With substance dualism and the existence of God, Swinburne (2004, The Existence of God, Oxford University Press, Oxford) and Moreland (2010, Consciousness and the Existence of God, Routledge, New York) have argued for a very powerful explanatory mechanism that can readily explain several philosophical problems related to consciousness. However, their positions come with presuppositions and ontological commitments which many are not prepared to share. The aim of this paper is to improve on the Swinburne-Moreland argument from consciousness by developing an (...) argument for the existence of God from consciousness without being committed to substance dualism. The argument proceeds by suggesting a solution to the exceptional-point-of-view problem, i.e., the question how it can be explained that there is a conscious being lucky enough to experience the point of view of a relatively tiny brain amidst a giant universe that is indifferent about which physical entities it brings about according to the laws of physics. (shrink)

The allocation of vaccines and therapeutics for Covid‐19 obviously raises ethical questions, and physicians and ethicists have begun to address them. Writers have identified various criteria that should guide allocation decisions, but the criteria often conflict and need to be balanced against one another. This article proposes a model for thinking about how different considerations that are relevant to the distribution of vaccines and scarce treatments for Covid‐19 could be integrated into an allocation procedure. The model employs the construct of (...) a weighted lottery, which is a construct that has been employed in other contexts that involve the distribution of scarce resources. The article highlights the advantages of applying a weighted lottery to the Covid‐19 context and offers an illustration for how it might work in practice. The primary aim of the article is to articulate the structural features of a weighted lottery for this context and to bring out its advantages over other methods for allocating Covid‐19 medications. (shrink)

""Catching Ourselves in the Act" is no less than an attempt to explain intelligence. Delightful how the author dismantles traditional views in.

We are currently in the midst of a revival of interest in thevirtues. A number of contemporary moral philosophers havedefended a virtue-based approach to ethics. But does thisrenewal of interest in the virtues have much to contributeto medical ethics and medical practice? This paper criticallydiscusses this question. It considers and rejects a number ofimportant arguments that purport to establish the significanceof the virtues for medical practice. Against these arguments,the paper seeks to show that while the virtues have a genuinerole to (...) play in medical ethics, it is a limited role, one thatis subordinate to the role that other moral concepts such asrules and principles play. (shrink)

If people sometimes participate in research because of altruism—because they want to help in the search for treatments—should we revise our views about what kinds of experiments are ethical? If participants act out of altruism, we might let them accept greater risks than we would if they are motivated only by a desire for personal gain. But how can we know when participants are genuinely altruistic?

In order to develop the ontology of tendencies for use in the representation of medical knowledge, tendencies are compared with other kinds of entities possessing the realizable-realization structure, specifically: dispositions, propensities, abilities and virtues. The peculiarities of tendencies are discussed and a standard schema of tendency ascription is developed in order to represent the relations between the ascriptions of tendency tokens to particulars and the ascriptions of tendency types to universals. Two nonstandard cases and their epistemic variants are discussed.

Functional explanations apply not only in cases of normal functioning, but also in the case of malfunctioning. According to a straightforward analysis, a bearer of the function to F is malfunctioning if and only if it does not F although it should do so. This makes malfunctions and malfunctionings analogous to negative causation and thus peculiarly problematic, because they seem to involve absent dispositions and absent processes. This analysis seems also to require that the function to F cannot be identical (...) with the disposition to F. Then we seem to be trapped in a dilemma: Either the realm of functions is separated from the realm of dispositions; then it seems that functions cannot be causally efficacious. Alternatively, functions are considered to be identical with dispositions; but then malfunctioning seems to be conceptually impossible. The paper defends and further develops the thesis of Röhl and Jansen that functions are not a special type of dispositions. For this purpose, it first reviews different varieties of malfunction and malfunctioning and suggests definitions of both malfunction and malfunctioning. It reviews how causal, etiological and intentional theories of functions can deal with these problems. In particular, the paper discusses the special-disposition account of the Basic Formal Ontology. Spear, Ceusters and Smith :103--128, 2016) have defended the special-disposition account of the Basic Formal Ontology by suggesting various strategies how a special-disposition account can deal with malfunctions. On the one side, the paper evaluates these strategies and indicates several problems arising from them. On the other hand, it describes how to account for the non-optionality and the causal efficacy of functions, if functions are not dispositions. While function types are not identical to disposition types, there are important interrelations between functions and dispositions, namely heuristically, from a design perspective for artefact functions, and from an evolutionary perspective for types of biological functions. (shrink)

This paper provides a new rationale for equating brain death with the death of the human organism, in light of well-known criticisms made by Alan D Shewmon, Franklin Miller and Robert Truog and a number of other writers. We claim that these criticisms can be answered, but only if we accept that we have slightly redefined the concept of death when equating brain death with death simpliciter. Accordingly, much of the paper defends the legitimacy of redefining death against objections, before (...) turning to the specific task of defending a new rationale for equating brain death with death as slightly redefined. (shrink)

This article presents an analysis and evaluation of what I call the “I’m not stupid” argument. This argument has ancient roots, which lie in Aristotle’s famous description of the weak man’s and strong man’s arguments. An “I’m not stupid” argument is typically used in a context of accusation and defense, by a defendant who argues that they did not commit the act of which they have been accused. The analysis of this type of argument takes the shape of an argumentative (...) pattern, which displays a full-fledged representation of its argumentation structure. It is based on a collection of ten contemporary instances of the “I’m not stupid” argument. Although ten instances constitute a small collection, the wide variation in the argumentative elements that they express explicitly or leave implicit made it possible to identify five new key premises in comparison with previous analyses of the weak man’s and strong man’s arguments (Walton, Tindale and Gordon 2014 in _Argumentation_ 28:85–119, 2014; Walton 2019 in _Argumentation_ 33:45–74, 2019). These new premises show that the crucial point of an evaluation of this argument is the arguer's supposedly rational character in making a gain-loss calculation. They also show that we need empirical data to strengthen our analyses of argument schemes and argumentation structures. (shrink)

Much work in social ontology analyzes how social entities are based on collective intentionality. A neglected perspective is, however, the distinction between those social entities that are explicitly established (often called formal institutions, like marriages), those that are established but not explicitly (informal institutions, like friendships), and those that are not established at all (social macro entities, like episodes of inflation). To shed more light on this trichotomy, a collection of examples taken from the works of John Searle will be (...) discussed, comprising money, marriages, friendship, cocktail parties, natural language, and episodes of inflation. The chapter argues that explicit establishment confers certain typical characteristics on formal institutions that informal institutions lack, thus explaining the typical differences between marriages and friendship. The focus on explicit establishment further develops Khalidi’s classification of social kinds, and it contributes to Epstein’s quest for grounds and anchors of social entities. It can thus contribute to overcoming the narrow focus on collective intentionality. (shrink)

: "Clinical pragmatism" is an important new method of moral problem solving in clinical practice. This method draws on the pragmatic philosophy of John Dewey and recommends an experimental approach to solving moral problems in clinical practice. Although the method may shed some light on how clinicians and their patients ought to interact when moral problems are at hand, it nonetheless is deficient in a number of respects. Clinical pragmatism fails to explain adequately how moral problems can be solved experimentally, (...) it underestimates the relevance and importance of judgment in clinical ethics, and it presents a questionable account of the role that moral principles should play in moral problem solving. (shrink)

This article analyses how recent critiques of secularism in political philosophy and cultural anthropology might productively be combined and contrasted with each other. I will show that Jürgen Habermas' postsecularism takes insufficient account of elementary criticisms of secularism on the part of anthropologists such as Talal Asad and Saba Mahmood. However, I shall also criticize Saba Mahmood’s reading of secularism by arguing that, in the end, she replaces the secular–religious divide with a secularity–piety divide; for example, in her reading of (...) Nasr Abu Zayd’s secular Islamic hermeneutics. This inhibits the use of her framework of analysis for a criticism of a problem central to Habermas' postsecularism, namely that it remains focused on specific intensities of belief. I shall then argue that, combined with the anthropological critiques of the secular, the political-historical nature of the fanaticism–piety–violence nexus should be integrated into political philosophical debates on secularism and postsecularism. (shrink)

The term “exploitation” has gained wide currency in recent discussions of biomedical and research ethics. This is due in no small measure to the influence of Alan Wertheimer’s path-breaking work on the topic (Wertheimer 1999, 2011). Wertheimer presented a clear and compelling non-Marxist account of the concept of exploitation—one that stressed the connection between exploitation and unfair distributive outcomes. On this account, when one party exploits another, she takes advantage of the other to gain unfairly. A number of contemporary bioethicists (...) have accepted Wertheimer’s account of exploitation and have proceeded to apply it to a range of issues in research ethics (Hawkins and Emanuel 2008; Miller and Brody .. (shrink)

Recent years have witnessed a growing concern that terminally illpatients are needlessly suffering in the dying process. This has ledto demands that physicians become more attentive in the assessment ofsuffering and that they treat their patients as `whole persons.'' Forthe most part, these demands have not fallen on deaf ears. It is nowwidely accepted that the relief of suffering is one of the fundamentalgoals of medicine. Without question this is a positive development.However, while the importance of treating suffering has generally (...) beenacknowledged, insufficient attention has been paid to the question ofwhether different types of terminal suffering require differnt responsesfrom health care professionals. In this paper we introduce a distinctionbetween two types of suffering likely to be present at the end of life,and we argue that physicians must distinguish between these types if theyare to respond appropriately to the suffering of their terminally illpatients. After introducing this distinction and explaining its basis,we further argue that the distinction informs a (novel) principle ofproportionality, one that should guide physicians in balancing theircompeting obligations in responding to terminal suffering. As weexplain, this principle is justified by reference to the intereststerminally ill patients have in restoration, as well as in therelief of suffering, at the end of life. (shrink)

This article critically analyzes the principle of beneficence and the principle of nonmaleficence in clinical medical ethics. It resists some recent skepticism about the principle of nonmaleficence, and then seeks to explain its role in medicine. The article proposes that the two principles are informed by different accounts of what is in the patient’s best interests. The principle of beneficence is tied to the patient’s best overall interests, whereas the principle of nonmaleficence is tied to the patient’s best medical interests (...) only. The article argues that the principle of nonmaleficence takes priority over the principle of beneficence in that it filters the treatment options that are appropriately subject to the principle of beneficence. Understanding how both principles can play an important role in medical practice, and how they relate when they come into conflict, can help clinicians to avoid certain mistakes in thinking about their duties to their patients. (shrink)

This piece looks into the atmospheric and catastrophic environments that punctuate H of H: storms, ice-breaks, volcanic eruptions, and nuclear explosions that give the tragic narrative an electrifying edge. It draws attention to a “chemical” poetics at the heart of Carson’s translation technique and thinking about Euripides’ play. This mannerism, also found in Euripides’s “combustible mixture of realism and extremism” (Grief Lessons, blurb), is not exclusive to H of H. It can be detected across Carson’s oeuvre – a tendency to (...) combust the reader’s mind in ways that become a philosophy for re-reading Euripides and, more ambitiously, Carson’s own sense of the tragic. (shrink)

Unrealistic optimism is a bias that leads people to believe, with respect to a specific event or hazard, that they are more likely to experience positive outcomes and/or less likely to experience negative outcomes than similar others. The phenomenon has been seen in a range of health-related contexts—including when prospective participants are presented with the risks and benefits of participating in a clinical trial. In order to test for the prevalence of unrealistic optimism among participants of early-phase oncology trials, we (...) conducted a survey with patients over 18 years of age who were enrolled in a phase I, phase I/II, or phase II clinical cancer trial in the New York City area between August 2008 and October 2009. Participants in our study were asked to compare their own chances of experiencing a range of risks and benefits related to the trial they were enrolled in with the chances of the other trial participants. We found a significant optimistic bias in their responses. Respondents tended to overestimate the benefits of the trial they were enrolled in and underestimate its risks. In addition, we found no significant relationship between respondents’ understanding of the trial’s purpose and how susceptible they were to unrealistic optimism. Our findings suggest that improving the consent process for oncology studies requires more than addressing deficits in understanding. (shrink)

This book discusses the philosophy of influential contemporary philosopher Peter van Inwagen. Looking at perennial philosophical problems from a modern point of view, Peter van Inwagen’s philosophy masterfully combines positions that have been considered irreconcilable: incompatibilism concerning free will, materialism, organicism, theism and realism concerning fictional entities. As readers will discover, his arguments are witty, surprising and deep. -/- The book includes Peter van Inwagen’s Münster Lecture of 2015 on free will, as well as eleven papers from the Münster colloquium (...) discussing central themes of his philosophy, and a reply to each paper by Peter van Inwagen himself. Introducing his philosophy and relating his work to other contemporary views, this book is of interest to graduate students and professionals in philosophy alike. (shrink)

Background In this article, the sources and features of moral distress as experienced by acute psychiatric care nurses are explored. Research design A qualitative design with 16 individual in-depth interviews was chosen. Braun and Clarke’s six analytic phases were used. Ethical considerations Approval was obtained from the Norwegian Social Science Data Services. Participation was confidential and voluntary. Findings Based on findings, a somewhat wider definition of moral distress is introduced where nurses experiencing being morally constrained, facing moral dilemmas or moral (...) doubt are included. Coercive administration of medicines, coercion that might be avoided and resistance to the use of coercion are all morally stressful situations. Insufficient resources, mentally poorer patients and quicker discharges lead to superficial treatment. Few staff on evening shifts/weekends make nurses worry when follow-up of the most ill patients, often suicidal, in need of seclusion or with heightened risk of violence, must be done by untrained personnel. Provision of good care when exposed to violence is morally challenging. Feelings of inadequacy, being squeezed between ideals and clinical reality, and failing the patients create moral distress. Moral distress causes bad conscience and feelings of guilt, frustration, anger, sadness, inadequacy, mental tiredness, emotional numbness and being fragmented. Others feel emotionally ‘flat’, cold and empty, and develop high blood pressure and problems sleeping. Even so, some nurses find that moral stress hones their ethical awareness. Conclusion Moral distress in acute psychiatric care may be caused by multiple reasons and cause a variety of reactions. Multifaceted ethical dilemmas, incompatible demands and proximity to patients’ suffering make nurses exposed to moral distress. Moral distress may lead to reduced quality care, which again may lead to bad conscience and cause moral distress. It is particularly problematic if moral distress results in nurses distancing and disconnecting themselves from the patients and their inner selves. (shrink)

There is broad agreement among research ethicists that investigators have a duty to obtain the informed consent of all subjects who participate in their research trials. On a common view, the duty to obtain this informed consent follows from the need to respect persons and their autonomous decisions. However, the nature of informed consent and the demands it places on investigators are open to dispute and recently have been challenged. Respect for persons, it has been claimed, does not require investigators (...) to guarantee that the subjects enrolled in their trials comprehend the risk/benefit information disclosed to them or even that they appreciate the difference between research and therapy. According to this critique, the significance of defects in informed consent, like therapeutic misconception or unrealistic optimism, has been greatly exaggerated. This article reevaluates informed consent in clinical research in light of this critique. It not only rebuts the main points the critics raise, but also shows that other points they raise can be accepted by a doctrine of informed consent that resembles the common view in maintaining that autonomous authorization is central to informed consent. (shrink)

Special Issue, n. I, ch. 1, On the Transcendental.

In this paper, I draw from Kantian and Husserlian reflections on the self-awareness of thinking for a contribution to the cognitive phenomenology debate. In particular, I draw from Kant’s conceptions of inner sense and apperception, and from Husserl’s notions of lived experience and self-awareness for an inquiry into the nature of our awareness of our own cognitive activity. With particular consideration of activities of attention, I develop what I take to be Kant’s and Husserl’s “agentive” and “proprietary” accounts. These, I (...) believe, augment contemporary discussions in interesting ways and further bolster the case for cognitive phenomenology. Moreover, the historical comparison highlights a number of assumptions made today that were not yet part of the framework at the time of Kant or at the time of Husserl. This helps reflect on the legitimacy of these assumptions. (shrink)

Paediatric Intensive Care Units (PICU) are complex interdisciplinary environments where challenging, high stakes decisions are frequently encountered. We assert that appropriate decisions are more likely to be made if the decision-making process is comprehensive, reasoned, and grounded in thoughtful deliberation. Strategies to overcome barriers to high quality decision-making including, cognitive and implicit bias, group think, inadequate information gathering, and poor quality deliberation should be incorporated. Several general frameworks for decision-making exist, but specific guidance is scarce. In this paper, we provide (...) specific guidance on collaborative complex decision-making for PICUs. The proposed approach is on principles of procedural justice and pragmatic hermeneutics. The process encompasses set-up/planning, information gathering, question formulation, analysis (perspectives, values, and principles), action plan development, decision documentation, and a review and appeal mechanism. The process can be adapted to suit other clinical contexts. Research evaluating the process, exploring how best to develop education for clinicians, and how to build a culture that values high quality deliberation, is worthwhile. (shrink)

Researchers and ethicists have long been concerned about the expectations for direct medical benefit expressed by participants in early phase clinical trials. Early work on the issue considered the possibility that participants misunderstand the purpose of clinical research or that they are misinformed about the prospects for medical benefit from these trials. Recently, however, attention has turned to the possibility that research participants are simply expressing optimism or hope about their participation in these trials. The ethical significance of this therapeutic (...) optimism remains unclear. This paper argues that there are two distinct phenomena that can be associated with the term ‘therapeutic optimism’—one is ethically benign and the other is potentially worrisome. Distinguishing these two phenomena is crucial for understanding the nature and ethical significance of therapeutic optimism. The failure to draw a distinction between these phenomena also helps to explain why different writers on the topic often speak past one another. (shrink)

BackgroundDefensive practice occurs when physicians provide services, such as tests, treatments and referrals, mainly to reduce their perceived legal or reputational risks, rather than to advance patient care. This behaviour is counter to physicians’ ethical responsibilities, yet is widely reported in surveys of doctors in various countries. There is a lack of qualitative research on the drivers of defensive practice, which is needed to inform strategies to prevent this ethically problematic behaviour.MethodsA qualitative interview study investigated the views and experiences of (...) physicians in Australia on defensive practice and its contribution to low value care. Interviewees were recruited based on interest in medico-legal issues or experience in a health service involved in ‘Choosing Wisely’ initiatives. Semi-structured interviews averaged 60 min in length. Data were coded using the Theoretical Domains Framework, which encapsulates theories of behaviour and behaviour change.ResultsAll participants (n = 17) perceived defensive practice as a problem and a contributor to low value care. Behavioural drivers of defensive practice spanned seven domains in the TDF: knowledge, focused on inadequate knowledge of the law and the risks of low value care; skills, emphasising patient communication and clinical decision-making skills; professional role and identity, particularly clinicians’ perception of patient expectations and concern for their professional reputation; beliefs about consequences, especially perceptions of the beneficial and harmful consequences of defensive practice; environmental context and resources, including processes for handling patient complaints; social influences, focused on group norms that encourage or discourage defensive behaviour; and emotions, especially fear of missing a diagnosis. Overall, defensive practice is motivated by physicians’ desire to avoid criticism or scrutiny from a range of sources, and censure from their professional peers can be a more potent driver than perceived legal consequences.ConclusionsThe findings call for strengthening knowledge and skills, for example, to improve clinicians’ understanding of the law and their awareness of the risks of low value care and using effective communication strategies with patients. Importantly, supportive cultures of practice and organisational environments are needed to create conditions in which clinicians feel confident in avoiding defensive practice and other forms of low value care. (shrink)

The human body can be regarded in at least two ways: objectively, as a physical and organic body; and subjectively, as the center of orientation and lived affective unity. However, this distinction can lose sight of the fact that the ‘lived body’ is not reducible to subjective idiosyncrasies. Trans-individual norms are embodied too, as Michel Foucault and Judith Butler have shown. Phenomenological investigations of normalization and habitualization help bring these two important dimensions of embodiment together and overcome simplistic oppositions between (...) phenomenological and poststructuralist approaches. These investigations lead into issues of female body optimization and control that we take to be characteristic of contemporary neoliberalist embodiment. (shrink)

This book provides a theory of the juridification of business ethics. Ethical codes pop up everywhere in the business world and increasingly resemble the code of law. A focus on compliance rather than reflection becomes the norm. Legal perspectives replace ethical perspectives, turning ethicists into lawyers without a law degree. This juridification of business ethics conceals a diminishing trust in ethics, as legal reasoning substitutes philosophical thinking. By appealing to the critical study of law, Bart Jansen advocates for a (...) renewed focus on the ethical side of business. This book shows the importance of a good balance between law and ethics in business and is of great interest to both academics and professionals. (shrink)

Being an "untimely review", this paper reviews Aristotle's 'Categories' as if they were published today, in the era of computerised information, where categorisation becomes more and more essential for information retrieval. I suggest a systematic ordering of Aristotle's list of categories and argue that Aristotle's discussion of ontological dependency and his focus on concrete entities are still a source of new insight and can indeed be read as a contribution to the emerging field of applied ontology and ontological engineering.

In recent decades, evidence-based medicine has become one of the foundations of clinical practice, making it necessary that healthcare practitioners develop keen critical appraisal skills for scientific papers. Worksheets to guide clinicians through this critical appraisal are often used in journal clubs, a key part of continuing medical education. A similar need is arising for health professionals to develop skills in the critical appraisal of medical ethics papers. Medicine is increasingly ethically complex, and there is a growing medical ethics literature (...) that modern practitioners need to be able to use in their practice. In addition, clinical ethics services are commonplace in healthcare institutions, and the lion’s share of the work done by these services is done by clinicians in addition to their usual roles. Education to support this work is important. In this paper, we present a worksheet designed to help busy healthcare practitioners critically appraise ethics papers relevant to clinical practice. In the first section, we explain what is different about ethics papers. We then describe how to work through the steps in our critical appraisal worksheet: identifying the point at issue; scrutinising definitions; dissecting the arguments presented; considering counterarguments; and finally deciding on relevance. Working through this reflective worksheet will help healthcare practitioners to use the ethics literature effectively in clinical practice. We also intend it to be a shared evaluative tool that can form the basis of professional discussion such as at ethics journal clubs. Practising these critical reasoning skills will also increase practitioners’ capacity to think through difficult ethical decisions in daily clinical practice. (shrink)

Introducing formal causation / Ludger Jansen and Petter Sandstad -- Form, intention, information : from scholastic logic to artificial intelligence / Gyula Klima -- Formal causation : accidental and substantial / David S. Oderberg -- A non-hylomorphic account of formal causation / Petter Sandstad and Ludger Jansen -- Formal causes for powers theorists / Giacomo Giannini and Stephen Mumford -- Away with dispositional essences in trope theory / Jani Hakkarainen and Markku Keinänen -- Functional powers / Michele Paolini (...) Paoletti -- An Aristotelian approach to existential dependence / Benjamin Schnieder and Jonas Werner -- Finean feature dependence and the Aristotelian alternative / Wolfgang Sattler -- A problem for natural-kind essentialism and formal causes / José Tomás Alvarado and Matthew Tugby -- Form as cause and the formal cause : Aristotle's answer / James G. Lennox -- Form, cause, and explanation in biology : a neo-Aristotelian perspective / Christopher J. Austin -- Formal explanation and mechanisms of conceptual representation / Sandeep Prasada. (shrink)

In this article I address the idea that in Husserl’s eidetic ontology all possibilities are fixed ‘in advance’ so that actual objects and events—despite their contingency—can only ever unfold possibilities that are ‘permitted’ to them by their essences. I show how this view distorts Husserl’s ontology and argue that this distortion stems from a misconstrual of the relations between essences and facts, and between ideal and real possibilities. These ‘local’ misconstruals reflect, I contend, a ‘global’ misunderstanding that mistakes descriptive distinctions (...) for ‘real’ separations, and that remains indebted to a non-Husserlian understanding of the a priori–a posteriori-distinction. In support of this argument, I first lay out the relevant objection to Husserl’s eidetics as I understand it. Then, I clarify the relation between ideal and real possibilities in the context of Husserl’s eidetics as I see it. Finally, I make a general point about the status of Husserl’s ontological differentiations ‘in the midst of life,’ namely in how what they differentiate is effective and (tacitly) manifest ever only as one moment (amongst many) of the complex whole that is a concrete life of consciousness. I end with some remarks on what this might mean for future phenomenological research on the imagination. (shrink)

In the literature the term “natural balance” occurs frequently and is used for highly divergent collections of facts and for results arrived at by different methods. In this paper it is attempted to give a review of the many possible meanings of “balance in nature”, and to evaluate the application of the term in the scientific literature.To achieve this twofold objective it seemed useful to start by giving as objective as possible a description of the “balance situation” in natural communities, (...) in analogy with the original physical concept and according to strict scientific criteria. On the basis of this working standard, part of the ecological literature is discussed with respect to statements and presumptions concerning “balance”. The extensive literature is classified according to several groups, on the one hand on the basis of the nature of the views , on the other hand according to the importance that certain authors attach to the theory of a given author. For each of these groups, an evaluation of the content of the term “balance” is given. It was found that the reasoning is not always sound and that the nature of the data on which the concept is based varies widely, which also holds for the method of reasoning applied in the conclusions drawn. In none of the publications arguments were found supporting the existence of a natural “balance situation” as formulated in the standard description. Consequently, it seemed justified to conclude that it is not correct to apply a concept “natural balance”, defined purely scientifically, to natural situations, either because “balance” in the indicated sense is simply not present or because the situation under consideration is not a natural one . The concept “natural balance” has had only heuristic value for scientific research. In other contexts it has a different value, because there criteria other than scientific or methodological ones hold for the content of a concept. It is therefore not objectionable to use the term “natural balance” in common parlance, especially since this usage makes it possible to convey to the layman a great deal in few words. (shrink)

Purpose Recent research has found unrealistic optimism among patient-subjects in early-phase oncology trials. Our aim was to investigate the cognitive and motivational factors that evoke this bias in this context. We expected perceptions of control to be a strong correlate of unrealistic optimism. Methods A study of patient-subjects enrolled in early-phase oncology trials was conducted at two sites in the USA. Respondents completed questionnaires designed to assess unrealistic optimism and several risk attribute variables that have been found to evoke the (...) bias in other contexts. Results One hundred and seventy-one patient-subjects agreed to be interviewed for our study. Significant levels of perceived controllability were found with respect to all nine research-related questions. Perceptions of control were found to predict unrealistic optimism. Two other risk attribute variables, awareness of indicators and mental image, were correlated with unrealistic optimism. However, in multivariate regression analysis, awareness and mental image dropped out of the model and perceived controllability was the only factor independently associated with unrealistic optimism. Conclusion Patient-subjects reported that they can, at least partially, control the benefits they receive from participating in an early-phase oncology trial. This sense of control may underlie unrealistic optimism about benefiting personally from trial participation. Effective interventions to counteract unrealistic optimism may need to address the psychological factors that give rise to distorted risk/benefit processing. (shrink)

In recent years, many states in the United States have passed legislation requiring laboratories to report the names of patients with low CD4 cell counts to their state Departments of Health. This name reporting is an integral part of the growing number of “HIV Reporting and Partner Notification Laws” which have emerged in response to recently revised guidelines suggested by the National Centers for Disease Control (CDC). Name reporting for patients with low CD4 cell counts allows for a more accurate (...) tracking of the natural history of HIV disease. However, given that this test is now considered to be an “indicator” of HIV, should it be subject to the same strict consent required for HIV testing? While the CDC has recommended that each state develop its own consent requirements for CD4 cell testing, most states have continued to rely on the presumed consent standards for CD4 cell testing that were in place before the passage of name reporting statutes. This allows physicians who treat patients who refuse HIV testing to order a CD4 cell blood analysis to gather information that is indicative of their patient’s HIV status. This paper examines the ethical and legal issues associated with the practice of “conscientious subversion” as it arises when clinicians use CD4 cell counts as a surrogate for HIV testing. (shrink)

The movement in bioethics toward disclosure of financial conflicts of interest is well and good, most of the time. But in some cases, disclosure is not only unnecessary but destructive. When bioethicists advance arguments whose premises and logical moves are open to scrutiny, disclosure—far from clearing the air of bias—introduces bias.

A model for the trapping of animals with a circular pitfall is formulated. The model's assumptions are: The animals move independently according to the same Brownian motions. The boundary of the pitfall acts as an absorbing or elastic barrier. Initially a fixed number of animals is independently homogeneously distributed over a finite study area, or the initial positions follow a homogeneous planar Poisson process. The model depends on three free parameters: the motility of the animals, their reaction to the pitfall, (...) the initial density.It appears that the catches in disjoint time intervals are multinomially or independently Poisson distributed. The parameters of these distributions are obtained by solving certain partial differential equations. (shrink)