyn med advokatbevillingene, mens landmålerne ikke er underlagt en autorisasjonsordning.Analysen viser at en finner de fem elementene både i god revisorskikk, god advokatskikk, god regnskapsføringsskikk og god landmålerskikk. God meglerskikk er derimot svært forskjellig fra de andre yrkesetiske reglene. Samlet viser analysene at de yrkesetiske reglene har en viss rettslig betydning, selv om den varierer.Nøkkelord: lovfestede god skikk-regler, yrkesetiske reglerEnglish summary: The significance of ethical rules based on legislated rules for Code of ConductIn accordance with statutory authority rules for Code of conduct, several professions have designed ethical rules with a legal foundation. This article is based on a legal analysis of CoC for auditors, lawyers, accountants, real estate agents and for land surveyors. The purpose of the article is to compare the legal significance of these rules for the CoC. The various rules for CoC are compared in terms of their legal basis, the professional organisation which has designed the professional ethical rules and the system of authorisation. The rules for CoC are also compared in a hypothesis about five elements. The hypothesis is that the ethical rules contain the following elements: professionalism, integrity, objectivity, confidentiality and competency.The comparison shows that legislated rules for CoC have enabled the relevant professional organisations to take responsibility for designing professional ethical rules. In the case of system of authorisation, the «Financial Supervisory Authority of Norway» is responsible for authorising auditors, accountants and real estate agents. For lawyers the «Supervisory Council For Legal Practice» is responsible for supervising their authorisation, whereas land surveyors are not subject to an authorisation system – either public or professional.The analysis shows that one can find all five elements in the CoC for auditors, lawyers, accountants, and land surveyors. The CoC for real estate agents, however, is different from the other ethical rules. Overall, the analysis shows that the ethical rules have a certain legal significance, although it varies. (shrink)

I Norge er ikke surrogati tillatt, og myndighetene fraråder norske statsborgere å benytte seg av surrogati i utlandet. I denne artikkelen fokuserer vi på kommersiell gestational surrogati og stiller spørsmålet: Bør man tillate at norske statsborgere benytter seg av surrogati i India? De etiske problemstillingene rundt surrogati er mange og sammensatte og blir spesielt utfordrende når tjenesten tilbys i et land med store kulturelle og økonomiske forskjeller både internt og i forhold til Norge. Vi baserer analysen og drøftingen av dette (...) etisk utfordrende spørsmålet på Beauchamps og Childress sin veletablerte metodiske tilnærming innen biomedisinsk etikk. Vi anvender de fire allmennmoralske prinsipper: respekt for autonomi, velgjørenhet, ikke-skade og rettferdighet på sakskomplekset for å synliggjøre spenningene involvert i dette etiske dilemmaet. Med full bevissthet om at det ikke finnes noen lettvinte og omkostningsfrie løsninger på dilemmaer generelt og dette spesielt, konkluderer vi med at interessene til de berørte parter, og spesielt surrogatmødrenes, kan bli bedre ivaretatt om surrogati tillates under omfattende reguleringer. Dersom man velger å gjøre praksisen illegal, vil man også miste mulighetene til å påvirke prosessen og sikre rettighetene til de involverte partene.Nøkkelord: surrogati, Norge–India, utnyttelse, autonomi, regulering av prosessenEnglish summary: Should Norwegian citizens be permitted to use surrogacy in India?Surrogacy is not permitted in Norway, and the government strongly advises against Norwegian citizens travelling abroad to have children through the use of the surrogacy industry. In this article, we focus on commercial gestational surrogacy and debate the question: Should Norwegian citizens be permitted to use surrogacy in India? The ethical concerns regarding surrogacy are complex and are especially challenging when the service is offered in a country with big cultural and economic differences both internal and in comparison to Norway. We base our analysis of this ethical, challenging question on Beauchamp’s and Childress’s well-established approach within biomedical ethics. We apply the four principles of respect for autonomy, beneficence, nonmaleficence and justice to shed light on the conflicts of interests in this ethical dilemma. With full awareness that there are no simple and correct solutions to dilemmas in general and on this issue, especially, our conclusion is that the interests of the involved parties, and especially those of the surrogate mothers, might be better attended to if surrogacy is allowed with extensive regulations. If this practice is made illegal, the opportunity to influence the process and secure the rights of the involved parties is lost. (shrink)

Background Caring behaviour is critical for nursing quality, and the clinical internship environment is a crucial setting for preparing nursing students for caring behaviours. Evidence about how to develop nursing students’ caring behaviour in the clinical environment is still emerging. However, the mechanism between the clinical internship environment and caring behaviour remains unclear, especially the mediating role of moral sensitivity and the moderating effect of self-efficacy. Research objective This study aimed to examine the mediating effect of moral sensitivity and the (...) moderating function of self-efficacy on the association between the clinical internship environment and caring behaviours. Research design A cross-sectional design used acceptable validity scales. The hypothesised moderated mediation model was tested in the SPSS PROCESS macro. Participants and research context This survey collected data from 504 nursing students in an internship at a teaching hospital in Changsha, China. Ethical considerations This study was pre-approved by the ethics committee of the medical school (No. E2022210). Informed consent was obtained from all students. Results The clinical internship environment ( B = 0.450, 95% CI = [0.371, 0.530]) and moral sensitivity ( B = 1.352, 95% CI = [1.090, 1.615]) had positive direct effects on nursing students' caring behaviours. Clinical internship environment also indirectly influenced students’ caring behaviours via moral sensitivity ( B = 0.161, 95% CI = [0.115, 0.206]). In addition, self-efficacy played a moderating role between the clinical internship environment and caring behaviours ( B = 0.019, 95% CI = [0.007, 0.031]), as well as the relationship between the clinical internship environment and moral sensitivity ( B = 0.006, 95% CI = [0.003, 0.010]). Conclusion Moral sensitivity mediates the effect of the clinical internship environment on caring behaviour, and self-efficacy strengthens both direct and indirect effects. This study emphasises the importance of self-efficacy in developing moral sensitivity and caring behaviours in nursing students. (shrink)

What is human reason, how did it arise, how is it connected to animal reason? In The Enigma of Reason (ER) Hugo Mercier and Dan Sperber (2017) suggest that reason evolved driven by the need to support communication and coordination in small human groups. They contrast this to the idea that the function of reason is to enable humans to make better decisions and develop more accurate beliefs. After a summation of the ER argument, the theory is critiqued and two (...) of their assumptions -- that human cognition is based on massive modularity and that reason co-evolved with and is dependent upon language -- are challenged. Alternatives to these assumptions are presented from the perspective of pattern matching processes in neural dynamical systems, which it is asserted provides a more realistic approach to the functioning of the brain and mind. (shrink)

Die religionstheologische Hermeneutik der Gegenwartskultur ist zu einem grundlegenden Forschungsfeld einer sich als Theorie der Religionspraxis verstehenden Praktischen Theologie geworden. Das Asthetische ist als eine zentrale Dimension des Kulturellen deshalb neu in den Mittelpunkt der Aufmerksamkeit geruckt. Die Erforschung der Zusammenhange von <I>Asthetik und Religion steht jedoch erst am Anfang. Mit dem Band kann ein teilweiser Uberblick uber den Stand der Diskussion zum Thema <I>Identitat und Differenz von asthetischer und religioser Erfahrung gegeben werden. Er bietet eine Zusammenschau unterschiedlicher Zugange zu (...) den Phanomenen bzw. differenter Theoriestrategien und weist Perspektiven fur den interdisziplinaren Diskurs auf, in denen die theoretischen Voraussetzungen und methodischen Massgaben fur die Verhaltnisbestimmung von religioser und asthetischer Erfahrung zu klaren sind.". (shrink)

If the slogan "No entity without identity" might be said to encapsulate the new essentialism, it has in any case been felt to serve the working ontologist as a powerful tool for ruling out certain dubious entities. The first half of Baruch Brody’s book consists in a radical "critique of this whole philosophical tradition," as it is seen to be "based upon a fundamental erroneous assumption," namely that "the truth-conditions of claims concerning identity vary as the type of entity (...) in question varies." In fact no such parochial identity conditions need be invoked according to Brody, seeing that the Principle of the Identity of Indiscernibles will suffice to define identity in omnibus fashion across the board, even to the extent of being "understood by those who want to learn the meaning of ‘identity'.". (shrink)

I dette bogkapitel skrevet sammen med Ingeborg Ilkjær fremlægges tre etiske positioner herunder dydsetik, pligtetik og konsekvensetik. Disse teorier er sammen med eksempler på etiske principper og værdier det grundlag, som sygeplejersker kan benytte sig af i arbejdet med patientinvolvering og etiske dilemma, hvor der skal foretages et valg, der har betydning for patienter, pårørrende og de klinisk involverede. -/- For at kunne træffe valg af denne art er det vigtigt at kunne gøre det på et oplyst grundlag samt at (...) kunne påtage sig et klinisk lederskab. Derfor er det nødvendigt at benytte sig af en etisk refleksionsmodel. Dette arbejde kan være med til at skabe klarhed over en given situation, der rummer vanskelige etiske dilemmaer. -/- Bogkapitlet findes i bogen Sygepleje & Patientinvolvering Bind 3 redigeret af Steen Hundborg og udgivet på FADL’s Forlag I 2019. (shrink)