There has long been tension between bioethicists whose work focuses on classical philosophical inquiry and those who perform empirical studies on bioethical issues. While many have argued that empirical research merely illuminates current practices and cannot inform normative ethics, others assert that research-based work has significant implications for refining our ethical norms. In this essay, I present a novel construct for classifying empirical research in bioethics into four hierarchical categories: Lay of the Land, Ideal Versus Reality, Improving Care, and Changing (...) Ethical Norms. Through explaining these four categories and providing examples of publications in each stratum, I define how empirical research informs normative ethics. I conclude by demonstrating how philosophical inquiry and empirical research can work cooperatively to further normative ethics. (shrink)

Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical requirements (...) usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase. (shrink)

In the United States, patients have a clear right to determine what is done to them by doctors. Starting in the early 20th century, multiple court cases paved the way for our current understanding...

To date, much of the current research has focused on examining the direct relationships between the components of the fraud triangle theory and fraud intention. However, limited empirical studies have explored the mediating effects of rationalization and opportunity. Therefore, the main aim of this study was to examine the mediating role of rationalization and opportunity on the direct relationship between pressure and fraud intention, as well as the relationship between pressure and opportunity. A sample of 166 managers participated in the (...) study, and partial least squares structural equation modelling was used to test the proposed model and hypotheses. Results showed that pressure was positively related to both rationalization and fraud intention. Moreover, the relationship between pressure and fraud intention was found to be partially mediated by both rationalization and opportunity. Similarly, rationalization was also found to partially mediate the relationship between pressure and opportunity. These findings suggest that pressure can increase fraud intention directly, as well as indirectly through rationalization and opportunity. This study contributes to the current literature by shedding light on the interplay among the three key components of the fraud triangle theory and their effects on fraud intention. The study provides valuable insights for relevant stakeholders, both theoretically and practically. (shrink)

The growing support for voluntary active euthanasia is evident in the recently approved Dutch Law on Termination of Life on Request. Indeed, the debate over legalized VAE has increased in European countries, the United States, and many other nations over the last several years. The proponents of VAE argue that when a patient judges that the burdens of living outweigh the benefits, euthanasia can be justified. If some adults suffer to such an extent that VAE is justified, then one may (...) conclude that some children suffer to this extent as well. In an attempt to alleviate the suffering of extremely ill neonates, the University Medical Center Groningen developed a protocol for neonatal euthanasia. In this article, I first present the ethical justifications for VAE and discuss how these arguments relate to euthanizing ill neonates. I then argue that, even if one accepts the justification for VAE in adults, neonatal euthanasia cannot be supported, primarily because physicians and parents can never accurately assess the suffering of children. I argue that without the testament of the patient herself as to the nature and magnitude of her suffering, physicians can never accurately weigh the benefits and burdens of a child’s life, and therefore any such system would condemn to death some children whose suffering is not unbearable. I conclude that because the primary duty of physicians is to never harm their patients, neonatal euthanasia cannot be supported. (shrink)

The American Journal of Bioethics, Volume 11, Issue 11, Page 22-23, November 2011.

This paper has two aims. First, to bring together the models of temporal phenomenology on offer and to present these using a consistent set of distinctions and terminologies. Second, to examine the methodologies currently practiced in the development of these models. To that end we present an abstract characterisation in which we catalogue all extant models. We then argue that neither of the two extreme methodologies currently discussed is suitable to the task of developing a model of temporal phenomenology. An (...) entirely top-down methodology is largely insensitive to empirical findings, while one that is entirely bottom-up is insensitive to both introspective evidence and more general philosophical considerations. We recommend a methodology that falls between these two extremes. (shrink)

Volume 20, Issue 3, March 2020, Page 19-21.

Volume 20, Issue 6, June 2020, Page 30-32.

Unfortunately, there is broad confusion regarding the justification for healthcare professionals unilaterally limiting or withdrawing life-prolonging interventions. Many mistakenly believe that suc...

One can often encounter claims that classical (Kolmogorovian) probability theory cannot handle, or even is contradicted by, certain empirical findings or substantive theories. This note joins several previous attempts to explain that these claims are unjustified, illustrating this on the issues of (non)existence of joint distributions, probabilities of ordered events, and additivity of probabilities. The specific focus of this note is on showing that the mistakes underlying these claims can be precluded by labeling all random variables involved contextually. Moreover, contextual (...) labeling also enables a valuable additional way of analyzing probabilistic aspects of empirical situations: determining whether the random variables involved form a contextual system, in the sense generalized from quantum mechanics. Thus, to the extent the Wang-Busemeyer QQ equality for the question order effect holds, the system describing them is noncontextual. The double-slit experiment and its behavioral analogues also turn out to form a noncontextual system, having the same probabilistic format (cyclic system of rank 4) as the one describing spins of two entangled electrons. (shrink)

The American Society for Bioethics and Humanities promulgated standards for clinical ethics consultants and is currently developing a national Quality Attestation in Clinical Ethics Consultation to assist facilities in ensuring that those performing clinical ethics consultations meet minimum standards. As the field moves towards such professionalization, there is a need to provide access to qualified clinical ethicists at a broad range of medical facilities. Currently, however, there are insufficient numbers of trained clinical ethicists to staff all healthcare facilities, and many (...) facilities lack the necessary resources to hire staff clinical ethicists. In this review, we describe several models for providing expert clinical ethics support to remote facilities that lack access to qualified clinical ethicists. Based on this analysis, we recommend telemedicine as the optimal model providing expert support to local ethics committee members tasked with providing clinical ethics consultation services. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 15-17, August 2012.

Where does the study of the flow of time belong: physics, the cognitive sciences, philosophy, or somewhere else? Physicists and philosophers have set themselves up into two camps: those who believe there is genuine flow or becoming in the world and those who believe there is just a block of events. What had not been considered is whether the subjective feeling of flow of time is the same the world over, whether it could be tampered with by brain injury, or (...) whether it is present at all developmental stages. We lay out the problem, explain terms, and provide synopses of relevant ideas. (shrink)

Being the parents of a premature infant can be extremely stressful. Even when parents know that there is a high chance of premature birth, they are often in shock when their infant arrives too earl...

Shocking. There seems no other response to the Fox findings. The bioethics community has been working for decades to improve the quality of, and access to, competent healthcare ethics consultation....

The American Journal of Bioethics, Volume 11, Issue 6, Page 41-42, June 2011.

(2011). Life and Death Choices in Neonatal Care: Applying Shared Decision-Making Focused on Parental Values. The American Journal of Bioethics: Vol. 11, No. 2, pp. 35-36.

A classic finding reported in Beck (1966a) is that observers tend to indicate a more natural texture break between a set of T’s and tilted T’s than between a set of T’s and backward L’s. This finding has played a prominent role in discussions about the properties of texture segmentation and in the development of computational theories of texture segmentation. Due to the small sample size of the original study, we replicated the original experiment with a larger sample. Regrettably, we (...) discovered that the description in Beck (1966a) is insufficient to allow us to reproduce the stimuli. For our replication, we created stimuli that seem consistent with the spirit of the original study. The results of the replication study partly matchBeck’s original data (r = .59), but conclusions indicated by these results deviate from some of Beck’s key conclusions.We also further explored the influential claim derived from a second experiment in Beck (1966a) that texture segmentation was not related to the perceived similarity of elements. Contrary to this claim, a re-analysis of Beck’s data indicates the counterintuitive conclusion that observers tend to indicate stronger texture segmentation between regions that are rated as being more similar. In a replication of the second experiment, this relation flipped so that the replication observers indicated stronger texture segmentation for regions with lower similarity ratings. Despite being influential, we conclude that there are substantial problems with the stimuli, analyses, and conclusions in Beck (1966a). (shrink)

Main Response Topics ? Introduction ? Open display and public evaluation ? Publicity versus patient privacy ? Facial tissue donation ? Validity of Louisville Instrument for Risk Acceptance ? Patients' understanding of risk ? Face versus hand transplantation ? Rejection rates/risks ? Patient compliance ? Exit strategy ? Functional recovery ? Societietal implications ? Psychological implications ? Conclusion: Uncertainty likely to persist.

In his constructive and well-informed commentary, Andrei Khrennikov acknowledges a privileged status of classical probability theory with respect to statistical analysis. He also sees advantages offered by the Contextuality-by-Default theory, notably, that it “demystifies quantum mechanics by highlighting the role of contextuality,” and that it can detect and measure contextuality in inconsistently connected systems. He argues, however, that classical probability theory may have difficulties in describing empirical phenomena if they are described entirely in terms of observable events. We disagree: contexts (...) in which random variables are recorded are as observable as the variables’ values. Khrennikov also argues that the Contextuality-by-Default theory suffers the problem of non-uniqueness of couplings. We disagree that this is a problem: couplings are all possible ways of imposing counterfactual joint distributions on random variables that de facto are not jointly distributed. The uniqueness of modeling experiments by means of quantum formalisms brought up by Khrennikov is achieved for the price of additional, substantive assumptions. This is consistent with our view of quantum theory as a special-purpose generator of classical probabilities. Khrennikov raises the issue of “mental signaling,” by which he means inconsistent connectedness in behavioral systems. Our position is that it is as inherent to behavioral systems as their stochasticity. (shrink)

One of Julian Barbour’s main aims is to solve the problem of time that appears in quantum geometrodynamics (QG). QG involves the application of canonical quantization procedure to the Hamiltonian formulation of General Relativity. The problem of time arises because the quantization of the Hamiltonian constraint results in an equation that has no explicit time parameter. Thus, it appears that the resulting equation, as apparently timeless, cannot describe evolution of quantum states. Barbour attempts to resolve the problem by allegedly eliminating (...) time from his interpretation of QG. In order to evaluate the efficacy of his solution, it is necessary to ascertain in what sense time has been eliminated from his theory. I proceed to do so by developing a form of conceptual analysis that is applicable to the concept of time in physical theories and applying this analysis to Barbour’s account. (shrink)

A fundamental characteristic of human visual perception is the ability to group together disparate elements in a scene and treat them as a single unit. The mechanisms by which humans create such groupings remain unknown, but grouping seems to play an important role in a wide variety of visual phenomena, and a good understanding of these mechanisms might provide guidance for how to improve machine vision algorithms. Here, we build on a proposal that some groupings are the result of connections (...) in cortical area V2 that join disparate elements, thereby allowing them to be selected and segmented together. In previous instantiations of this proposal, connection formation was based on the anatomy (e.g., extent) of receptive fields, which made connection formation obligatory when the stimulus conditions stimulate the corresponding receptive fields. We now propose dynamic circuits that provide greater flexibility in the formation of connections and that allow for top-down control of perceptual grouping. With computer simulations we explain how the circuits work and show how they can account for a wide variety of Gestalt principles of perceptual grouping, texture segmentation tasks, amodal illusory contours, and ratings of perceived groupings. We propose that human observers use such top-down control to implement task-dependent connection strategies that encourage particular groupings of stimulus elements in order to promote performance on various visual tasks. (shrink)

The classical estrogen receptor model does not sufficiently account for the tumor‐promoting activity of extrogens or for the antiproliferative effect of antiestrogens in estrogen‐dependent tumors. Particular difficulties not readily accommodated within the model are that hormonal autonomy can supervene without loss of the estrogen receptor and that antiestrogen effects are highly context‐dependent, without apparent differences in the estrogen receptor itself or in metabolic transformation of antiestrogens. Recent studies suggest that estrogens may promote cell proliferation, in part, through the mediation of (...) growth factors and that antiestrogens may exert some of their effects by mechanisms unrelated to the estrogen receptor. (shrink)

(2010). Ethical Rules for Human Subjects Research: A Case Where the “Is” Must Inform the “Ought”. The American Journal of Bioethics: Vol. 10, No. 6, pp. 14-15.

Recently, five major critical care professional organizations in North America and Europe published a consensus policy statement on how intensive care unit clinicians should respond to patient or surrogate requests for potentially inappropriate treatments. Subsequently, the Society for Critical Care Medicine, the largest multidisciplinary critical care organization and one of the authors of the Multiorganization Policy Statement, issued a companion statement defining futile and potentially inappropriate interventions. These statements support previous work published by the SCCM Ethics Committee 20 years ago. (...) The critical care... (shrink)