In the 24 years since the founding of BioEssays, the level of translational research, as well as the expectations for its success, have burgeoned. Based on our analysis of current and projected US efforts to establish effective centers of translational research, our own institutional experience and discussions with academic research center leaders and institutional research executives, we have arrived at several critical conclusions about how best to foster disease‐based research on the institutional, national and international level, what summary statistics may (...) best serve as a measurement of successful practice, roughly how much more money will be required to fund the ongoing venture in the US and how to organize and promote this vision. BioEssays 30:1025–1029, 2008. © 2008 Wiley Periodicals, Inc. (shrink)

Putative counterexamples to the Principle of Identity of Indiscernibles (PII) are notoriously inconclusive. I establish ground rules for debate in this area, offer a new response to such counterexamples for friends of the PII, but then argue that no response is entirely satisfactory. Finally, I undermine some positive arguments for PII.

Many conditionals seem to convey the existence of a link between their antecedent and consequent. We draw on a recently proposed typology of conditionals to argue for an old philosophical idea according to which the link is inferential in nature. We show that the proposal has explanatory force by presenting empirical results on the evidential meaning of certain English and Dutch modal expressions.

I examine two challenges that collaborative research raises for science. First, collaborative research threatens the motivation of scientists. As a result, I argue, collaborative research may have adverse effects on what sorts of things scientists can effectively investigate. Second, collaborative research makes it more difficult to hold scientists accountable. I argue that the authors of multi-authored articles are aptly described as plural subjects, corporate bodies that are more than the sum of the individuals involved. Though journal editors do not currently (...) conceive of the authors of multi-authored articles this way, this conception provides us with the conceptual resources to make sense of how collaborating scientists behave.Keywords: Collaborative research; Authorship; Multi-authored articles; Responsibility; Reward system; Plural subject. (shrink)

E.J. Lowe claims that quantum physics provides examples of ontic indeterminacy, of vagueness in the world. Any such claim must confront the Evans-Salmon argument to the effect that the notion of ontic indeterminacy is simply incoherent (Evans 1978, Salmon 1981: 243-46). Lowe argues that a standard version of the Evans-Salmon argument fails quite generally (Lowe 1994). Harold Noonan (1995) has outlined a non-standard version of the argument, but Lowe argues that this non-standard version fails for specifically quantum mechanical reasons (Lowe (...) 1997). He claims that it is perfectly coherent to suppose that his quantum case is an example of ontic indeterminacy. In this paper, I raise some objections to Lowe's claim. (shrink)

What are the criteria for reasonable clinical judgements? The reasonableness of macro-level decision-making has been much discussed, but little attention has been paid to the reasonableness of applying guidelines generated at a macro-level to individual cases. This paper considers a framework for reasonable clinical decision-making that will capture cases where relevant guidelines cannot reasonably be followed. There are three main sections. (1) Individual claims on healthcare from the point of view of concerns about equity are analysed. (2) The demands of (...) responsibility and equity on professional clinical performance are discussed, and how the combination of these demands emerges into seven requirements that constitute the framework is explored. Since this framework is developed to assist in reasonable clinical decision-making, practical implications of all these requirements are also suggested. (3) Challenges concerning the framework are discussed. First, a crucial presumption that the framework relies upon is considered—namely, clinicians’ willingness to justify their decisions as requested. Then how public deliberation may influence clinical decision-making is discussed. Next is a consideration of how clinicians’ need to have confidence in their own judgements in order to perform in a manner worthy of trust would be compatible with adherence to the framework supported by public deliberation. It is concluded that fair distribution in the interplay between macro- and micro-level considerations can be secured by legitimising procedures on each level, by ensuring well-organised and continuing public debate and by basing individual clinical judgements upon well-justified and principled normative bases. (shrink)

This volume is a state-of-the-art survey of the psychology of reasoning, based around, and in tribute to, one of the field "s most eminent figures: Jonathan St B.T. Evans.

In the present study, using event-related functional magnetic resonance imaging, we investigated a group of participants on a grammaticality classification task after they had been exposed to well-formed consonant strings generated from an artificial regular grammar. We used an implicit acquisition paradigm in which the participants were exposed to positive examples. The objective of this studywas to investigate whether brain regions related to language processing overlap with the brain regions activated by the grammaticality classification task used in the present study. (...) Recent meta-analyses of functional neuroimaging studies indicate that syntactic processing is related to the left inferior frontal gyrus (Brodmann's areas 44 and 45) or Broca's region. In the present study, we observed that artificial grammaticality violations activated Broca's region in all participants. This observation lends some support to the suggestions that artificial grammar learning represents a model for investigating aspects of language learning in infants [TICS 4 (2000) 178] and adults [Proceedings of the National Academy of Sciences of United States of America 99 (2002) 529]. (shrink)

A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice (...) of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation—namely, the evincing and sharing of ethical opinion about a case—but also enables consultants to improve their practice and to pursue research on clinical ethics consultation. (shrink)

This paper raises the questions: 'What do we expect from nursing ethics?' and 'Is the literature of nursing ethics any different from that of medical ethics?' It is suggested that rather than develop nursing ethics as a separate field writers in nursing ethics should take a lead in making the patient the central focus of health care ethics. The case is made for empirical work in health care ethics and it is suggested that a good way of setting about this (...) is to ask practising nurses about the real ethical problems they encounter. (shrink)

Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may (...) be as important as that of the students. (shrink)

Quality of life is a difficult concept to define and to measure. An hypothesis is proposed which suggests that the quality of life measures the difference, or the gap, at a particular period of time between the hopes and expectations of the individual and that individual's present experiences. Quality of life can only be described by the individual, and must take into account many aspects of life. The approach is goal-orientated, and one of task analysis. The hypothesis is developed in (...) a diagramatic way, and several methods of testing the hypothesis suggested. (shrink)

We propose that the pragmatic factors that mediate everyday deduction, such as alternative and disabling conditions (e.g. Cummins et al., 1991) and additional requirements (Byrne, 1989) exert their effects on specific inferences because of their perceived relevance to more general principles, which we term SuperPs. Support for this proposal was found first in two causal inference experiments, in which it was shown that specific inferences were mediated by factors that are relevant to a more general principle, while the same inferences (...) were unaffected by factors not relevant to the general principle. These results were extended to deontic inferences in two further experiments. Taken together, these findings show that unstated superordinate principles play a significant role in certain types of reasoning. Questions raised by the findings for the main theoretical approaches are discussed. (shrink)

At the University of Newcastle, health law and ethics is taught and assessed in each year of the five-year curriculum. However, the critical question for assessment remains: 'Does teaching ethics have a measurable effect on the clinical activity of medical students who have had such courses?' Those responsible for teaching confront this question each year they sit down to construct their assessment tools. Should they assess what the student knows? Should they assess the student's moral reasoning, that is, what decisions (...) the student makes, and, how these decisions are justified, or should they assess what the student actually does when dealing with patients in the clinical setting, and how he or she does it? From 1982 to 1991, assessment at Newcastle was primarily aimed at determining the quality of the students' ethics knowledge base. This paper describes the strengths and limitations of a purely knowledge-based method of evaluation and why in 1992, we are now attempting to redefine and assess, what we call 'clinical ethical competence' in terms of how students actually apply this knowledge base in a controlled clinical context. (shrink)

Arguments about the morality of the use of deception in patient care have been conducted largely in an empirical vacuum, with few data about the situations in which deception occurs. Do staff frequently deceive their patients and, if so, under what conditions? Can the consequences of deception always be foreseen? What justifications do staff use to explain their behaviour? The small-scale study reported here on the uses of deception by nurses when attempting to reassure patients provides information on these questions. (...) The results suggest that deception can have deleterious effects on trust and increase the emotional distance between patients and staff. (shrink)

Mind uploading speculation and debate often concludes that a procedure described as gradual in-place replacement preserves personal identity while a procedure described as destructive scan-and-copy produces some other identity in the target substrate such that personal identity is lost along with the biological brain. This paper demonstrates a chain of reasoning that establishes metaphysical equivalence between these two methods in terms of preserving personal identity.

Clinician gate-keeping is the process whereby healthcare providers prevent access to eligible patients for research recruitment. This paper contends that clinician gate-keeping violates three principles that underpin international ethical guidelines: respect for persons or autonomy; beneficence or a favourable balance of risks and potential benefits; and justice or a fair distribution of the benefits and burdens of research. In order to stimulate further research and debate, three possible strategies are also presented to eliminate gate-keeping: partnership with professional researchers; collaborative research (...) design and clinician education. (shrink)

A study found that women participating in mammography screening were content with the programme and the paternalistic invitations that directly encourage participation and include a pre-specified time of appointment. We argue that this merely reflects that the information presented to the invited women is seriously biased in favour of participation. Women are not informed about the major harms of screening, and the decision to attend has already been made for them by a public authority. This short-circuits informed decision-making and the (...) legislation on informed consent, and violates the autonomy of the women. Screening invitations must present both benefits and harms in a balanced fashion, and should offer, not encourage, participation. It should be stated clearly that the choice not to participate is as sensible as the choice to do so. To allow this to happen, the responsibility for the screening programmes must be separated from the responsibility for the information material. (shrink)

An Institute of Medical Ethics working party argues that an ethically desirable relationship of mutual empowerment between patient and clinician is more likely to be achieved if patients understand the ground rules of medical confidentiality. It identifies and illustrates ambiguities in the General Medical Council's guidance on AIDS and confidentiality, and relates this to the practice of different doctors and specialties. Matters might be clarified, it suggests, by identifying moral factors which tend to recur in medical decisions about maintaining or (...) breaching confidentiality. The working party argues that two such factors are particularly important: the patient's need to exercise informed choice and the doctor's primary responsibility to his or her own patients. (shrink)

The debate about the moral status of the embryo has gained new impetus because of the advances in reproductive technology that have made early human embryo experimentation a possibility, and because of the public concern that this arouses. Several philosophical arguments claiming that fertilisation is the event that accords moral status to the embryo were initially formulated in the context of the abortion debate. Were they formulated with sufficient precision to account for the scientific facts as we now understand them? (...) Or do these arguments need modification? Aspects of three arguments for moral status being acquired at fertilisation are examined in relation to current scientific knowledge, highlighting the reasons why such arguments, at present, seem to provide an inadequate basis for the determination of moral status. (shrink)

. Donald MacKay has suggested that the logical concept of complementarity is needed to relate scientific and theological thinking. According to Ian Barbour, this concept should only be used within, not between, disciplines. This article therefore attempts to clarify that contrast from the standpoint of cognitive process. Thinking in terms of complementarity is explicated within a structuralist‐genetic, interactive‐constructivist, developmental theory of the neo‐ and post‐Piagetian kind, and its role in religious development is indicated. Adolescents'complementary views on Creation and on the (...) corresponding scientific accounts serve as an illustration. After further analysis of parallel and circular complementarity, it is shown under which conditions complementarity of science and theology can be better justified and may be potentially more fruitful than is apparent from Barbour's or even MacKay's considerations. (shrink)

It is well documented that the higher the socioeconomic status (SES) of patients, the better their health and life expectancy. SES also influences the use of health services—the higher the patients' SES, the more time and specialised health services provided. This leads to the following question: should clinicians give priority to individual patients with low SES in order to enhance health equity? Some argue that equity is best preserved by physicians who remain loyal to ‘ordinary medical fairness’ in non-ideal circumstances (...) when health disparities persist; ie, doctors should allocate care according to needs only and treat everyone with equal regard by being neutral with respect to patients' SES. This paper furthers a discussion of this view by questioning how equitable needs relate to SES. To clarify, it distinguishes between four versions of ‘healthcare need’ and approaches an acceptable conceptualisation of the notion supported by Norman Daniels' theory on health equity. It concludes that doctors should remain neutral to patients' SES in cases in which several patients require the same health care. However, equitable health care requires considerations of the impact of socioeconomic factors (SEF) on patients' capacity to benefit from the care. Remaining neutral towards patients' SES in this respect does not promote equal regard. It follows that priority setting on the basis of SEF is required in fair clinical distribution of care, eg, through allocating more time to patients with low SES. In order to advance equity accurately, the concept of ordinary medical fairness should be amplified according to this clarification. (shrink)

Kant's political thinking is predominantly evaluated in contractarian terms, though recent contributions have also emphasized the natural law influence on him. This paper argues that the assimilation of Kant into either tradition is problematic. An analysis of his account of political obligation cannot ignore the distinctiveness of Kant's general philosophical framework. Two recurrent Kantian themes are crucial to a reconstruction of his political argument. The first is the tension between freedom and causality, or nature. The second is the role of (...) reflective judgment in practical reasoning. The paper analyses Kant's property argument, and his related account of political obligation, from the perspective of these Kantian themes. Kant's ‘antinomy of Right’, formulated in the context of his property argument, is interpreted as a conflict between freedom and nature, and in analogy with the third antinomy of the Critique of Pure Reason. Kant's obscure theorem, the lex permissiva, is central to his ‘solution’ to the antinomy. The theorem is best understood as a reflective practical judgment, through which agents are brought to acknowledge that their obligations of justice towards one another are a direct entailment of their respective claims to property. The connection between property rights and political obligations is thus intrinsic, not extrinsic; the acknowledgement of that connection an act of reflective judgment, not contractual. (shrink)

In a recent article in Philosophia Christi, Hugh G. Gauch, Jr., argues for the necessity of “public presuppositions” for Christian apologetics. In the course of his argument, he critiques three tenets of my approach, as given in my book, Covenantal Apologetics. Though all three objections have been lodged and answered in numerous places, I respond to Gauch by arguing that the three tenets are embedded in and consistent with the theology that came out of the Reformation. Thus, I conclude that (...) our apologetic differences have their roots in our theological differences. (shrink)

There are important ethical issues to be examined before launching any public health intervention, particularly when targeting vulnerable groups. The aim of this article is to identify and discuss ethical concerns that may arise when intervening for health behavior change among adolescents identified as overweight. These concerns originate from an intervention designed to capacitate adolescents to increase self-determined physical activity. Utilizing an ethical framework for prevention of overweight and obesity, we identified three ethical aspects as particularly significant: the attribution of (...) responsibility for health behavior, liberty to choose, and the effect on the participants’ psychosocial well-being. It is discussed whether and how measures can be taken to deal with these aspects. It seems evident that the ethical aspects are mainly concerned with the vulnerability of adolescents identified as overweight. However, we claim that when individual feedback and counseling is provided, tailored interventions have a unique potential to empower adolescents to make ethically anchored decisions about their own health behavior. (shrink)

The manner in which limited vaccines are distributed during a pandemic is an ethical issue. The utility principle has been used to argue priority be given to certain individuals based on factors such as the epidemiology of the spread of disease and maintaining the functioning of society. The equity principle has been used to encourage fair practices that account for the economic and social costs of all decisions made. We argue that both principles are met through priority vaccination of homeless (...) individuals, as this strategy protects a medically vulnerable population while reducing the chances of transmission to others as they move through populated urban spaces. We begin by reviewing debates around ethical vaccine distribution. We then argue the homeless are a medically high-risk population who may contribute to the spread of disease through their mobility. As immunization rates are generally lower among the homeless and many do not access mainstream health care, we argue that community vaccine clinics must be used to reach these individuals. We provide support by analyzing Toronto Public Health’s operation of vaccine clinics in shelters and drop-in centres during pH1N1 and conclude that this strategy is effective for immunizing homeless individuals, bringing together the equity and utility principles. (shrink)

It is well known that successive observations of the instantaneous state of a decaying system lead to a modified decay law. In the limit of infinitely frequent observations, the modified lifetime becomes infinite (“Zeno's paradox”). We study here the behavior of decaying systems under continuous rather than successive observations. Such continuous observation is achieved by a permanent coupling of the decaying system to a counter, which is sufficiently sensitive to the presence of the decay products. For two explicitly soluble models (...) we obtain a result very similar to Zeno's paradox: The observation again strongly modifies the decay law, and prevents the decay completely in the limit of a perfect (i.e., infinitely sensitive) counter. Like Zeno's paradox, however, this “watchdog effect” is not very likely to be detected in actual experiments, e.g., with radioactive nuclei. (shrink)

Summary In this article the authors seek to broaden the scope of the methodological debates now underway in Germany between proponents of a critical theory of society — principally the late T. W. Adorno and J. Habermas — on the one side and proponents of an analytical theory of social science — principally Karl Popper and Hans Albert — on the other. An attempt is made to formulate and systematize some of the fundamental epistemological and methodological principles which are basic (...) to Habermas' philosophy of social science and to bring them into a critical confrontation with some of the relevant counter-positions which have today a wide currency in analytic circles. (shrink)