Background Biobank participants often do not understand much of the information they are provided as part of the informed consent process, despite numerous attempts at simplifying consent forms and improving their readability. We report the first assessment of biobank enrollees’ comprehension under an "integrated consent” process, where patients were asked to enroll in a research biobank as part of their normal healthcare experience. A number of healthcare systems have implemented similar integrated consent processes for biobanking, but it is unknown how (...) much patients understand after enrolling under these conditions. Methods: We recruited patients who enrolled in a biobank while in a healthcare setting when receiving ordinary care. We assessed knowledge of consent materials using 11 true/false questions drawn from a well-known biobank knowledge test. After reviewing the results from 114 participants, we revised the consent form and repeated the knowledge assessment with 144 different participants. Results: Participants scored poorly on the knowledge test in both rounds, with no significant differences in overall scores or individual items between the rounds. In Phase 1, participants answered 53% of the questions correctly, 25% incorrectly, and 22% “I don’t know.” In Phase 2, participants answered 53% of questions correctly, 24% incorrectly, and 23% “I don’t know.” Participants scored particularly poorly on questions about data sharing and accessing medical records. Conclusions: Enrollees under an integrated consent model had significant misunderstandings that persisted despite an attempt to improve information specifically about those topics in a consent form. These results raise challenges for current approaches that attribute misunderstanding to overly complex consent forms. They also suggest that the pressures of the clinic may compound other problems with patient understanding of biobank consent. As health systems increasingly blend research and care, they may need to rethink their approach to educating patients about participation in a biobank. (shrink)

Gametes, tissue, and organs can be taken from the dying or dead for reproduction, transplantation, and research. Whole bodies as well as parts can be used for teaching anatomy. While these uses are diverse, they have an ethical consideration in common: the claims of the people whose bodies are used. Is some use permissible only when people have consented to the use, actually wanted the use, would have wanted the use, not opposed the use, or what? The aim of this (...) article is to make progress in answering these questions. Initially I assume knowledge of people’s desires in order to test whether consent is directly required by their rights without worrying about mistaken uses against their wishes. I claim consent is not directly required by people’s rights. If we know people wanted or would want a use, their rights permit the use, but if we know they wanted or would want not to be used, their rights do not permit the use. The knowledge assumption is then dropped and the question becomes how to decide what to do when the wishes of rightholders are not known. I suggest working out what to do when wishes are known and then adjusting, on the basis of whatever evidence there is, for probability and strength of desire. There are other considerations too, for instance about default rules. The key general comment here is that, in setting rules, the costs to rightholders in not getting what they want needs to be taken into account. The final section tries to show that, in setting these rules, mistaken uses are not to be taken as worse than mistaken failure to use. (shrink)

A unifying theory of general anesthetic-induced unconsciousness must explain the common mechanism through which various anesthetic agents produce unconsciousness. Functional-brain-imaging data obtained from 11 volunteers during general anesthesia showed specific suppression of regional thalamic and midbrain reticular formation activity across two different commonly used volatile agents. These findings are discussed in relation to findings from sleep neurophysiology and the implications of this work for consciousness research. It is hypothesized that the essential common neurophysiologic mechanism underlying anesthetic-induced unconsciousness is, as with (...) sleep-induced unconsciousness, a hyperpolarization block of thalamocortical neurons. A model of anesthetic-induced unconsciousness is introduced to explain how the plethora of effects anesthetics have on cellular functioning ultimately all converge on a single neuroanatomic/neurophysiologic system, thus providing for a unitary physiologic theory of narcosis related to consciousness. (shrink)

I argue here that in the end Bourdieu's theory of practice fails to overcome the problem on which it expressly centers, namely, subject-object dualism. The failure is registered in his avowed materialism, which, though significantly "generalized," remains what it says: a materialism. In order to substantiate my criticism, I examine for their ontological presuppositions three areas of his theoretical framework pertaining to the questions of (1) human agency (as seen through the conceptual glass of the habitus), (2) otherness, and (3) (...) the gift. By scrutinizing Bourdieu's powerful and progressive social theory, with an eye to finding fault, I hope to show the need to take a certain theoretical action, one that is patently out of keeping with the usual self-presentation and self-understanding of social science. The action I have in mind is this: because the problem of subject-object dualism is in the first place a matter of ontology, in order successfully to address it there must take place a direct shift of ontological starting point, from the received starting point in Western thought to one that projects reality in terms of ambiguity that is basic. With this shift the dualism of subject and object dissolves by definition, leaving a social reality that, for reasons of its basic ambiguity, is best approached as a question of ethics before power. (shrink)

It is claimed by the future like ours anti-abortion argument that since killing adult humans is wrong because it deprives them of a future of value and the fetus has a future of value, killing fetuses is wrong in the same way that killing adult human beings is wrong. In The morality of abortion and the deprivation of futures (this journal, April 2000) I argued that the persuasive power of this argument rests upon an equivocation on the term “future of (...) value”. If the expression means “a potential future of value” then the moral claim is implausible because people do not in general have rights to what they need to fulfill their potential; if the expression means “self-represented future of value” then the argument fails because the fetus does not represent its future. Under no interpretation is the argument sound. In Deprivations, futures and the wrongness of killing (this journal, December 2001) Donald Marquis, author of the future like ours argument, responds at length to this objection. In the present essay the focus of the debate shifts to the proper interpretation of the right not to be killed. Donald Marquis argues that this liberty right entails the welfare right to the means necessary to sustain life; I argue that the right not to be killed does not entail unlimited welfare rights. On Marquis's view, the right not to be killed confers upon the fetus the right to whatever it takes to sustain life; on the view I defend, the right not to be killed does not confer upon the fetus or anyone else the right to another person's body. On Marquis's view, abortion is almost never permissible; on my view abortion is almost always permissible. (shrink)

Descartes' methodical doubt is being criticized by naïve realists and others who don't find doubt as a good starting point for metaphysical thought, however, the philosophical achievements of his method have been absorbed in all later philosophies. The objective of this paper is to demonstrate how an inevitable question concerning the foundation of Descartes' mathesis universalis, which led him to investigate this foundation by applying this very method in Metaphysics, has finally enabled him to discover his most important philosophical principle, (...) i.e., the necessary relation between being and reason in the identity of the "I". To demonstrate this, after summarizing the fundamental ideas of mathesis uneversalis, and showing the inner necessity of introducing the methodical doubt to fortify these ideas, the decisive role of metaphysical doubt as the third step of the methodical doubt, and malicious demon as its second phase would be highighted. It would also become clear that the metaphysical doubt has a great importance as a turning point from different aspects: as a knot that ties mathesis universalis with its underlying Metaphysics; as a bridge from within the psychological "I" to the metaphysical "I". (shrink)

Cadaveric transplantation and living transplantation exist side by side. Both practices help to alleviate organ need. They provide us with two separate moral schemes. Is it rational to keep them apart? The cadaveric system is organised along strict, impartial lines, while the living system is inherently partial and local. The ethical justification for this partial scheme seems to be that it merely supplements the cadaveric scheme: partial transplants do not come at the expense of cadaveric impartiality, but in fact significantly (...) reduce the waiting time for patients on the list for a cadaveric transplant.This seemingly peaceful coexistence is challenged by new initiatives, among them living donation list exchange, and also the LifeSharers initiative, leading to practices that undermine cadaveric impartiality. Should we bemoan this fact, or should we move on towards a new balance in the relationship between cadaveric and living transplantation practices, towards a new moral weighing of impartial and partial values? I argue, against the background of a rapid growth of living donations, that we have good, ethical reasons—not only utilitarian ones—for giving the value of partiality a more prominent place in our policies. (shrink)

The problem of representing a single localized particle has played a crucial role in the historical development of quantum theories. In particular, the failure to construct a relativistically invariant position eigenstate was a contributing factor in the demise of the so-called relativistic quantum mechanics, in favor of quantum field theories. Nevertheless, non-locality which stems from standard accounts of Single-particle localization still presents itself as a problem in the form of Gerhard Hegerfeldt's eponymous theorem of 1974. Accepting that a link may (...) be maintained between invariance and 'objectivity,' it is shown how Hegerfeldt's paradoxical result arises in relativistic theories from a failure of objectivity of localization-the so-called 'Jericho effect'. (shrink)

In an influential essay entitled Why abortion is wrong, Donald Marquis argues that killing actual persons is wrong because it unjustly deprives victims of their future; that the fetus has a future similar in morally relevant respects to the future lost by competent adult homicide victims, and that, as consequence, abortion is justifiable only in the same circumstances in which killing competent adult human beings is justifiable.1 The metaphysical claim implicit in the first premise, that actual persons have a future (...) of value, is ambiguous. The Future Like Ours argument (FLO) would be valid if “future of value” were used consistently to mean either “potential future of value” or “self-represented future of value”, and FLO would be sound if one or the other interpretation supported both the moral claim and the metaphysical claim, but if, as I argue, any interpretation which makes the argument valid renders it unsound, then FLO must be rejected. Its apparent strength derives from equivocation on the concept of “a future of value”. (shrink)

Is it really necessary to add something like the Health Impact Fund to the existing global patent system? We can divide this question into two parts. First, is there something seriously wrong with the status quo and, if so, what exactly is it? Second, how do we best go about solving the problem; that is, how does the design of the reform proposal address the flaws in the status quo? Jorn Sonderholm, in his critique of the Health Impact Fund, or (...) HIF, raises both of these issues. These criticisms afford us the opportunity to reaffirm our commitment to ameliorating glaring problems with the current system for incentivizing R&D for essential medicines, and to clarify why we believe the HIF is exactly what the world needs. (shrink)