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)

One strategy for blocking Chalmers's overall case against physicalism has been to deny his claim that showing that phenomenal properties are in some sense physical requires an a priori entailment of the phenomenal truths from the physical ones. Here I avoid this well-trodden ground and argue instead that an a priori entailment of the phenomenal truths from the physical ones does not require an analysis in the Jackson/Chalmers sense. This is to sever the dualist's link between conceptual analysis and a (...) priori entailment by showing that the lack of the former does not imply the absence of the latter. Moreover, given the role of the argument from conceptual analysis in Chalmers's overall case for dualism, undermining that argument effectively undermines that case as a whole in a way that, I'll argue, undermining the conceivability arguments as stand-alone arguments does not. (shrink)

‘Unfair to Facts’ is a follow-up on Ch. 5, addressing objections Peter Strawson raised against Austin’s view of truth as a description of the conditions that must be satisfied if we are to say of a statement that it is true. Austin addresses the objection that his description of these conditions is due to a misunderstanding about the use of ‘fact’, arguing, against Strawson, that facts are not pseudo-entities and that the notion of ‘fitting the facts’ is not a useless (...) notion. (shrink)

Originally published in Proceedings of the British Academy 60 (1974), 339-359.

I first sketch an account of humility as a character trait in which we are unimpressed with our good, envied, or admired features, achievements, etc., where these lack significant salience for our image of ourselves, because of the greater prominence of our limitations and flaws. I situate this view among several other recent conceptions of humility (also called modesty), dividing them between the inward-directed and outward-directed, distinguish mine from them, pose problems for each alternative account, and show how my understanding (...) of humility captures truths present but exaggerated in several of them. Responding to some problems for my view, including what I call “Driver’s Paradox”(i.e., the strangeness of someone’s proclaiming ‘I’m humble!’), I suggest that some over-ambitious claims about our moral responsibilities may indicate a lack of proper humility. I discuss the relationship of the character trait of humility both to what humiliates and to what humbles, concluding with consideration of the background assumptions against which, and the circumstances in which, humility may reasonably be classified as a moral virtue. (shrink)

Drawing chiefly on recent sources, in Part One I sketch an untraditional way of articulating what I claim to be central elements of traditional Catholic morality, treating it as based in virtues, focused on the recipients (“patients”) of our attention and concern, and centered in certain person-to-person role-relationships. I show the limited and derivative places of “natural law,” and therefore of sin, within that framework. I also sketch out some possible implications for medical ethics of this approach to moral theory, (...) and briefly contrast these with the influential alternative offered by the “principlism” of Beauchamp and Childress. In Part Two, I turn to a Catholic understanding of the nature and meaning of human suffering, drawing especially on writings and addresses of the late Pope John Paul II. He reminds us that physical and mental suffering can provide an opportunity to share in Christ's salvific sacrifice, better to see the nature of our earthly vocation, and to reflect on the dependence that inheres in human existence. At various places, and especially in my conclusion, I suggest a few ways in which this can inform bioethical reflection on morally appropriate responses to those afflicted by physical or mental pain, disability, mental impairment, disease, illness, and poor health prospects. My general point is that mercy must be informed by appreciation of the person's dignity and status. Throughout, my approach is philosophical rather than theological. (shrink)

Mark McCreary has argued that I cannot consistently advance both the hiddenness argument and certain arguments for religious scepticism found in my book The Wisdom to Doubt (WD). This reaction was expected, and in WD I explained its shortsightedness in that context. First, I noted how in Part III of WD, where theism is addressed, my principal aim is not to prove atheism but to show theists that they are not immune from the scepticism defended in Parts I and II. (...) To the success of this aim, McCreary's arguments are not so much as relevant, for a thoroughgoing scepticism embracing even the hiddenness argument is quite compatible with its success. But I also explained how someone convinced that the hiddenness argument does prove atheism escapes the grip of religious scepticism because of that argument's reliance on apparent conceptual truths. McCreary's critique obscures this point but does not defuse it. (shrink)

Philosophical Studies Vol. 2, No. 2, p. 163, l. 24 for ‘Pocreon’ read “Creon’ and p. 165, l.4 for “Nereus” read “Nessus”, l. 16 for “Corrolate” read “Correlate” and l. 27 for “ Trachinae ” read “ Trachiniae ”. Proffessor Mackinnon should also have been described as Norris-Hulse Professor of Divinity in the University of Cambridge and Fellow of Corpus Christi College.

The aim of this paper is to present the Nyāya concept of number in the light of contemporary philosophy and to show that the Frege-Russell concept of number does not contradict the Nyāya concept of number but rather supplements it.

Reflecting on a three year long exploratory research of ethics committees in the Czech Republic authors discuss the current role and identity of research ethics committees. The research of Czech ethics committees focused on both self-presentation and self-understanding of ECs members, and how other stakeholders (representatives of the pharmaceutical industry) view them. The exploratory research was based on formal and informal communication with the members of the ethics committees. Members of the research team took part at six regular voluntary meetings (...) of the ethics committees' members, organised by the Forum of Czech Ethics Committees, and at three summer schools of medical ethics. There were realised twenty-five semi-structured interviews as well as six focus group sessions and a participant observation of several regular meetings of three ethics committees. On the grounds of experience from the interviews a simple questionnaire survey was realised among the members of the ethics committees. The ethics committees comprise a community of members working voluntarily, without claims to remuneration or prestige; the unifying goal is protection of subjects of research. The principal working methods are dialogue and agreement. The members of the ethics committees thus, among other things, create an informal community, which can be to a certain extent seen as a Kantian ethical community in a weak sense. The phenomenon of ethics committees can also be described by terms of an epistemic community and a community of practice. These concepts, which are borrowed from other authors and areas, are used as a way how to think of ECs role and identity a bit differently and are meant as a contribution to the current international debate on the topic. (shrink)

Formal training in clinical ethics must become a central part of residency curricula to prepare practitioners to manage the ethical dimensions of patient care. Residency educators must ground their teaching in an understanding of the conceptual, biomedical, and psychosocial aspects of the important ethical issues that arise in that field of practice. Four aspects of professional competence in clinical ethics provide a useful framework for curricular planning. The physician should learn to: (1) recognize ethical issues as they arise in clinical (...) care and identify hidden values and unacknowledged conflicts; (2) think clearly and critically about these issues in ways that lead to ethically justifiable courses of action; (3) apply those practical skills needed to implement an ethically justifiably course of action; and (4) judge when the management of a clinical situation requires consultation with individuals or institutional bodies with additional expertise or authority. We argue that these practical goals can be accomplished with a relatively modest emphasis on the theoretical aspects of medical ethics. (shrink)

The basic reproduction ratio, R0, is a fundamental concept in epidemiology. It is defined as the total number of secondary infections brought on by a single primary infection, in a totally susceptible population. The value of R0 indicates whether a starting epidemic reaches a considerable part of the population and causes a lot of damage, or whether it remains restricted to a relatively small number of individuals. To calculate R0 one has to evaluate an integral that ranges over the duration (...) of the infection of the host. This duration is, of course, limited by remaining host longevity. So, R0 depends on remaining host longevity and in this paper we show that for long-lived hosts this aspect may not be ignored for long-lasting infections. We investigate in particular how this epidemiological measure of pathogen fitness depends on host longevity. For our analyses we adopt and combine a generic within- and between-host model from the literature. To find the optimal strategy for a pathogen from an evolutionary point of view, we focus on the indicator $$R_0^{{opt}}$$, i.e., the optimum of R0 as a function of its replication and mutation rates. These are the within-host parameters that the pathogen has at its disposal to optimize its strategy. We show that $$R_0^{{opt}}$$ is highly influenced by remaining host longevity in combination with the contact rate between hosts in a susceptible population. In addition, these two parameters determine whether a killer-like or a milker-like strategy is optimal for a given pathogen. In the killer-like strategy the pathogen has a high rate of reproduction within the host in a short time span causing a relatively short disease, whereas in the milker-like strategy the pathogen multiplies relatively slowly, producing a continuous small amount of offspring over time with a small effect on host health. The present research allows for the determination of a bifurcation line in the plane of host longevity versus contact rate that forms the boundary between the milker-like and killer-like regions. This plot shows that for short remaining host longevities the killer-like strategy is optimal, whereas for very long remaining host longevities the milker-like strategy is advantageous. For in-between values of host longevity, the contact rate determines which of both strategies is optimal. (shrink)

This is an invited response to Peter Forrest’s review of my trilogy on the philosophy of religion, which appeared in a previous issue of this journal.

We are witnessing at present a substantial efflorescence of the view that there are and must necessarily be fundamental differences between the methods—and especially the types of explanation—appropriate to the social sciences on the one hand and those appropriate to the natural sciences on the other. New and ever more subtle arguments seeking to re-establish a Geisteswissenschaften vs. Naturwissenschaften distinction are flowing from scholarly presses in ever greater volume. The works cited in footnote one are a mere sample just of (...) recent books which, while diverse to the point of contradiction in some respects, have as their common underlying theme the defense of such a methodological duality. (shrink)

On 6 September 1966, the prime minister of South Africa, Dr HF Verwoerd was killed by Mr Tsafendas, a Portuguese national of Greek descent, in parliament by stabbing him in the chest. Mr Tsafendas was a messenger in parliament. At the enquiry trial of Mr Tsafendas, he was found unfit to stand trial on the ground that he suffered from schizophrenia. The psychiatric evidence during the enquiry trial was reviewed and discussed under the following headings: Diagnosis of schizophrenia; Consideration of (...) cultural factors in forensic psychiatric settings; Delusional infestation v. extreme overvalued beliefs; Simulation of psychosis; Ethical considerations in criminal capacity and trial competency assessments. Lessons from the Mr Tsafendas enquiry trial for forensic psychiatrists where a defendant previously diagnosed with schizophrenia commits a prominent political murder, are summarised. It is emphasised that the personhood of an accused referred for forensic observation should be respected and protected, instead of focusing exclusively on a specific diagnosis. (shrink)

It is not only in science that abstraction is found as a method of dealing with the world, and we may profitably begin by showing its wide use in ordinary practical life.

This is a descriptive study which examined the attitudes and perceptions of 273 business students at eight universities across the U.S. towards ethics education. The results indicate that students perceive that the level of discussion of ethics and ethical issues ranges from less than adequate in some marketing courses to adequate in others. Sales/sales management courses received the highest ratings for coverage of ethical issues, while transportation/logistics courses scored the lowest.The study also finds that students believe, quite strongly, that the (...) discussion of ethics and ethical issues is worthwhile and important. Many feel a course in business/marketing ethics should be required and more indicate that they would take such a course, if offered, even if it was not required. (shrink)

The development of the typical cladomothallus of the red algae Antithaminion plumula (Ellis) Le Jolis [= Pterothamnion plumula (Ellis) Nägcli], (Rhodophyceae, Ceramiales) is simulated with the help of a formal language called L-systems. Two types of uniseriate filaments are distinguished: axial filaments of cladomes with indefinite growth and branching and pleuridia with definite growth and branching. The rythmical acropetal formation of secondary axes with basitonic arrangement contrasts with the intercalary basitonic formation of pleuridia, resulting in an acrotonic arrangement within an (...) axial segment. Five types of cells and two types of cell divisions intervene in the system. In addition, for the graphical representations, some morphological particularities of A. plumula are taken into account: the curvature of axial filaments, the extension of growth zones, variable cell generation times, and segment length variability along an axis. The incidence of these variables on the generated thallus form is emphasized, pointing to the singularities of A. plumula. (shrink)