Objective: To determine whether a moral reasoning exercise can improve response quality to surveys of healthcare priorities Methods: A randomised internet survey focussing on patient age in healthcare allocation was repeated twice. From 2574 internet panel members from the USA and Canada, 2020 (79%) completed the baseline survey and 1247 (62%) completed the follow-up. We elicited respondent preferences for age via five allocation scenarios. In each scenario, a hypothetical health planner made a decision to fund one of two programmes identical (...) except for average patient age (35 vs 65 years). Half of the respondents (intervention group) were randomly assigned to receive an additional moral reasoning exercise. Responses were elicited again 7 weeks later. Numerical scores ranging from –5 (strongest preference for younger patients) to +5 (strongest preference for older patients); 0 indicates no age preference. Response quality was assessed by propensity to choose extreme or neutral values, internal consistency, temporal stability and appeal to prejudicial factors. Results: With the exception of a scenario offering palliative care, respondents preferred offering scarce resources to younger patients in all clinical contexts. This preference for younger patients was weaker in the intervention group. Indicators of response quality favoured the intervention group. Conclusions: Although people generally prefer allocating scarce resources to young patients over older ones, these preferences are significantly reduced when participants are encouraged to reflect carefully on a wide range of moral principles. A moral reasoning exercise is a promising strategy to improve response quality to surveys of healthcare priorities. (shrink)

In this brief reply I argue that criticisms of the hiddenness argument recently published in this journal by Imran Aijaz and Markus Weidler are without force. As will be shown, their critique of my conceptual version of the argument misses the mark by missing crucial distinctions. Their critique of my analogical version of the argument misunderstands that argument and also misapplies the work of W. H. Vanstone. And their critique of my view that belief is necessary for a certain kind (...) of relationship with God overlooks both some central features of that kind of relationship and some good reasons for not accepting acceptance or anything similarly nonbelieving as a substitute for belief in this context. (shrink)

The purpose of this article is to highlight ways in which institutional policymakers tend to insufficiently conceptualise their role as ethics practitioners. We use the case of blood product recall notification as a means of raising questions about the way in which, as we have observed it, discourse for those who make institutional ethics policies is constrained by routine balancing of simplified principles to the exclusion of reflexive practices—those that turn ethics reasoning back on itself. The latter allows ethics practitioners (...) with comparatively little formal training to take ownership of traditional parameters, which define their discussions and ultimately ought to make them more insightful when doing ethics. Thus, in the midst of calls for more training to increase the competency of ethics committees, we suggest that an additional problem of how these lay ethicists conceive of their roles also needs to be addressed. (shrink)

The typical approach to decoding speech from the brain (using brain-machine interfaces) is to decode low-level linguistic units (e.g. phonemes, syllables) from motor articulation areas (e.g. Premotor cortex) with the aim of assembling these low-level units into higher-level discourse. We propose that brain-to-speech decoding may benefit from adopting a functional view of language, which conceives of language as an instrumental tool for interacting with others' intentions in order to fulfil one's own intentions. This functional view of language motivates adopting usability (...) (i.e. the decoder's usefulness as a tool for achieving goals), in addition to decoding accuracy, as a criterion for assessing decoder performance. Decoders may achieve gains in usability by incorporating data about communicative situations and speaker intentions in order to generate and fill in speech act templates. We suggest that this intention-oriented, template-based, and functionally inspired view of brain-to-speech decoding may facilitate efforts to achieve naturalistic speech decoding. (shrink)

Background Informed consent is an integral component of good medical practice. Many researchers have investigated measures to improve the quality of informed consent, but it is not clear which techniques work best and why. To address this problem, we propose developing a core outcome set to evaluate interventions designed to improve the consent process for surgery in adult patients with capacity. Part of this process involves reviewing existing research that has reported what is important to patients and doctors in the (...) informed consent process. Methods This qualitative synthesis comprises four phases: identification of published papers and determining their relevance; appraisal of the quality of the papers; identification and summary of the key findings from each paper while determining the definitiveness of each finding against the primary data; comparison of key themes between papers such that findings are linked across studies. Results Searches of bibliographic databases returned 11,073 titles. Of these, 16 studies met the inclusion criteria. Studies were published between 1996 and 2016 and included a total of 367 patients and 74 health care providers. Thirteen studies collected data using in-depth interviews and constant comparison was the most common means of qualitative analysis. A total of 94 findings were extracted from the primary papers and divided into 17 categories and ultimately 6 synthesised findings related to: patient characteristics, knowledge, communication, the model patient, trust and decision making. Conclusions This qualitative meta-aggregation is the first to examine the issue of informed consent for surgery. It has revealed several outcomes deemed important to capture by patients and clinicians when evaluating the quality of a consent process. Some of these outcomes have not been examined previously in research comparing methods for informed consent. This review is an important step in the development of a COS to evaluate interventions designed to improve the consent process for surgery. Registration The study protocol was registered on the international prospective register for systematic reviews. (shrink)

Many apparently complex mechanisms in biology, especially in embryology and molecular biology, can be explained easily by reasoning at the level of the “efficient cause” of the observed phenomenology: the mechanism can then be explained by a simple geometrical argument or a variational principle, leading to the solution of an optimization problem, for example, via the co-existence of a minimization and a maximization problem . Passing from a microscopic level to the macroscopic level often involves an averaging effect that gives (...) birth to a global functional feature . We will illustrate these general principles by building in four different domains of application “a minima” models and showing the main properties of their solutions: extraction of a minimal RNA structure functioning as the first “peptidic machine,” a kind of ancestral ribosome; study of a genetic regulatory network of Drosophila centred on Engrailed gene and expressing successively two genes inside a limit cycle; study of a genetic network regulating neural activity and proliferation in mammals; and study of a simple geometric model of epiboly in zebrafish. (shrink)

Health care services increasingly face patient populations with high levels of ethnic and cultural diversity. Cultures are associated with distinctive ways of life; concepts of personhood; value systems; and visions of the good that affect illness experience, help seeking, and clinical decision-making. Cultural differences may impede access to health care, accurate diagnosis, and effective treatment. The clinical encounter, therefore, must recognize relevant cultural differences, negotiate common ground in terms of problem definition and potential solutions, accommodate differences that are associated with (...) good clinical outcomes, and manage irresolvable differences. Clinical attention to and respect for cultural difference (a) can provide experiences of recognition that increase trust in and commitment to the institutions of the larger society, (b) can help sustain a cultural community through recognition of its distinct language, knowledge, values, and healing practices, and (c) to the extent that it is institutionalized, can contribute to building a pluralistic civil society. (shrink)

The present study is the result of two questions which arose in dealing with the Critique of Pure Reason. What is the relationship of the “Doctrine of Method” to the “Doctrine of Elements?” Does the “Doctrine of Method” tell us anything important about Kant and his philosophy? It will be the contention of this paper that the second half of the Critique relies heavily on the “Doctrine of Elements,” and is a natural expansion of the first half of the Critique. (...) In effect, this is a tentative denial of Norman Kemp Smith’s patchwork thesis. With respect to the second question mentioned above, we shall see that Kant does have a very special place for methodology in his philosophy. This methodology of philosophy has implications for a theory of the division of the sciences and the method proper to each of them. (shrink)