Neuropsychiatric disorders introduce distinct challenges to clinical decision-making. Affected patients often experience impairments or absences in rationality, lucidity and cogni-emotional capacities, rendering it difficult for them to engage in the decision-making process. In turn, dynamics of the patient-physician relationship become strained, including when physicians employ bioethical principlism or moral case deliberation to arrive at ethically justified courses of action–both of which require sufficient communication and rationality that may be impaired or altogether absent in the presence of psychopathology. The complexity of (...) neuropsychiatric conditions therefore compels interrogation towards how ethics consultations are currently constructed and conducted when full communication or rational decision-making cannot be assumed. Delany et al, for example, present a robust, methodical framework for ethical deliberation.1 Such methodologies for facilitating ethical decision-making, although valuable in predominant contexts, assume full participant engagement and decision-making capacities (eg, independent moral agency). Neuropsychiatric disorders complicate this assumption, making it difficult for patients with limited decision-making capacity to engage meaningfully in proposed ethics consultations.2 This paper will explore how neuropsychiatric disorders complicate the assumptions of full participant engagement underlying ethical frameworks. It will argue that, by adapting ethics consultations to function as a ‘mental prosthesis’, clinicians can better navigate the ethical challenges posed by neuropsychiatric disorders, helping to ensure that patient autonomy is upheld even in cases of impaired cognitive …. (shrink)

Background The post-trial period is the time period after the end of study drug administration. It is unclear whether post-trial arrangements for patient surveillance are routinely included in study protocols and consents, and whether research ethics boards (REB) consider the post-trial period. Objectives The objective was to determine whether trial protocols and consent forms reviewed by the REB describe procedures for post-trial period surveillance. Methods An observational study of protocols of randomised trials of chronic therapies for cardiac conditions, approved by (...) the REB of two academic institutions affiliated with the University of Toronto in Canada (University Health Network and Mount Sinai Hospital) from 1995 to 2007. Plans for patient surveillance in the post-trial period described in the protocol or in the consent form before and after REB approval were recorded. Results 42 studies were identified including 18 heart failure and 15 coronary artery disease trials. Only four studies planned a clinical visit after trial termination, and an additional three planned a telephone contact after trial completion. Five trials submitted consent forms to the REB with a discussion of the post-trial period. Conclusions The majority of protocols and consent forms did not discuss plans for post-trial period surveillance. The post-trial period and the REB approval process could be improved by systematic follow-up being described in the protocol and consent form. The small number of trial protocols evaluated in the study may impair the degree to which the results can be generalised. (shrink)

‘Banality of evil’ was a concept introduced by Hannah Arendt in order to characterize a new form of wickedness embodied in people as Adolf Eichmann and others nazis criminals. Arendt thougt that this perverseness was very awey from the one of ‘radical evil’, a notion built by Kant and employed by Arendt herself in former works. This article seeks to point out that concepts of radical evil and banality of evil are closer than Arendt recognizes.

Since the 1930s, scientists studying the neurological disease scrapie had assumed that the infectious agent was a virus. By the mid 1960s, however, several unconventional properties had arisen that were difficult to reconcile with the standard viral model. Evidence for nucleic acid within the pathogen was lacking, and some researchers considered the possibility that the infectious agent consisted solely of protein. In 1982, Stanley Prusiner coined the term `prion' to emphasize the agent's proteinaceous nature. This infectious protein hypothesis was denounced (...) by many scientists as `heretical'.This essay asks why the concept of an infectious protein was considered controversial. Some biologists justified their evaluation of this hypothesis on the grounds that an infectious protein contradicted the `central dogma of molecular biology'. Others referred to vague theoretical constraints such as molecular biology's `theoretical structure' or `framework'. Examination of the objections raised by researchers reveals exactly what generalizations were being challenged by a protein model of infection.This two-part survey of scrapie and prion research reaches several conclusions: (1) A theoretical framework is present in molecular biology, exerting its influence in hypothesis formation and evaluation; (2) This framework consists of several related, yet separable, generalizations or `elements', including Francis Crick's Central Dogma and Sequence Hypothesis, plus notions concerning infection, replication, protein synthesis, and protein folding; (3) The term `central dogma' has stretched beyond Crick's original 1958 definition to encompass at least two other `framework elements': replication and protein synthesis; and (4) From the study of scrapie and related diseases, biological information has been delineated into at least two classes: sequential and what I call `conformational'.In Part I of this essay, a brief review of the central dogma, as outlined by both Francis Crick and James Watson, will be given. The developments in scrapie research from 1965 to 1972 will then be traced. This section will summarize many of the puzzling, non-viral-like properties of the scrapie agent. Alternative hypotheses to the viral explanation will also be presented, including early versions of a protein-only hypothesis. Part II of this essay will follow the developments in scrapie and prion research from the mid 1970s through 1991. The growing prominence of a protein-only model of infection will be balanced by continued objections from many researchers to a pathogen devoid of nucleic acid. These objections will help illuminate those generalizations in molecular biology that were indeed challenged by a protein-only model of infection. (shrink)

Paperback. The book treats two general questions: 1. Whether Erasmanism and Erasmian Humanism existed as a recognizable attitude during the sixteenth and early seventeenth centuries; 2. Whether Erasminism represented a definable middle way between the confessional conflicts of these times. How important was Erasmanism in these respects? The treatment of these two questions is geographically limited to those countries where Erasmus himself was active: Italy, The Netherlands, Holy Roman Empire, Switzerland and England.Erasmanism as a concept has hardly been studied before, (...) although the term is used freely by scholars of the early modern period. This book is a first attempt at a begriffsgeschichte of Erasminism. (shrink)

We show that the analysis of Keisler’s order can be localized to the study of φ-types. Specifically, if is a regular ultrafilter on λ such that and M is a model whose theory is countable, then is λ+-saturated iff it realizes all φ-types of size λ.

Some theorists, worried about liberalism’s potential as a foundation for public health ethics, suggest that republicanism provides a better background of justification for public health policies, interventions, etc. In this article, this suggestion is put to the test, and it is argued that (i) contemporary (civic) republicanism and liberalism are not nearly as opposed as it is sometimes suggested, and that (ii) the kind of republicanism which one leading scholar in the field, Bruce Jennings, as an alternative to liberalism, does (...) not reflect the contemporary understanding of republicanism as held by, e.g. Phillip Pettit et al. (shrink)