The Association of Research Ethics Committees is one of the leading providers of training and education for members of Research Ethics Committees. The introduction of the research governance strategy and the increasing complexity of ethical review place great demands on research ethics committee members that in turn creates challenges for training providers. This paper presents the outcome of an audit of REC members' views about training. Findings demonstrate that REC members are not a homogenous group. Several distinct sub-groups, each with (...) particular training needs emerged. All showed a preference for short, easily accessible events in which there were opportunities for discussion. (shrink)

Artificial intelligence (AI) is increasingly being developed for use in medicine, including for diagnosis and in treatment decision making. The use of AI in medical treatment raises many ethical issues that are yet to be explored in depth by bioethicists. In this paper, I focus specifically on the relationship between the ethical ideal of shared decision making and AI systems that generate treatment recommendations, using the example of IBM’s Watson for Oncology. I argue that use of this type of system (...) creates both important risks and significant opportunities for promoting shared decision making. If value judgements are fixed and covert in AI systems, then we risk a shift back to more paternalistic medical care. However, if designed and used in an ethically informed way, AI could offer a potentially powerful way of supporting shared decision making. It could be used to incorporate explicit value reflection, promoting patient autonomy. In the context of medical treatment, we need value-flexible AI that can both respond to the values and treatment goals of individual patients and support clinicians to engage in shared decision making. (shrink)

Many philosophers have suggested that claims of need play a special normative role in ethical thought and talk. But what do such claims mean? What does this special role amount to? Progress on these questions can be made by attending to a puzzle concerning some linguistic differences between two types of 'need' sentence: one where 'need' occurs as a verb, and where it occurs as a noun. I argue that the resources developed to solve the puzzle advance (...) our understanding of the metaphysics of need, the meaning of 'need' sentences, and the function of claims of need in ethical discourse. (shrink)

One central question about propositions is whether they have representational properties. While the orthodox answer is ‘yes,’ this appears to be inconsistent with many leading theories of propositions, which identify them with sets of worlds or property-like entities of various sorts. This paper defends orthodoxy, but, using standard tests for polysemy, demystifies the sense in which propositions represent. The result is that any theory which can make sense of propositions’ role as the objects of the attitudes can give a satisfactory (...) explanation of the representational properties of propositions.This undercuts one prominent recent line of argument in favor of revisionary theories of propositions which identify them with cognitive acts of subjects (or other entities involving cognitive acts of some sort). (shrink)

In health care priority setting different criteria are used to reflect the relevant values that should guide decision-making. During recent years there has been a development of value frameworks implying the use of multiple criteria, a development that has not been accompanied by a structured conceptual and normative analysis of how different criteria relate to each other and to underlying normative considerations. Examples of such criteria are unmet need and severity. In this article these crucial criteria are conceptually clarified (...) and analyzed in relation to each other. We argue that disease-severity and condition-severity should be distinguished and we find the latter concept better reflects underlying normative values. We further argue that unmet need does not fulfil an independent and relevant role in relation to condition-severity except for in some limited situations when having to distinguish between conditions of equal severity. (shrink)

BackgroundThe theory and practice of ethics consultations (ECs) in health care are still characterized by many controversies, including, for example, the practice of giving recommendations. These controversies are complicated by an astonishing lack of evidence in the whole field. It is not clear how often a recommendation is issued in ethics consultations and when and why this step is taken. Especially in a facilitation model in which giving recommendations is optional, more data would be helpful to evaluate daily practice, ensure (...) that this practice is in line with the overarching goals of this approach and support the development of standards.MethodsWe analyzed all consultations requested from an EC service working under a facilitation approach at a maximum-care university hospital in Germany over a period of more than 10 years. Our aim was to better understand why—and under what circumstances—some consultation requests result in a recommendation, whereas others can be sufficiently addressed solely by facilitated meetings. We especially wanted to know when and why clients felt the need for clear advice from the EC service while in other cases they did not. We compared ethics consultations in terms of the differences between cases with and without recommendations issued by the ethics consultants using χ2 difference tests and Welch’s t-test.ResultsA total of 243 ECs were carried out between September 2008 and December 2019. In approximately half of the cases, a recommendation was given. All recommendations were issued upon the request of clients. When physicians asked for an EC, the consultation was significantly more likely to result in a recommendation than when the EC was requested by any other party. ECs in cases on wards with ethics rounds resulted in comparably fewer recommendations than those in wards without ethics rounds. When interpersonal conflicts were part of the problem or relatives were present in the meeting, clients less frequently asked for a recommendation.ConclusionFrom the client’s point of view, there does not seem to be only one “right” way to provide ethics consultations, but rather several. While facilitated meetings are obviously appreciated by clients, there also seem to be situations in which a recommendation is desired (especially by physicians). Further empirical and theoretical research is needed to validate our single-center results and re-evaluate the role of recommendations in ethics consultations. (shrink)

In 2010, randomized controlled trials (RCTs) of two different biomedical strategies to prevent HIV infection had positive findings. However, despite ongoing very high levels of HIV infection in some countries and population groups, it has been made clear by regulatory authorities that the evidence remains insufficient to support either product being made available outside of research contexts in the developing world for at least two years. In addition, prevention trials in endemic areas will continue to test new interventions against placebo. (...) But the judgments of evidentiary standards are never value-neutral. Using the recent trials and their contexts as case studies, we examine the basis for these decisions, which will potentially delay access to scientific innovation to the people who are most urgently in need of it. (shrink)

In two recent essays, Thomas Pogge addresses the question of how research and development of essential drugs should be incentivized. Essential drugs are drugs for diseases that ruin human lives. The current incentivizing scheme for such drugs is, according to Pogge, a significant causal factor in bringing about a state of affairs in which millions of people die or suffer from lack of access to essential drugs. Pogge, therefore, suggests a reform plan for how to incentivize research and development of (...) these drugs, and he is of the opinion that implementation of this plan will have a significant positive impact on the global disease burden. This paper is a critical examination of Pogge's reform plan. In the first part of the paper, Pogge's reasons for being dissatisfied with the current incentivizing scheme are spelled out. The reform plan is then presented, and in the final part of the paper, it is argued that the reform plan is flawed at a number of levels. (shrink)

There is a widespread impression that General Relativity, unlike Quantum Mechanics, is in no need of an interpretation. I present two reasons for thinking that this is a mistake. The first is the familiar hole argument. I argue that certain skeptical responses to this argument are too hasty in dismissing it as being irrelevant to the interpretative enterprise. My second reason is that interpretative questions about General Relativity are central to the search for a quantum theory of gravity. I (...) illustrate this claim by examining the interpretative consequences of a particular technical move in canonical quantum gravity. (shrink)

abstract The argument that scarce health care resources should be distributed so that patients in ‘need’ are given priority for treatment is rarely contested. In this paper, we argue that if need is to play a significant role in distributive decisions it is crucial that what is meant by need can be precisely articulated. Following a discussion of the general features of health care need, we propose three principal interpretations of need, each of which focuses (...) on separate intuitions. Although this account may not be a completely exhaustive reflection of what people mean when they refer to need, the three interpretations provide a starting‐point for further debate of what the concept means in its specific application. We discuss combined interpretations, the meaning of grading needs, and compare needs‐based priority setting to social welfare maximisation. (shrink)

Blair, David What's the best policy to deal with the catastrophe that looms due to global warming? Fundamentally, we must quickly change our sources of energy away from fossil fuels to non-carbon emitting sources - namely nuclear power and the various renewable sources. 'What's nuclear doing in there?' you may respond. 'Isn't the news about nuclear all bad?' But a growing chorus of scientists and thinkers is warning that, not only is nuclear power quite safe, but that to rule it (...) out poses a grave danger. I quote: Renewables like wind and solar and biomass will certainly play roles in a future energy economy, but those energy sources cannot scale up fast enough to deliver cheap and reliable power at the scale the global economy requires. While it may be theoretically possible to stabilise the climate without nuclear power, in the real world there is no credible path to climate stabilisation that does not include a substantial role for nuclear power. (shrink)

In Theory Z-style management everybody participates in corporate decision making. This more open process should give us fewer Pintos, Love Canals, and massive international payoffs as executives are forced to expose their reasoning to the moral sensibilities of the whole corporation. So far everything looks good. But we are a long way from showing that only corporations so managed can be fully moral. Yet Dwiggins seems to believe this, putting his faith in the basic goodness of the many while virtually (...) dismissing the managers as mere technicians. This is too slick; even if it describes our average corporation today, there are plenty of less radical changes which can also produce the desired moral corporation. Good leadership which acts on their commitment to improve the company is surely one historically respectable alternative; cynicism about the present crop of leaders should not distract us from investigating this route. Finally, I wonder if Dwiggins can consistently urge us to embrace a full-scale Theory Z organizational structure, given his position on the place of ethics and profitability. (shrink)

It is necessary to take into account that every ontology and also every scientific system draws a picture of the World according to the abstractions and presuppositions which were accepted, consciously or unconsciously, during the construction of the system. That is why Aristotle, Hegel, and the paraconsistent logics gave us different world views. On the basis of contemporary logics, including paraconsistent logics, we can better understand what the objects of the Aristotelian logic are, what are the presuppositions used in it, (...) what are the meanings of its terms and how their meaning was changed when used in other theories. (shrink)

The catch 22 situation in psychiatry is that for precise diagnostic categories/criteria, we need precise investigative tests, and for precise investigative tests, we need precise diagnostic criteria/categories; and precision in both diagnostics and investigative tests is nonexistent at present. The effort to establish clarity often results in a fresh maze of evidence. In finding the way forward, it is tempting to abandon the scientific method, but that is not possible, since we deal with real human psychopathology, not just (...) concepts to speculate over. Search for clear-cut definitions/diagnostic criteria in psychiatry must be relentless. There is a greater need to be ruthless and blunt in this, rather than being accommodative of diverse opinions. Investigative tests - psychological, serum, CSF, or neuroimaging - are only corroborative at present; they need to become definitive. Medicalisation appears most prominent in psychiatry; so, diagnostic proliferation and fuzziness appear inevitable. And yet, the established diagnostic entities need to forward greater and conclusive precision. Also, the need for clarity and precision must outweigh pandering to and mollifying diverse interests, moreso in the upcoming revision of diagnostic manuals. This is specially because the DSM-5, being an Association manual, may need to accommodate powerful member lobbies; and ICD-11 may similarly need to cater to diverse country lobbies. Finding precise biological correlates of psychiatric phenomena, whether through neuroimaging, molecular neurobiology and/or neurogenomics, is the right way forward. It is in the 1.5-kg structure in the cranium that all secrets of psychiatric conditions lie. Social forces, behavioural modification, psychosocial restructuring, study of intrapsychic processes, and philosophical insights are not to be discounted, but they are supplementary to the primary goal - studying and deciphering those brain processes that result in psychiatric malfunction. Experimental breakthroughs, both in psychiatric aetiology and therapeutics, will come mainly from biology and its adjunct, psychopharmacology; while supplementary and complementary breakthroughs will come from the psychosocial, cognitive and behavioural approaches; the support base will come from phenomenology, epidemiology, nosology and diagnostics; while insights and leads can hopefully come from many fields, especially the psychosocial, the behavioural, the cognitive and the philosophical. Major energies must now be marshalled towards finding biomarkers and deciphering the precise phenotype-genotype-endophenotype axis of psychiatric disorders. Energies also need to be focussed on unravelling those critical processes in the brain that tip the scale towards psychiatric disorders. At how those critical processes are set into motion by forces de novo, in utero, in the genes and their expression, by the environment's psychopathological social forces - stress, peer pressure, poverty, deprivation, alienation, malnutrition, discrimination of various types (caste, gender, race, etc.), mass conflicts (war, terror attacks, etc.), disasters (natural and man-made), religious/ideological fascism - or social institutions like marriage, family, work place, political governance, etc. Ultimately, we must decipher how the brain goes into malfunction when such varied forces impinge on it, which precise cortical areas and neuronal cellular and molecular processes are involved in such malfunction and its manifestation, as also which of these are involved when malfunction ceases and health is restored, and the psychosocial processes and institutions which aid such health restoration, as also those which promote well-being and help in primary prevention. Emphasis on the brain and its intimate neurological and molecular mechanisms will not impinge on, or nullify, importance of the 'mind,' wherein subtle and gross brain functions in the form of behaviour, thought and emotions in all their ramifications will continue to be the focus of psychological, cognitive, sociological, psychopharmacological, behavioural and philosophical research. Progress in brain research must move in tandem with progress in 'mind' research. (shrink)

The big question mark (in guise of a preface) -- This incredible need to believe : interview with Carmine Donzelli -- From Jesus to Mozart : Christianity's difference? -- Suffering : Lenten lectures, March 19, 2006 -- The genius of Vatholicism -- Don't be afraid of European culture.

The aim of the present paper is to show the need for cosmology in Peirce’s thought. To reach this goal, I first clarify Peirce’s definition of cosmology and its place in the classification of the sciences. Then, I shed slight on the entailment of cosmology in Peirce’s understanding of metaphysics and of logic, and I elucidate these connections in view of Synechism. Finally, in the light of the results achieved through the analysis, I provide a summarily description of Peirce’s (...) cosmology, far from the common interpretation of it. (shrink)

We present a range of mathematical theorems whose proofs require unexpectedly strong logical methods, which in some cases go well beyond the usual axioms for mathematics.

In “On Certainty” Wittgenstein regards doubting as meaningful and reasonable only in a context providing language game where some background is taken for granted. Doubt, just as knowledge, should be backed up by an argument, only this time, one presenting reasons for uncertainty. Common sense propositions constitute part of the background for the arguments of doubting and because of their function and place within the system of language, they are regarded as indubitable. I discuss critically the idea of linguistically determined (...) indubitability and advocate the possibility of a different kind of doubt, one that does not require its own justification and is still a reasonable epistemic attitude. Such doubt characterizes the states of affairs where the certainty of a proposition is not yet rationally established. I argue that, language does not limit us in doubting and in doubting reasonably. (shrink)