The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

Clinicians' work depends on sincere and complete disclosures from their patients; they honour this candidness by confidentially safeguarding the information received. Breaching confidentiality causes harms that are not commensurable with the possible benefits gained. Limitations or exceptions put on confidentiality would destroy it, for the confider would become suspicious and un-co-operative, the confidant would become untrustworthy and the whole climate of the clinical encounter would suffer irreversible erosion. Excusing breaches of confidence on grounds of superior moral values introduces arbitrariness and (...) ethical unreliability into the medical context. Physicians who breach the agreement of confidentiality are being unfair, thus opening the way for, and becoming vulnerable to, the morally obtuse conduct of others. Confidentiality should not be seen as the cosy but dispensable atmosphere of clinical settings; rather, it constitutes a guarantee of fairness in medical actions. Possible perils that might accrue to society are no greater than those accepted when granting inviolable custody of information to priests, lawyers and bankers. To jeopardize the integrity of confidential medical relationships is too high a price to pay for the hypothetical benefits this might bring to the prevailing social order. (shrink)

In their paper, “Helpful Lessons and Cautionary Tales: How Should COVID-19 Drug Development and Access Inform Approaches to Non-Pandemic Diseases?” Holly Fernandez Lynch and colleagues have present...

Objective: To evaluate one ethics rounds model by describing nurses’ and doctors’ experiences of the rounds. Methods: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to promote mutual understanding and stimulate ethical reflection, without giving any recommendations or solutions. Interviews with seven doctors and 11 nurses were conducted regarding their experiences from the rounds, which were then analysed using content analysis. Findings: The goal of the rounds was partly (...) fulfilled. Participants described both positive and negative experiences. Good rounds included stimulation to broadened thinking, a sense of connecting, strengthened confidence to act, insight into moral responsibility and emotional relief. Negative experiences were associated with a sense of unconcern and alienation, as well as frustration with the lack of solutions and a sense of resignation that change is not possible. The findings suggest that the ethics rounds above all met the need of a forum for crossing over professional boundaries. The philosophers seemed to play an important role in structuring and stimulating reasoned arguments. The nurses’ expectation that solutions to the ethical problems would be sought despite explicit instructions to the contrary was conspicuous. Conclusion: When assisting healthcare professionals to learn a way through ethical problems in patient care, a balance should be found between ethical analyses, conflict resolution and problem solving. A model based on the findings is presented. (shrink)

Let us call an integer part of an ordered field any subring such that every element of the field lies at distance less than 1 from a unique element of the ring. We show that every real closed field has an integer part.

Objective: To evaluate whether ethics rounds stimulated ethical reflection. Methods: Philosopher-ethicist-led interprofessional team ethics rounds concerning dialysis patient care problems were applied at three Swedish hospitals. The philosophers were instructed to stimulate ethical reflection and promote mutual understanding between professions but not to offer solutions. Questionnaires directly before and after rounds were answered by 194 respondents. The analyses were primarily content analysis with Boyd’s framework but were also statistical in nature. Findings: Seventy-six per cent of the respondents reported a moderate (...) to high rating regarding new insights on ethical problem identification, but the ethics rounds did not seem to stimulate the ethical reflection that the respondents had expected (p<0.001). Dominant new insights did not seem to fit into traditional normative ethics but were instead interpreted as hermeneutic ethics. This was illustrated in the extended perspective on the patient and increased awareness of relations to other professions. Regarding insights into how to solve ethical problems, the request for further interprofessional dialogue dominated both before and after rounds. Conclusion: The findings show the need for interprofessional reflective ethical practice but a balance between ethical reflection and problem solving is suggested if known patients are discussed. Further research is needed to explore the most effective leadership for reflective ethical practice. (shrink)

Peckham claims that my "behavior" in dealing with the quotations in Natural Supernaturalism is the same, in methodology and validity, as the interpretative behavior of Booth's waiter. But the great bulk of the utterances in my quotations—and no less, of the utterances constituting Peckham's own essay—do not consist of orders, requests, or commands. Instead, they consist of assertions, descriptions, judgments, exclamations, approbations, condemnations, and many other kinds of speech-acts, the meanings of which are not related to my interpretative behavior, even (...) in the indirect way in which the meaning of Booth's order is related to the future behavior of his waiter. M. H. Abrams, author of Natural Supernaturalism and The Mirror and the Lamp and Class of 1916 Professor of English at Cornell University, responds in this essay to Morse Peckham's "The Infinitude of Pluralism" . Morse Peckham, in his Critical Response, was commenting on issues raised by the forum on "The Limits of Pluralism" , to which M. H. Abrams contributed. Previous contributions to Critical Inquiry are "Rationality and Imagination in Cultural History: A Reply to Wayne Booth" and "The Deconstructive Angel". (shrink)

Problem solving is an essential part of every scientific discipline. It has two components: (1) problem identification and formulation, and (2) the solution to the formulated problem. One can solve a problem on its own using ad hoc techniques or by following techniques that have produced efficient solutions to similar problems. This requires the understanding of various algorithm design techniques, how and when to use them to formulate solutions, and the context appropriate for each of them. Algorithms: Design Techniques and (...) Analysis advocates the study of algorithm design by presenting the most useful techniques and illustrating them with numerous examples -- emphasizing on design techniques in problem solving rather than algorithms topics like searching and sorting. Algorithmic analysis in connection with example algorithms are explored in detail. Each technique or strategy is covered in its own chapter through numerous examples of problems and their algorithms. Readers will be equipped with problem solving tools needed in advanced courses or research in science and engineering. (shrink)

In this paper we examine ethical issues relevant to conducting mental health research with refugees and immigrant communities that have cultural orientations and social organisation that are substantially different to those of the broader Australian community, and we relate these issues to NH&MRC Guidelines. We describe the development and conduct of a mental health research project carried out recently in Melbourne with the Somali community, focusing on ethical principles involved, and relating these to the NH&MRC National Statement on Ethical Conduct (...) in Research Involving Humans, and the NH&MRC document Values and Ethics: Guidelines for Ethical Conduct in Aboriginal and Torres Strait Islander Health Research.The experience of conducting mental health research with the Somali community highlights the fact that the principles of inclusion and benefit enunciated in the NH&MRC document Values and Ethics are particularly pertinent when conducting research with refugees and immigrant communities that are culturally distant to those of the broader Australian community. These principles inform issues of research design and consent, as well as guiding respectful engagement with the participating community and communication of the research findings. (shrink)

Clinical and research practices designed by developed countries are often implemented in host nations of the Third World. In recent years, a number of papers have presented a diversity of arguments to justify these practices which include the defence of research with placebos even though best proven treatments exist; the distribution of drugs unapproved in their country of origin; withholding of existing therapy in order to observe the natural course of infection and disease; redefinition of equipoise to a more bland (...) version, and denial of post-trial benefits to research subjects. These practices have all been prohibited in developed, sponsoring countries, even though they invariably have pockets of poverty where conditions comparable to the Third World prevail. Furthermore, the latest update of the Declaration of Helsinki clearly decries double ethical standards in research protocols. Under these circumstances, it does not seem appropriate that First World scholars should propose and defend research and clinical practices with less stringent ethical standards than those mandatory in their own countries. Recent years have witnessed frequent reports of less stringent ethical standards being applied to both clinical and research medical practices, for the most part in the field of drug trials and drug marketing, initiated by developed countries in poorer nations. Still more unsettling, a number of articles have endorsed the policy of employing ethical norms in these host countries, which would be unacceptable to both the legislations and the moral standards of the sponsor nations. Also, these reformulations often contravene the Declaration of Helsinki or one of its updates. This paper is not so much concerned with the actual practices, which have been subjected to frequent scrutiny and publicly decried when gross misconduct occurred. Rather, my concern relates to the approval and support such practices have found in the literature on bioethics from authors who might be expected to use their energy and scholarship to explore and endorse the universalisability of ethics rather than to develop ad hoc arguments that would allow exceptions and variations from accepted moral standards. To this purpose, issue will be taken with arguments in three fields: medical and pharmaceutical practices, research strategies, and local application of research results. (shrink)

As out-of-hospital emergencies become more commonplace, so does the call for a “doctor in the house”. New York City paediatrician Mitchell Rubin has responded to numerous such crises over the past 25 years. He explores reactions on all sides of this peculiar physician–victim relationship, his growing concerns and fears, and possible reasons why many doctors hesitate to act. His thoughts and experiences instigate the discussion about the need for a universal system of Good Samaritan physician respondersWhile flying to Italy last (...) spring, the pilot’s voice came over the loudspeaker: “Is there a doctor on board”? How many times have I heard this request in the last 25 years? A passenger had fainted. As I began caring for her, the pilot asked me, “Should we take the plane down?”. Surprised to be given this responsibility, I took my best guess and answered “no”. After a stressful landing, while I gave oxygen to the prostrate woman, we were met by an ambulance on the tarmac. The woman was appreciative and gracious, the pilot scarcely offered thanks, and I began my vacation exhausted.Having been trained as a paediatrician, I have responded to nearly two dozen “Good Samaritan” scenarios, where a person was injured or became critically sick in a public setting. Perhaps I have had more than my fair share, but I wonder if this is an important and mounting phenomenon. With America growing older and more and more people with serious, chronic illnesses remaining active in the community, we should not be surprised to see increasing numbers of out-of-hospital emergencies. And, as this becomes more commonplace, I become less and less certain of the role I—and other physicians like me—should have.When I was young, cocky and fearless, the call to meet an emergency was exciting. Shortly after training, an …. (shrink)