“Evidence based medicine” is often seen as a scientific tool for quality improvement, even though its application requires the combination of scientific facts with value judgments and the costing of different treatments. How this is done depends on whether we approach the problem from the perspective of individual patients, doctors, or public health administrators. Evidence based medicine exerts a fundamental influence on certain key aspects of medical professionalism. Since, when clinical practice guidelines are created, costs affect the content of EBM, (...) EBM inevitably becomes a form of rationing and adopts a public health point of view. This challenges traditional professionalism in much the same way as managed care has done in the US. Here we chart some of these major philosophical issues and show why simple solutions cannot be found. The profession needs to pay more attention to different uses of EBM in order to preserve the good aspects of professionalism. (shrink)

ABSTRACT This paper is about the problem of the moral responsibility resting on any person to form rational beliefs about, and moral attitudes towards, the deterrent threat of mutual assured destruction (MAD), which still lies behind the graduated nuclear response strategies now more fashionably discussed by military experts. The problem is to decide what kinds of reasons there are, and how to arrive in the light of them at determinate conclusions about deterrence and unilateral disarmament. Consequential arguments would be powerful, (...) if only they were determinate; but not only do they not point conclusively to one strategy rather than another, there is not even sufficient reason for accepting one rather than another of the competing optimising criteria by which the strategies might be assessed. So the reasons of other kinds against forming a conditional intention to retaliate with a massive second strike could be conclusive, if retaliation itself could do no (consequential) good, and if, as is claimed, the conditional intention could not be simulated. To form such an intention is held to be contrary to core values of a humane, rationalist culture. To assent to a nuclear retaliatory strike would do violence to the moral nature of anyone participating in such a culture, and to form an intention to make (or condone) such a strike would be a corruption of such a nature. So too would condoning the fostering of such an intention in others, as a way of making the retaliatory intention credible. The author accordingly considers this argument against MAD, and for unilateral nuclear disarmament, sufficient, given the inadequacy of the consequential arguments, while acknowledging that this might involve great sacrifice. The paper concludes, however, by considering whether anyone can reject nuclear deterrence who also believes that resistance to Nazism in 1939 was justified, given the then prevailing belief that the war might be massively destructive. The author holds that there is no inconsistency in both supporting resistance to evil, even at risk of total destruction, and in refusing to form or condone a conditional intention to do equivalent but pointless evil in order to make a threat credible. (shrink)

In Australia and Oregon, USA, legislation to permit statutory sanctioned physician-assisted dying was enacted. However, opponents, many of whom held strong religious views, were successful with repeal in Australia. Similar opposition in Oregon was formidable, but ultimately lost in a 60-40% vote reaffirming physician-assisted dying. This paper examines the human dilemma which arises when technological advances in end-of-life medicine conflict with traditional and religious sanctity-of-life values. Society places high value on personal autonomy, particularly in the United States. We compare the (...) potential for inherent contradictions and arbitrary decisions where patient autonomy is either permitted or forbidden. The broader implications for human experience resulting from new legislation in both Australia and Oregon are discussed. We conclude that allowing autonomy for the terminally ill, within circumscribed options, results in fewer ethical contradictions and greater preservation of dignity. (shrink)

The approach used by physics is based on the identification and study of ideal objects, which is also the basis of biophysics, in combination with von Neumann heuristic modeling and functional fractionation according to R.Rosen is discussed as a tool for studying the properties of consciousness. The object of the study is a kind of line of analog systems: the human brain, the vertebrate brain, the invertebrate brain and artificial neural networks capable of reflection, which is a key property characteristic (...) of consciousness. Reflection in the broad sense of the word, understood as an internal representation of the external world, is characteristic of a wide range of animals, and some of them (bumblebees, fish) even demonstrate reflection in the narrow sense of the word, understood as an inner self-representation. This complex behavior is realized by miniature brains of ~1 million neurons. The use of simple recurrent neural networks (RNNs) to obtain answers to general questions is illustrated. For example, it has been shown a small RNS is able to pass delayed matching to sample (DMTS) test, forming an individual dynamic representation of the received stimulus, allowing decoding by a special external neural detector.. It has been demonstrated in the reflexive game “even-odd”, the RNS has a huge advantage over a multi-layered neural network, with the same and a larger number of neurons – reflection defeats regression. It was found that the asymmetry of outcomes in the odd-even game, which was explained by various causes, including psychological ones – “it’s easier to catch up than to run away”, is reproduced in the game of two RNNs. Obviously, there are no psychological causes here and the advantage of the player playing for “even” is explained by the more complex strategy of the “odd” player – he needs to predict the opponent’s move and choose the opposite one. (shrink)