Surgical ethics is a well-recognized field in clinical ethics, distinct from medical ethics. It includes at least a dozen important issues common to surgery that do not exist in internal medicine simply because of the differences in their practices. But until now there has been a tendency to include ethical issues of anesthesiology as a part of surgical ethics. This may mask the importance of ethical issues in anesthesiology, and even help perpetuate an unfortunate view that surgeons are “captain of (...) the ship” in the operating theater (leaving anesthesiologists in a subservient role).We will have a better ethical understanding if we see surgery and anesthesia as two equal partners, ethically as well as in terms of patient care. Informed consent is one such issue, but it is not limited to that. Even on the topic of what type of anesthesia to use, anesthesiologists have often felt subsumed to the surgeon’s preferences. This commentary takes the case study and uses it as a exemplar for this very claim: it is time to give due recognition for a new field in clinical ethics, ethics in anesthesia. (shrink)

Surgical ethics is a well-recognized field in clinical ethics, distinct from medical ethics. It includes at least a dozen important issues common to surgery that do not exist in internal medicine simply because of the differences in their practices. But until now there has been a tendency to include ethical issues of anesthesiology as a part of surgical ethics. This may mask the importance of ethical issues in anesthesiology, and even help perpetuate an unfortunate view that surgeons are “captain of (...) the ship” in the operating theater (leaving anesthesiologists in a subservient role. We will have a better ethical understanding if we see surgery and anesthesia as two equal partners, ethically as well as in terms of patient care. Informed consent is one such issue, but it is not limited to that. Even on the topic of what type of anesthesia to use, anesthesiologists have often felt subsumed to the surgeon’s preferences. This commentary takes the case study and uses it as a exemplar for this very claim: it is time to give due recognition for a new field in clinical ethics, ethics in anesthesia. (shrink)

Our aim is to expand the regulative ideal governing consent. We argue that consent should not only be informed but also based on rational beliefs. We argue that holding true beliefs promotes autonomy. Information is important insofar as it helps a person to hold the relevant true beliefs. But in order to hold the relevant true beliefs, competent people must also think rationally. Insofar as information is important, rational deliberation is important. Just as physicians should aim to provide (...) relevant information regarding the medical procedures prior to patients consenting to have those procedures, they should also assist patients to think more rationally. We distinguish between rational choice/action and rational belief. While autonomous choice need not necessarily be rational, it should be based on rational belief. The implication for the doctrine of informed consent and the practice of medicine is that, if physicians are to respect patient autonomy and help patients to choose and act more rationally, not only must they provide information, but they should care more about the theoretical rationality of their patients. They should not abandon their patients to irrationality. They should help their patients to deliberate more effectively and to care more about thinking rationally. We illustrate these arguments in the context of Jehovah's Witnesses refusing life-saving blood transfusions. Insofar as Jehovah's Witnesses should be informed of the consequences of their actions, they should also deliberate rationally about these consequences. (shrink)

The concept of information can be viewed from two perspectives, namely epistemic and ontological. In the epistemic view, information is associated with meaning, semantics, and knowledge, while in the ontological view, it is understood as structures and forms of objects. Information is most often perceived as epistemic information, yet a closer look at epistemic information reveals that this concept does not account for ontological information. This paper poses the following question: Should we select epistemic (...) or ontological information as our primary concept of information, or should we acknowledge that both kinds of information are required for a full comprehension? The discussion here is supported by references to modern research in physics, computing, cosmology, and information sciences. (shrink)

The exponential digitization of medical data has led to a transformation of the practice of medicine. This change notably raises a new complexity of issues surrounding health IT. The proper use of these communication tools, such as telemedicine, e-health, m-health the big medical data, should improve the quality of monitoring and care of patients for an information system to "human face". Faced with these challenges, the author analyses in an ethical angle the patient-physician relationship, sharing, transmission and storage of (...) medical information, setting pins to an ethic for the digitization of medical information. Drawing on good practice recommendations closely associated with values, this model is developing tools for reflection and present the keys to understanding the decision-making issues that reflect both the technological constraints and the complex nature of human reality in medicine. (shrink)

Purpose: The method of diagnosing diabetic retinopathy (DR) through artificial intelligence (AI)-based systems has been commercially available since 2018. This introduces new ethical challenges with regard to obtaining informed consent from patients. The purpose of this work is to develop a checklist of items to be disclosed when diagnosing DR with AI systems in a primary care setting. -/- Methods: Two systematic literature searches were conducted in PubMed and Web of Science databases: a narrow search focusing on DR and a (...) broad search on general issues of AI-based diagnosis. An ethics content analysis was conducted inductively to extract two features of included publications: (1) novel information content for AI-aided diagnosis and (2) the ethical justification for its disclosure. -/- Results: The narrow search yielded n = 537 records of which n = 4 met the inclusion criteria. The information process was scarcely addressed for primary care setting. The broad search yielded n = 60 records of which n = 11 were included. In total, eight novel elements were identified to be included in the information process for ethical reasons, all of which stem from the technical specifics of medical AI. -/- Conclusions: Implications for the general practitioner are two-fold: First, doctors need to be better informed about the ethical implications of novel technologies and must understand them to properly inform patients. Second, patient's overconfidence or fears can be countered by communicating the risks, limitations, and potential benefits of diagnostic AI systems. If patients accept and are aware of the limitations of AI-aided diagnosis, they increase their chances of being diagnosed and treated in time. (shrink)

Informed consent is thought to exist as a well-defined entity. Altered concepts of patient autonomy, differential cultural understanding of the entity, and the failure of clients to distinguish between research and clinical ethics, and various hierarchical cultural views of informed consent all suggest that alterations may be needed in the traditional concept. By using the methodology outlined by Gasking in which he defines the idea of “cluster concepts,” one may be able to enlarge the definition and augment the understanding of (...) the informed consent and include the time and culture-specific variants which exist. (shrink)

The study tests the hypothesis that conditional probability judgments can be influenced by causal links between the target event and the evidence even when the statistical relations among variables are held constant. Three experiments varied the causal structure relating three variables and found that (a) the target event was perceived as more probable when it was linked to evidence by a causal chain than when both variables shared a common cause; (b) predictive chains in which evidence is a cause of (...) the hypothesis gave rise to higher judgments than diagnostic chains in which evidence is an effect of the hypothesis; and (c) direct chains gave rise to higher judgments than indirect chains. A Bayesian learning model was applied to our data but failed to explain them. An explanation-based hypothesis stating that statistical information will affect judgments only to the extent that it changes beliefs about causal structure is consistent with the results. (shrink)

To be true of every experience, the axioms of Integrated information theory are necessarily basic properties and should not be “over-psychologized.” Information, for example, merely asserts that experience is specific, not generic. It does not require “access.” The information a system specifies about itself in its current state is revealed by its unfolded cause–effect structure and quantified by its integrated information.

The 2014 Varsity Medical Ethics debate convened upon the motion: “This house believes that genetic information should not be commoditised”. This annual debate between students from the Universities of Oxford and Cambridge, now in its sixth year, provided the starting point for arguments on the subject. The present article brings together and extends many of the arguments put forward during the debate. We explore the circumstances under which genetic material should be considered patentable, the possible effects of this on (...) the research and development of novel therapeutics, and the need for clear guidelines within this rapidly developing field. (shrink)

Theory of Mind (ToM), the cognitive capacity to attribute internal mental states to oneself and others, is a crucial component of social skills. Its formal study has become important, witness recent research on reasoning and information update by intelligent agents, and some proposals for its formal modelling have put forward settings based on Epistemic Logic (EL). Still, due to intrinsic idealisations, it is questionable whether EL can be used to model the high-order cognition of ‘real’ agents. This manuscript proposes (...) a framework that takes visibility, memory, perspective and communication as the main factors underpinning mental attributions. This is more in-line with findings in cognitive science and allows us to model well-known False-Belief Tasks that are typically used in testing people's ToM. We discuss some of the framework's technical features, arguing why it does justice to empirical observations. (shrink)

The current ethical and regulatory framework for research is often charged with burdening investigators and impeding socially valuable research. To address these concerns, a growing number of research ethicists argue that informed consent should be adapted to the risks of research participation. This would require less rigorous consent standards in low-risk research than in high-risk research. However, the current discussion is restricted to cases of research in which the risks of research participation are outweighed by the potential clinical benefits for (...) the individual research participant. Furthermore, current proposals do not address the worry that risk-adapted informed consent may result in enrolling participants into research without their autonomous authorization. In this paper, we show how the standard view of informed consent – consent as autonomous authorization – can be adapted to risk even when the research does not have a favourable risk-benefit profile for the participant. Our argument has two important implications: first, it implies that current and proposed consent standards are not adequately calibrated to risk and, second, that consent standards also need to be adapted to factors other than risk. (shrink)

This article explores universal normative bases that could help to shape a workable legal construct that would facilitate a global use of advance directives. Although I believe that advance directives are of universal character, my primary aim in approaching this issue is to remain realistic. I will make three claims. First, I will argue that the principles of autonomy, dignity and informed consent, embodied in the Oviedo Convention and the UNESCO Declaration on Bioethics and Human Rights, could arguably be regarded (...) as universal bases for the global use of advance directives. Second, I will demonstrate that, despite the apparent consensus of ethical authorities in support of their global use, it is unlikely, for the time being, that such consensus could lead to unqualified legal recognition of advance directives, because of different understandings of the nature of the international rules, meanings of autonomy and dignity which are context-specific and culture-specific, and existing imperfections that make advance directives either unworkable or hardly applicable in practice. The third claim suggests that the fact that the concept of the advance directive is not universally shared does not mean that it should not become so, but never as the only option in managing incompetent patients. A way to proceed is to prioritize work on developing higher standards in managing incompetent patients and on progressing towards the realization of universal human rights in the sphere of bioethics, by advocating a universal, legally binding international convention that would outlaw human rights violations in end-of-life decision-making. (shrink)

The relations between ontology and information are many and fundamental, and they help us to understand the present gulf between (formal) ontology and (philosophical) Ontology: We can speak of respectively ontology-driven information and information-driven ontology as the focus on being informed vs. informed being. The question of whether these two (can) coincide is relevant to both fields, and in this article I elaborate on what needs to be addressed first of all to provide us with (...) an answer: The form. This core ontological concept rooting in Aristotelian metaphysics was central to philosophical ontology, in particular in Latin Scholasticism, when it was clearly put into relation with information as that which defines an entity. In this context, Dietrich of Freiberg synthesized this long debate in a way that matters not only to the philosophical effort of producing information-driven ontologies but also to the engineering constructs of ontology-driven information systems. (shrink)

One of the open problems in the philosophy of information is whether there is an information logic (IL), different from epistemic (EL) and doxastic logic (DL), which formalises the relation “a is informed that p” (Iap) satisfactorily. In this paper, the problem is solved by arguing that the axiom schemata of the normal modal logic (NML) KTB (also known as B or Br or Brouwer’s system) are well suited to formalise the relation of “being informed”. After having (...) shown that IL can be constructed as an informational reading of KTB, four consequences of a KTB-based IL are explored: information overload; the veridicality thesis (Iap → p); the relation between IL and EL; and the Kp → Bp principle or entailment property, according to which knowledge implies belief. Although these issues are discussed later in the article, they are the motivations behind the development of IL. (shrink)

The paper argues that Information Ethics (IE) can provide a successful approach for coping with the challenges posed by our increasingly globalized reality. After a brief review of some of the most fundamental transformations brought about by the phenomenon of globalization, the article distinguishes between two ways of understanding Global Information Ethics, as an ethics of global communication or as a global-information ethics. It is then argued that cross-cultural, successful interactions among micro and macro agents call for (...) a high level of successful communication, that the latter requires a shared ontology friendly towards the implementation of moral actions, and that this is provided by IE. There follows a brief account of IE and of the ontic trust, the hypothetical pact between all agents and patients presupposed by IE. (shrink)

This paper investigates a problem about freedom of information. Although freedom of information is generally considered desirable, there are a number of areas where there is substantial agreement that freedom of information should be limited. After a certain ordering of the landscape, I argue that we need to add the category of "dangerous" information and that this category has gained a new quality in the context of current information technology, specifically the Internet. This category includes (...) information the use of which would be morally wrong as well as some of what may be called "corrupting" information. Some such information should not be spread at all and some should be very limited in its spread. (shrink)

Luciano Floridi (2003) offers a theory of information as a strongly semantic notion, according to which information encapsulates truth, thereby making truth a necessary condition for a sentence to qualify as information. While Floridi provides an impressive development of this position, the aspects of his approach of greatest philosophical significance are its foundations rather than its formalization. He rejects the conception of information as meaningful data, which entails at least three theses – that information can (...) be false; that tautologies are information; and, that It is true that ... is non-redundant – appear to be defensible. This inquiry offers various logical, epistemic, and ordinary-language grounds to demonstrate that an account of his kind is too narrow to be true and that its adoption would hopelessly obscure crucial differences between information, misinformation, and disinformation. (shrink)

Braüner, Blackburn and Polyanskaya relate children’s being deceived to their theory of mind skills. Second‐order false‐belief tasks are often used to test children’s second‐order theory of mind development. The article gives a logical analysis of the reasoning needed to solve four types of second‐order false belief tasks, distinguished on whether a story character is deceived, and on whether the story hinges on facts in the world changing. The principle of inertia plays an important role. [74].

In Being as Communion philosopher and mathematician William Dembski provides a non-technical overview of his work on information. Dembski attempts to make good on the promise of John Wheeler, Paul Davies, and others that information is poised to replace matter as the primary stuff of reality. With profound implications for theology and metaphysics, Being as Communion develops a relational ontology that is at once congenial to science and open to teleology in nature. All those interested in (...) the intersections of theology, philosophy and science should read this book. (shrink)

There is a debate at the highest levels of government about how to classify the risks of research studies that evaluate therapies that are in widespread use. Should the risks of those therapies be considered as risks of research that is designed to evaluate those therapies? Or not? The Common Rule states, “In evaluating risks and benefits, the IRB should consider only those risks and benefits that may result from the research.” ). By contrast, the Office of Human Research Protections, (...) in a proposed “guidance” states, “The reasonably foreseeable risks of research include already-identified risks of the standards of care being evaluated as a purpose of the research.”.In this paper, I argue that the Common Rule got it right and OHRP got it wrong. When treatments are in widespread use, the risks of those treatments are ever-present for all patients. By enrolling in formal studies that use rigorous methods to compare one treatment with another and that carefully monitor outcomes and adverse events, patients are protected from the risks of idiosyncratic practice variation. Their risks are decreased, rather than increased.If OHRP's approach becomes the law of the land, patients will be misinformed about the relative risks of treatment and research in ways that undermine autonomy rather than promoting it and that make truly informed consent impossible. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:To Be or Not to Be:Waiving Informed Consent in Emergency ResearchCharles R. McCarthy (bio)The requirements for prior, legally authorized informed consent constitute a necessary condition for recruiting subjects into biomedical or behavioral research. However, informed consent requirements pose a serious problem for most research conducted in emergency care settings. For this reason, the Food and Drug Administration's (FDA) regulations governing investigational devices and the Department of Health and Human (...) Services' (HHS) regulations for the protection of human subjects allow narrow exceptions to the general requirements of informed consent. In a joint effort to clarify the applicability of the current FDA regulations and to better understand the intent of the HHS regulations as they apply to emergency research, the FDA and the National Institutes of Health (NIH) cosponsored a public forum on the ethical conduct of emergency research in January 1995.Although the forum was not designed as a consensus conference and participants vigorously disagreed on some of the details, a broad consensus emerged on several major points: (1) both HHS and FDA regulations should, in the immediate future, be interpreted to allow for randomized clinical trials in emergency situations so long as the subjects are carefully protected; and (2) consideration should be given to producing new, closely harmonized regulations from both agencies that will provide greater clarity concerning what kinds of emergency research may be allowed without obtaining prior informed consent.The FDA-NIH forum in January was occasioned primarily by controversy about the hypothermia research protocol described below, but it is obvious that many other kinds of emergency research also await the outcome of deliberations concerning waiver of informed consent in emergency situations. These include research into the care and treatment of: occlusive stroke; subarachnoid hemorrhage due to intracranial aneurysm; metabolic coma; status epilepticus; cardiac arrest; myocardial infarction; cardiac arrhythmia; hemorrhagic shock; pulmonary embolism; acute asthmatic attack; and poisoning. All of these conditions [End Page 155] are encountered in emergency settings where obtaining informed consent from the patient-subjects to participate in research is seldom possible, and obtaining consent from legally authorized representatives of the subjects is either not feasible, or, if obtained, is of doubtful validity.The Hypothermia Research Case and HHS RegulationsA $7.2 million grant for research on the use of hypothermia in the treatment of severe head trauma, the largest award ever made to the University of Texas Health Sciences Center at Houston, is in danger of expiring before the study is completed. The protocol, which involves the use of cooling blankets to induce hypothermia in patients suffering from severe head injuries, is designed to test the hypothesis that: "Early lowering of the body temperature of patients suffering from severe head trauma to approximately 91 degrees Fahrenheit will slow patients' metabolism and will/will not, as a consequence, reduce the rates of both morbidity and mortality in these patients." The protocol was approved by seven Institutional Review Boards (IRBs), each of which waived the requirement to obtain informed consent from research subjects in accordance with Sec. 46. 116(d) of the HHS Regulations for the Protection of Human Subjects.1However, NIH's Office for Protection from Research Risks (OPRR), which is responsible for assuring compliance with the HHS regulations, has taken a controversial regulatory position by requiring informed consent from a legally authorized representative of each subject to be entered in the hypothermia trial. Because the obtaining of surrogate consent has proved to be very difficult, OPRR's position has slowed the research to a point where it may have to be terminated.At issue in the controversy is a fundamental question of ethics and public policy. Is it ever permissible to involve incompetent subjects in research without either their consent, or the consent of their legally authorized representatives? Pertinent HHS regulations for the protection of human subjects seem to answer the question affirmatively by allowing local IRBs to waive some or all of the elements of informed consent under carefully limited circumstances (45 CFR 46 116(d)). Nevertheless, OPRR has signalled the research community that use of the informed consent waiver provision for the Houston hypothermia study is not permitted under the regulations. OPRR judged that the risks... (shrink)

A discussion of a number of ways that information can be present in a computer program without being explicitly represented.

Over-enthusiastic newborn screening has often caused substantial harm and has been imposed on the public without adequate information on benefits and risks and without parental consent. This problem will become worse when genomic screening is implemented. For the past 40 years, there has been broad agreement about the criteria for ethically responsible screening, but the criteria have been systematically ignored by policy makers and practitioners. Claims of high benefit and low risk are common, but they require precise definition and (...) documentation, which has often not occurred, undermining claims that involuntary testing is justified. Even when the benefits and risks are well established, it does not automatically follow that involuntary testing is justified, a position supported by the widespread tolerance for parental refusal of immunizations and newborn screening. (shrink)

With their methodical attention to detail, their tirelessness, their immunity to boredom, and their very high speed, all coupled now with reasoning power and information, machines are beginning to produce knowledge, often faster and better — “smarter” — than the human who taught them. By promising to replace man, the computer is giving us a new definition of man, as an “information processor,” and of nature, as “information to be processed.” It is not that we cannot live (...) without computers, but that we will be different people because we live with them. (shrink)

The information revolution has fostered the rise of new ways of waging war, generally by means of cyberspace-based attacks on the infrastructures upon which modern societies increasingly depend. This new way of war is primarily disruptive, rather than destructive; and its low barriers to entry make it possible for individuals and groups (not just nation-states) easily to acquire very serious war-making capabilities. The less lethal appearance of information warfare and the possibility of cloaking the attacker''s true identity put (...) serious pressure on traditional just war doctrines that call for adherence to the principles of right purpose, duly constituted authority, and last resort. Age-old strictures about noncombatant immunity are also attenuated by the varied means of attack enabled by advanced information technologies. Therefore, the nations and societies leading the information revolution have a primary ethical obligation to constrain the circumstances under which information warfare may be used -- principally by means of a pledge of no first use of such means against noncombatants. (shrink)

In biobanks, a broader model of consent is often used and justified by a range of different strategies that make reference to the potential benefits brought by the research it will facilitate combined with the low level of risk involved (provided adequate measures are in place to protect privacy and confidentiality) or a questioning of the centrality of the notion of informed consent. Against this, it has been suggested that the lack of specific information about particular uses of the (...) samples means that such consent cannot be fully autonomous and so is unethical. My answer to the title question is a definite ‘yes’. Broad consent can be informed consent and is justified by appeal to the principle of respect for autonomy. Indeed, I will suggest that the distinction between the various kinds of consent is not a distinction between kinds of consent but between the kinds of choice a person makes. When an individual makes a choice (of any kind) it is important that they do so according to the standards of informed consent and consistent with the choice that they are making. (shrink)

Psychiatry is the only branch of medicine legally ­permitted to treat people against their will. In most countries, decisions related to involuntary detention and treatment involve a brief court pr...

Computer ethicists have for some years been troubled by the issue of how to assign moral responsibility for disastrous events involving erroneous information generated by expert information systems. Recently, Jeroen van den Hoven has argued that agents working with expert information systems satisfy the conditions for what he calls epistemic enslavement. Epistemically enslaved agents do not, he argues, have moral responsibility for accidents for which they bear causal responsibility. In this article, I develop two objections to van (...) den Hoven’s argument for epistemic enslavement of agents working with expert information systems. (shrink)

We examine a special case of inquiry games and give an account of the informational import of asking questions. We focus on yes-or-no questions, which always carry information about the questioner's strategy, but never about the state of Nature, and show how strategic information reduces uncertainty through inferences about other players' goals and strategies. This uncertainty cannot always be captured by information structures of classical game theory. We conclude by discussing the connection with Gricean pragmatics and contextual (...) constraints on interpretation. (shrink)

In the present paper, we first argue that it is critical for humans to forget; that is, to have some means of preventing out-of-date information from interfering with the recall of current information. We then argue that the primary means of accomplishing such adaptive updating of human memory is retrieval inhibition: Information that is rendered out of date by new learning becomes less retrievable, but remains at essentially full strength in memory as indexed by other measures, such (...) as recognition and word-fragment completion. We conclude with a speculation that certain unconscious influences of prior events may, in fact, be stronger if those events were to be forgotten rather than to be remembered. (shrink)

The aim of this article is to examine whether informational manipulation, used intentionally by the researcher to increase recruitment in the research study, can be morally acceptable. We argue that this question is better answered by following a non-normative account, according to which the ethical justifiability of informational manipulation should not be relevant to its definition. The most appropriate criterion by which informational manipulation should be considered as morally acceptable or not is the researcher’s special moral duties towards their subjects. (...) We also propose that a broader definition of manipulation of information should be adopted (than that already existing in the literature) since informational manipulation can affect not only a person’s beliefs but also their desires in decision-making. We conclude that manipulation of information can either be used to protect the potential subject and facilitate the informed consent process or be used to exploit and merely use a person for scientific goals. (shrink)

Jeff Speaks has recently argued that perfect being theology treating God as the greatest possible being—he calls it alethic perfect being theology—cannot deliver new information about God. This argument is central to his critique of all forms of perfect being theology. For as Speaks sees it, other forms of perfect being theology may collapse into alethic perfect being theology, i.e. fail in the end to be a different sort of project. I lay out (...) how he understands alethic perfect being theology and then contest his argument. (shrink)

This study examined possible ways to ensure that participants provide fully informed consent for online surveys. Participants were randomly assigned to read either a traditional informed consent or one of three modified versions: enhanced, consent for each key element, or a combination of these two. Those who read the combination version scored higher on a comprehension quiz, guessed at fewer questions, and were more likely to read all of the informed consent than those who received the traditional version. These findings (...) suggest that comprehension can be improved by adopting alternatives to the traditional informed consent. (shrink)

The concept of information has well-known difficulties. Among the many issues that have been discussed is the alethic nature of a semantic conception of information. Floridi :197–222, 2004; Philos Phenomenol Res 70:351–370, 2005; EUJAP 3:31–41, 2007; The philosophy of information, Oxford University Press, Oxford, 2011) argued that semantic information must be truthful. In this article, arguments will be presented in favor of an alethically neutral conception of semantic information and it will be shown that such (...) a conception can withstand Floridi’s criticism. In particular, it is argued that an alethically neutral conception of semantic information can manage the so-called Bar-Hillel Carnap paradox, according to which contradictions have maximum informational content. This issue, as well as some of Floridi’s other arguments, is resolved by disentangling the property of being information from the property of being informative. The essay’s final conclusion is that although semantic information is alethically neutral, a veridical conception of semantic information can, and should, be retained as a subconcept of semantic information, as it is essential for the analysis of informativity, which, unlike the property of being information, depends on truth. (shrink)

In Québec, the Act Respecting Access to Documents Held by Public Bodies and the Protection of Personal Information provides an exception to transparency to most public institutions where public health research is conducted by allowing them to not disclose their uses of personal data. This exceptionalism is ethically problematic due to important concerns and we argue that all those who conduct research should be transparent and accountable for the work they do in the public interest.

Stakeholder involvement in design is desirable from both a practical and an ethical point of view. It is difficult to do well, however, and some problems recur again and again, both of a practical nature, e.g. stakeholders acting strategically rather than openly, and of an ethical nature, e.g. power imbalances unduly affecting the outcome of the process. Hidden Design has been proposed as a method to deal with the practical problems of stakeholder involvement. It aims to do so by taking (...) the observation of stakeholder actions, rather than the outcomes of a deliberative process, as its input. Furthermore, it hides from stakeholders the fact that a design process is taking place so that they will not behave differently than they otherwise would. Both aspects of Hidden Design have raised ethical worries. In this paper I make an ethical analysis of what it means for a design process to leave participants uninformed or deceived rather than acquiring their informed consent beforehand, and to use observation of actions rather than deliberation as input for design, using Hidden Design as a case study. This analysis is based on two sets of normative guidelines: the ethical guidelines for psychological research involving deception or uninformed participants from two professional psychological organisations, and Habermasian norms for a fair and just process. It supports the conclusion that stakeholder involvement in design organised in this way can be ethically acceptable, though under a number of conditions and constraints. (shrink)

We shall draw an affirmative answer to the question posed in the title. The key point will be a quantum description of physical reality. Once fixed at ontic level two basic elements, namely the laws of physics and the matter, we argue that the underlying physical reality emerges from the interconnection between these two elements. We consider any physical process, including measurement, modeled by unitary evolution. In this context, we will deduce quantum random- ness as a consequence of inclusion of (...) the observer into the quantum system. The global picture of the universe is in a sense deterministic, but from our own local perspective (as part of the system) we perceive quantum mechanical randomness. Then, the notion of "information" turns out to be a derivative concept. (shrink)

It is now an ethical dictum that patients should be informed by physicians about their diagnosis, prognosis and treatment options. In this paper, I ask: ‘How informed are the ‘informers’ in clinical practice?’ Physicians have a duty to be ‘well-informed’: patient well-being depends not just in conveying adequate information to patients, it also depends on physicians keeping up-to-date about: popular misunderstandings of illnesses and treatments; and the importance of patient psychology in affecting prognosis. Taking the case of depression (...) as an entry point, this paper argues that medical researchers and physicians need to pay serious attention to the explanations given to patients regarding their diagnosis. Studies on lay understanding of depression show that there is a common belief that depression is wholly caused by a ‘chemical imbalance’ that can be restored by chemically restorative antidepresssants, a claim that has entered ‘folk wisdom’. However, these beliefs oversimplify and misrepresent the current scientific understanding of the causes of depression: first, there is consensus in the scientific community that the causes of depression include social as well as psychological triggers ; second, there is significant dissensus in the scientific community over exactly what lower level, biological or biochemical processes are involved in causing depression; third, there is no established consensus about how antidepressants work at a biochemical level; fourth, there is evidence that patients are negatively affected if they believe their depression is wholly explained by of ‘biochemical imbalance’. I argue that the medical community has a duty, to provide patients with adequate information and to be aware of the negative health impact of prevalent oversimplifications—whatever their origins. (shrink)

We consider measurements, described by a positive-operator-valued measure (POVM), whose outcome probabilities determine an arbitrary pure state of a D-dimensional quantum system. We call such a measurement a pure-state informationally complete (PS I-complete) POVM. We show that a measurement with 2D−1 outcomes cannot be PS I-complete, and then we construct a POVM with 2D outcomes that suffices, thus showing that a minimal PS I-complete POVM has 2D outcomes. We also consider PS I-complete POVMs that have only rank-one POVM elements and (...) construct an example with 3D−2 outcomes, which is a generalization of the tetrahedral measurement for a qubit. The question of the minimal number of elements in a rank-one PS I-complete POVM is left open. (shrink)

Objective: To determine the practice in UK hospitals regarding the level of patient involvement and consent when representatives of commercial surgical device manufacturers attend and advise during operations.Methods: An anonymous postal questionnaire was sent to the senior nurse in charge in all 236 UK gynaecology theatres in 2004. 79/236 replies were received.Results: Operating departments were visited every 2 weeks on average by a representative of the surgical device manufacturer. Actual operations were attended every 10 weeks, although there was much variation. (...) 33/79 units consistently obtained patient consent for visits, usually orally, whereas 40/79 units did not. 65/79 units had no guidelines for surgical device representative visits. 91% of nurses in charge believed that there should be guidelines to protect both patients and staff. 6/79 units were preparing local guidelines at the time of the survey.Conclusions: Currently, patient safety, confidentiality and autonomy are being protected by a minority of NHS operating theatres when surgical device representatives attend surgery. National guidelines would hopefully ensure that fully informed patient consent is obtained and that representatives are fully trained and supervised. (shrink)