Person‐specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self‐determination method with people with various long‐term health conditions. It explains the mechanisms of mobilizing relational capacity by including person‐specific evidence in shared decision‐making. Person‐specific self‐insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self‐management challenges. This step paved the way for sharing these insights and (...) challenges in a relationship with a supportive health professional, who could then rely on person‐specific evidence instead of assumptions or a narrow disease perspective for shared decision‐making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person‐specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self‐insights in daily life with other people, decreasing loneliness they experienced in self‐management. Relational capacity, the core of the theory, is mobilized in both people with long‐term health conditions and healthcare professionals. Further research on person‐specific evidence and relational capacity in healthcare is recommended. (shrink)

In this article we provide an in-depth description of a new model of informed consent called ‘meta consent’ and consider its practical implementation. We explore justifications for preferring meta consent over alternative models of consent as a solution to the problem of secondary use of health data for research. We finally argue that meta consent strikes an appropriate balance between enabling valuable research and protecting the individual.

Background There has been debate on whether a global or unified field of bioethics exists. If bioethics is a unified global field, or at the very least a closely shared way of thinking, then we should expect bioethicists to behave the same way in their academic activities anywhere in the world. This paper investigates whether there is a 'global bioethics' in the sense of a unified academic community. Methods To address this question, we study the web-linking patterns of bioethics institutions, (...) the citation patterns of bioethics papers and the buying patterns of bioethics books. Results All three analyses indicate that there are geographical and institutional differences in the academic behavior of bioethicists and bioethics institutions. Conclusion These exploratory studies support the position that there is no unified global field of bioethics. This is a problem if the only reason is parochialism. But these regional differences are probably of less concern if one notices that bioethics comes in many not always mutually understandable dialects. (shrink)

One of the arguments that is often put forward in the discussion of human cloning is that it is in itself wrong to create a copy of a human being.

From reason to practice in bioethics brings together original contributions from some of the world's leading scholars in the field of bioethics. With a particular focus on, and critical engagement with, the influential work of Professor John Harris, the book provides a detailed exploration of some of the most interesting and challenging philosophical and practical questions raised in bioethics.

Social media applications such as Facebook hold great promise as means of communicable disease control. We argue here that the use of social media in communicable disease control may cause various forms of harm, and that these harms are aggravated by some of the very same features making social media attractive in the attempt to control disease. We point to alternative measures of disease control and further argue that although disease control may be the primary task of health practitioners, there (...) is no good reason why the choosing of the least invasive measures in terms of privacy and confidentiality should not also be a key priority. (shrink)

This paper discusses the use of the Milgram obedience experiments and the Tuskegee syphilis study in the bioethical literature. The two studies are presented and a variety of uses of them identified and discussed. It is argued that the use of these studies as paradigms of problematic research relies on a reduction of their complexity. What is discussed is thus often constructions of these studies that are closer to hypothetical examples than to the real studies.

OBJECTIVES: To study the ethical reasoning of nurses and physicians, and to assess whether or not modified focus groups are a valuable tool for this purpose. DESIGN: Discussion of cases in modified focus groups, each consisting of three physicians and three nurses. The discussion was taped and analysed by content analysis. SETTING: Five departments of internal medicine at Danish hospitals. SAMPLE: Seven discussion groups. MAIN MEASUREMENTS: Ethical content of statements, style of statements, time used by each participant. RESULTS: Danish physicians (...) and nurses do not differ in the kind of ethical reasoning they use, but physicians use more of the discussion time than nurses, they use a more assertive style of argumentation, and the solutions chosen are usually first put forward by physicians. CONCLUSION: The results and informal comparisons with similar data from long qualitative interviews indicate that groups of this kind are a useful tool for gathering data on ethical reasoning. (shrink)

The Principles of Biomedical Ethics by Tom L Beauchamp and James F Childress which is now in its fourth edition has had a great influence on the development of bioethics through its exposition of a theory based on the four principles: respect for autonomy; non-maleficence; beneficence, and justice (1). The theory is developed as a common-morality theory, and the present paper attempts to show how this approach, starting from American common-morality, leads to an underdevelopment of beneficence and justice, and that (...) the methods offered for specification and balancing of principles are inadequate. (shrink)

In the United Kingdom (and elsewhere), there are moves to extend formal ethical review of research involving human subjects beyond the traditional oversight by NHS local or multi-centre research ethics committees of medical or clinical research, to also encompass all ‘non-clinical’ research involving human subjects. This paper describes and analyses the development and implementation of a model for ethical review within the university sector. At Cardiff University, a devolved or two-tiered system of ethics review has been created in which a (...) top-level university research ethics committee provides policy advice to and oversight of school-based research ethics committees that engage in formal ethics review of research conducted in their respective schools. We describe the system and reflect on the challenges and benefits of implementing such a coordinated and comprehensive university-wide system of ethics review. (shrink)

Cardiff Law School, Museum Avenue, Cardiff CF10 3AX, UK. Tel: +44(0)2920875447, Fax: +44(0)2920874097; Email: Holms{at}cardiff.ac.uk ' + u + '@' + d + ' '//--> Abstract The paper presents a brief overview of current knowledge about (i) the link between parental behaviour and lifestyle and childhood obesity, (ii) the many other factors influencing overweight and obesity rates in children and (iii) the effectiveness of interventions in children who are already overweight and obese. On the basis of this, it is analysed (...) to what extent it is meaningful to attribute causal and moral responsibility to parents in theory and in practice. It is argued that although there is a sense in which many parents are causally and morally responsible for the obesity of their children, most parents are not blameworthy and the attribution of parental responsibility in most cases does not justify intervention in the family context by society on behalf of the children. In the analysis of the possible justification of more general interventions, parallels are drawn to the distinction between hard and soft forms of paternalism. Train up a child in the way he should go; and when he is old, he will not depart from it. (Proverbs 22: 6) For I have told him that I will judge his house for ever for the iniquity which he knoweth; because his sons made themselves vile, and he restrained them not. 1. (Samuel 3: 13) CiteULike Connotea Del.icio.us What's this? (shrink)

In this paper, I discuss the aetiological account of biological interests, developed by Varner, in the context of artefactual organisms envisioned by current research in synthetic biology. In “Sections 2–5”, I present Varner's theory and criticise it for being incapable of ascribing non-derivative interests to artefactual organisms due to their lack of a history of natural selection. In “Sections 6–7”, I develop a new alternative to Varner's account, building on the organisational theory of biological teleology and function. I argue that (...) the organisational account of biological interest is superior to Varner's aetiological account because it can accommodate both artefactual and naturally evolved organisms, provides a non-arbitrary and practical way of determining biological interests, supports the claim that organisms have interests in a sense in which artefacts do not, and avoids the possibility of there being a conflict between what an organismic part is supposed to do and what is in the interest of the organism. (shrink)

The purpose of this paper is to describe the scientific background to the current ethical and legislative debates about the generation and use of human stem cells, and to give an overview of the ethical issues underlying these debates. The ethical issues discussed are 1) stem cells and the status of the embryo, 2) women as the sources of ova for stem cell production, 3) the use of ova from other species, 4) slippery slopes towards reproductive cloning, 5) the public (...) presentation of stem cell research and 6) the evaluation of scientific uncertainty and its implications for public policy. (shrink)

This short personal essay considers the principles behind housing reform in New York at the turn of the last century in light of the controversies around the ghetto law in contemporary Denmark. I take the example of documentary journalist and reformer Jacob Riis, who photographed housing conditions in immigrant neighbor-hoods on the Lower East Side in New York at the turn of the twentieth century, as a case study for considering the ways that race informed—and continues to inform—ideals around urban (...) planning. Conversely, I also consider contemporary controversies around the ghetto law, and activism by community members as a way of re-thinking a research approach to historical urban reforms. (shrink)

The poverty of stimulus argument is one of the most controversial arguments in the study of language acquisition. Here we follow previous approaches challenging the assumption of impoverished primary linguistic data, focusing on the specific problem of auxiliary (AUX) fronting in complex polar interrogatives. We develop a series of corpus analyses of child‐directed speech showing that there is indirect statistical information useful for correct auxiliary fronting in polar interrogatives and that such information is sufficient for distinguishing between grammatical and ungrammatical (...) generalizations, even in the absence of direct evidence. We further show that there are simple learning devices, such as neural networks, capable of exploiting such statistical cues, producing a bias toward correct AUX questions when compared to their ungrammatical counterparts. The results suggest that the basic assumptions of the poverty of stimulus argument may need to be reappraised. (shrink)

In an analysis of recent work on nudging we distinguish three positions on the relationship between nudging founded in libertarian paternalism and the protection of personal autonomy through informed consent. We argue that all three positions fail to provide adequate protection of personal autonomy in the clinical context. Acknowledging that nudging may be beneficial, we suggest a fourth position according to which nudging and informed consent are valuable in different domains of interaction.

In his recent book The Foundation of Bioethics , H. Tristam Engelhardt Jr. advances the idea of a peaceable pluralist moral society based on principles of autonomy, beneficience, and ownership. This paper tries to show that unless there is one and only one rationally sustainable definition of "a person", then the peaceable society cannot remain peaceable, but will be stirred up by groups with different and equally rational definitions. The paper further tries to show that Engelhardt's own definition of "a (...) persons in the strict sense" is an unsatisfactory solution to the problem, and the same is true for any of the possible compromises. Keywords: medical ethics, persons, autonomy CiteULike Connotea Del.icio.us What's this? (shrink)

Non-compliance is a label often used about patients who do not follow therapeutic advice. This paper analyses the notion of compliance, and tries to show that this notion is inextricably bound to a paternalistic conception of the doctor-patient relationship. It is proposed that we should perhaps not talk so much about the non-compliant patient, but instead shift the focus towards the non-compliant doctor.

One of the ways in which public health officials control outbreaks of epidemic disease is by attempting to control the situations in which the infectious agent can spread. This may include isolation of infected persons, quarantine of persons who may be infected and detention of persons who are present in or have entered premises where infected persons are being treated. Most who have analysed such measures think that the restrictions in liberty they entail and the detriments in welfare they impose (...) can be justified and this paper proceeds from the assumption that detention measures are justifiable in some circumstances. Such measures are often implemented without any compensation being given to the persons who are detained. This raises the question: What do we owe to those whose liberty is justifiably restricted (e.g. through isolation, quarantine or detention) as a public health measure during a public health emergency? More specifically, do we owe them compensation for any losses they experience? The paper falls in four main sections. The first section provides examples of the current regulatory state of affairs from the US, Canada and WHO. The second section lays out the liberal, welfarist and pragmatic arguments for providing compensation. The third section discusses the arguments against compensation and the fourth and final section provides the conclusion. It is argued that the arguments for providing compensation clearly outweigh the counterarguments and that the default public policy therefore should be that compensation is provided. (shrink)

The dissertation concerns F. A. Hayek’s critique of legislation. The purpose of the investigation is to clarify and assess that critique. I argue that there is in Hayek’s work a critique of legislation that is distinct from his well-known critique of social planning. Further that the main claim of this critique is what I refer to as Hayek’s legislation tenet, namely that legislation that aims to achieve specific aggregate results in complex orders of society will decrease the welfare level. The (...) legislation tenet gains support; from the welfare claim – according to which there is a positive correlation between the utilization of knowledge and the welfare level in society; from the dispersal of knowledge thesis – according to which the total knowledge of society is dispersed and not available to any one agency; and from the cultural evolution thesis – according to which evolutionary rules are more favorable to the utilization of knowledge in social cooperation than are legislative rules. More specifically, I argue that these form two lines of argument in support of the legislation tenet. One line of argument is based on the conjunction of the welfare claim and the dispersal of knowledge thesis. I argue that this line of argument is true. The other line of argument is based on the conjunction of the welfare claim and the cultural evolution thesis. I argue that this line of argument is false, mainly because the empirical work of political scientist Elinor Ostrom refutes it. Because the two lines of argument support the legislation tenet independently of each other, I argue that Hayek’s critique of legislation is true. In this dissertation, I further develop a legislative policy tool as based on the welfare claim and Hayek’s conception of coercion. I also consider Hayek’s idea that rules and law are instrumental in forging rational individual action and rational social orders, and turn to review this idea in light of the work of experimental economist Vernon Smith and economic historian Avner Greif. I find that Smith and Greif support this idea of Hayek’s, and I conjecture that it contributes to our understanding of Adam Smith’s notion of the invisible hand: It is rules – not an invisible hand – that prompt subjects to align individual and aggregate rationality in social interaction. Finally, I argue that Hayek’s critique is essentially utilitarian, as it is concerned with the negative welfare consequences of certain forms of legislation. And although it may appear that the dispersal of knowledge thesis will undermine the possibility of carrying out the utilitarian calculus, due to the lack of knowledge of the consequences of one’s actions – and therefore undermine the legislation tenet itself – I argue that the distinction between utilitarianism conceived as a method of deliberation and utilitarianism conceived as a criterion of correctness may be used to save Hayek’s critique from this objection. (shrink)

The relationship between first and second language literacy was examined by identifying the skills and processes developed in the first language that were transferred to the second language. The performance of 40 university students from The People's Republic of China, Hong Kong, Vietnam and Australia were compared on a series of tasks that assessed phonological awareness and reading and spelling skills in English. The results indicated that the Hong Kong students (with non-alphabetic first language literacy) had limited phonological awareness compared (...) to those students with alphabetic first language literacy. The reading and spelling tasks showed no differences between the groups on real word processing. However, the students from Hong Kong had difficulty processing nonwords because of their poor phonological awareness. The results supported the hypothesis that people learning English as a second language (ESL) transfer their literacy processing skills from their first language to English. When the phonological awareness required in English had not been developed in the first language, ESL students were limited to a whole-word, visual strategy. The findings indicate that students from non-alphabetic written language backgrounds might have difficulties with new, or unfamiliar words when attending universities where English is the medium of instruction. (shrink)

In public debate GMPs are oftenreferred to as being unnatural or a violationof nature. Some people have serious moralconcerns about departures from what is natural.Others are concerned about potential risks tothe environment arising from the combination ofhereditary material moving across naturalboundaries and the limits of scientificforesight of long-term consequences. To addresssome of these concerns we propose that anadditional element in risk assessment based onthe concept of familiarity should beintroduced. The objective is to facilitatetransparency about uncertainties inherent inthe risk assessment of (...) the GMP. Familiarityconventionally involves data and experiencerelating to the plant species and the ecosystemin question. We would like to extend thisconcept to the molecular level of plantbreeding and suggest that GMP characteristicsshould be compared to a reference baselinedetermined by conventional breeding techniques.Three GMPs are ranked according to familiarityat the plant and ecosystem level and themolecular level. The approach may help tointegrate discussion of the scientificarguments and moral questions raised in thedebate about GMOs by providing an operationalscheme within which moral concerns are broughtwithin the framework of science-based riskassessment. (shrink)

In an analysis of artificially intelligent systems for medical diagnostics and treatment planning we argue that patients should be able to exercise a right to withdraw from AI diagnostics and treatment planning for reasons related to (1) the physician’s role in the patients’ formation of and acting on personal preferences and values, (2) the bias and opacity problem of AI systems, and (3) rational concerns about the future societal effects of introducing AI systems in the health care sector.

According to Bedau and Triant decision-makers will be substantially ignorant about the consequences of their candidate choices when making decisions about synthetic biology. Bedau and Triant charac...

Ich will meine Gedanken folgendermaßen zusammenfassen: Ein spontanes und früh erlerntes Glaubenserlebnis ringt immer mit einer wissenschaftlichen Analyse. Zwar wird die Religionspsychologie negativ aufgefaßt, aber sie hilft uns auch einzusehen, wie solch eine Einstellung entstehen kann. Die intensive Glaubenserfahrung enthält immer eine Totalitätsorientierung, die den eigentlichen Grund in transzendentalen Größen sucht. Eine aufgezwängte Umorientierung bringt immer einen gewissen Schmerz mit sich. Eine religionspsychologische Analyse der Glaubensmotive führt jedoch auch zu einem Verständnis für das wichtige Zusammenspiel, das die Symbol-motive der Tradition (...) haben, und müßte auch mit den persönlich erlebten Situationen seit der Kindheit rechnen. Dadurch, daß man Zusammenspielsmöglichkeiten zwischen den historisch gegebenen Modellen und den individuellen Situationen findet, geschieht ein Wechsel, der wichtige Modelle des menschlichen Lebens vertieft und ins Bewußtsein bringt. Dies ist doch kein selbstverständlicher oder automatischer Prozeß, sondern falsche Verbindungen und negative Bindungen sind auch möglich. Hier muß eine religionsspychologische Ethik entwickelt werden. Große Aufträge erwarten uns in der Zukunft. Das oben Erwähnte kann man auch so ausdrücken: Der Glaube an Gottes Wirken ist nicht streitig mit dem Handhaben wissenschaftlicher Modelle. Ebensowenig wie das Brot und der Wein des Abendmahls was anderes als Brot und Wein zu sein brauche, ebensowenig brauchen das Gesundbeten, das Zungenreden, die Prophezeiung, die Stigmatisierung, ja des Lebens heilige Momente etwas anderes zu sein als die Ergebnisse menschlich gegebener Prozesse, um Gottes Gegenwart zu erleben. Durch die innere symbolische Interaktion wird menschliche Dürftigkeit in eine Heiligkeit mit Ewigkeitswert verwandelt - und umgekehrt: Die jahrhundertelange Mythologie findet ihre menschliche Inkarnation. (shrink)

Frailty is a state of increased vulnerability to poor resolution of homeostasis after a stressor event. Frailty is most frequently assessed in the old using the Clinical Frailty Scale (CSF) which ranks frailty from 1 to 9. This assessment typically takes less than one minute and is not validated in patients with learning difficulties or those under 65 years old. The National Institute for Health and Care Excellence (NICE) developed guidelines that use “frailty” as one of the priority-setting criteria for (...) how scarce, but potentially lifesaving, health care resources should be allocated during the COVID-19 pandemic. Similar guidelines have been developed elsewhere. This paper discusses the ethical implications of such rationing and argues that this is an unproven and ethically problematic form of health care rationing. It specifically discusses: (1) how the frailty ascription becomes a self-fulfilling prophecy, (2) the problematic use of “frailty” in COVID-19 “triage,” (3) the circularity of the link between age and frailty, (4) indirect discrimination because of the use of a seemingly neutral criterion in health care rationing, and (5) the difficult link between comorbidities and frailty. It is found that there was no research into the use of global frailty scores as a criterion for access to acute treatment before January 2020 and so it is concerning how readily frailty scoring has been adopted to ration access to potentially lifesaving treatments. Existing gerontological frailty scoring systems have not been developed for this purpose, and repurposing them creates significant ethical issues. (shrink)

Intelligence allows people to understand events and to shape their surrounding environment. This book delves deeper into the theories and applications of intelligence, showing it is a multifaceted concept —defined and explained differently by prestigious experts of various disciplines in their own research. The book provides interdisciplinary connections of intelligence as it relates to a variety of clearly outlined subject areas, and should lead to a deep understanding of the phenomenon as it pertains to practical applications in different domains. Contributors (...) in this volume present results from evolutionary biology, mathematics, artificial intelligence, medicine, psychology, cultural studies, economy, political sciences and philosophy. Individual scientific models are integrated in an interdisciplinary concept of wisdom. This volume will help enhance the common understanding of intelligence for fellow researchers and scientists alike. (shrink)

'The VILE MULTITUDE' - MARX AND THE PARIS COMMUNEThe entire purpose of Marx’s work is to enable the working class to act as a revolutionary subject, i.e. as its own liberator, destined to overthrow capitalism. However, this paper demonstrates that this view, which has political validity, is supplemented by another more nuanced and more theoretically interesting understanding of revolutionary upheavals in Marx’s work. This more subtle approach is found particularly in his political analyses, and the paper specifically interprets his writings (...) on the Paris Commune in this light. It is argued that in Marx’s analysis of the actual events, it is not the working classes of Paris that make the revolution. Rather, the revolution is triggered by a series of extraordinary circumstances, and by external agents. It produces an undecidedness, here referred to as a multitude, which is only après coup seized and defined by the working classes. Finally, the paper details how this reading has consequences for a Marxist understanding of politics in general and revolutionary upheavals in particular. (shrink)

In many European countries, the introduction of private hospitals into predominantly public health systems has raised serious questions of distributive justice about access to care and the extent of acceptable inequalities.