Theoretical and Applied Issues Edited by Andrew Ortony Jon Slack Oliviero Stock NATO ASI Series Series F: Computer and Systems Sciences, Vol. 100 Communication from an Artificial Intelligence Perspective NATO ASI Series Advanced ...

First published in 2000. Routledge is an imprint of Taylor & Francis, an informa company.

Patient outcome after serious brain injury is highly variable. Following a period of coma, some patients recover while others progress into a vegetative state (unresponsive wakefulness syndrome) or minimally conscious state. In both cases, assessment is difficult and misdiagnosis may be as high as 43%. Recent advances in neuroimaging suggest a solution. Both functional magnetic resonance imaging and electroencephalography have been used to detect residual cognitive function in vegetative and minimally conscious patients. Neuroimaging may improve diagnosis and prognostication. These techniques (...) are beginning to be applied to comatose patients soon after injury. Evidence of preserved cognitive function may predict recovery, and this information would help families and health providers. Complex ethical issues arise due to the vulnerability of patients and families, difficulties interpreting negative results, restriction of communication to “yes” or “no” answers, and cost. We seek to investigate ethical issues in the use of neuroimaging in behaviorally nonresponsive patients who have suffered serious brain injury. The objectives of this research are to: (1) create an approach to capacity assessment using neuroimaging; (2) develop an ethics of welfare framework to guide considerations of quality of life; (3) explore the impact of neuroimaging on families; and, (4) analyze the ethics of the use of neuroimaging in comatose patients. (shrink)

Qualitative evidence concerning the relationship between QoL and a wide range of disabilities suggests that subjective judgments regarding other people’s QoL are wrong more often than not and that such judgments by medical practitioners in particular can be biased. Guided by their desire to do good and avoid harm, surgeons often rely on "the eyeball test" to decide whether a patient will or will not benefit from surgery. But the eyeball test can easily harbor a range of implicit judgments and (...) biases against patients with disabilities, including erroneous assumptions about QoL. We critique the use of the "eyeball" test and offer suggestions to reduce bias and ensure that patients’ values are more consistently prioritized in surgical decision-making. (shrink)

Behrendt & Young's (B&Y's) novel “unifying model” of hallucinations, although comprehensive, fails to incorporate research into the possible role of 5-HT2A receptors in the mode of action of novel “atypical” antipsychotic drugs (which treat hallucinations effectively), and into the role of such receptors, which are located in thalamocortical circuits, in mediating drug-induced hallucinations.

Walter Benjamin's Politics of 'bad tasteMichael Mac Modernity as an unfinished Project: Benjamin and Political RomanticismRobert Sinnerbrink Violence, ...

BackgroundHIV prevention research in resource-limited countries is associated with a variety of ethical dilemmas. Key amongst these is the question of what constitutes an appropriate standard of health care (SoC) for participants in HIV prevention trials. This paper describes a community-focused approach to develop a locally-appropriate SoC in the context of a phase III vaginal microbicide trial in Mwanza City, northwest Tanzania.MethodsA mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional and modern (...) bars, restaurants, hotels and guesthouses has been established in 10 city wards. Wards were divided into geographical clusters and community representatives elected at cluster and ward level. A city-level Community Advisory Committee (CAC) with representatives from each ward has been established. Workshops and community meetings at ward and city-level have explored project-related concerns using tools adapted from participatory learning and action techniques e.g. chapati diagrams, pair-wise ranking. Secondary stakeholders representing local public-sector and non-governmental health and social care providers have formed a trial Stakeholders' Advisory Group (SAG), which includes two CAC representatives.ResultsKey recommendations from participatory community workshops, CAC and SAG meetings conducted in the first year of the trial relate to the quality and range of clinic services provided at study clinics as well as broader standard of care issues. Recommendations have included streamlining clinic services to reduce waiting times, expanding services to include the children and spouses of participants and providing care for common local conditions such as malaria. Participants, community representatives and stakeholders felt there was an ethical obligation to ensure effective access to antiretroviral drugs and to provide supportive community-based care for women identified as HIV positive during the trial. This obligation includes ensuring sustainable, post-trial access to these services. Post-trial access to an effective vaginal microbicide was also felt to be a moral imperative.ConclusionParticipatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting.Trial registrationCurrent Controlled Trials ISRCTN64716212. (shrink)

Progress in emergency and critical care requires that clinical research be performed on patients who are incapable of granting consent for research participation. Analyses of the ethics of such research have left some questions incompletely answered. Why should we be permitted to expose vulnerable patients to research risks without their consent? In particular, how do we justify research interventions that have no potential benefit for participants (nontherapeutic interventions)? This article presents a moral justification for nontherapeutic interventions in emergency research. By (...) relying on a framework for assessing research risks, and by drawing on the example of pediatric research, this justification is founded in how institutional review boards, and society in general, analyze risk. Our justification for emergency research also suggests additional protections for emergency research participants, including a stringent threshold for research risk, that still permit important research to proceed. (shrink)

BackgroundSevere brain injury is a leading cause of death and disability. Diagnosis and prognostication are difficult, and errors occur often. Novel neuroimaging methods can improve diagnostic and prognostic accuracy, especially in patients with prolonged disorders of consciousness (PDoC). Yet it is currently unknown how family caregivers understand this information, raising ethical concerns that disclosure of neuroimaging results could result in therapeutic misconception or false hope.MethodsTo examine these ethical concerns, we conducted semi-structured interviews with caregivers of patients with PDoC who were (...) enrolled in a concurrent neuroimaging research program designed to detect covert consciousness following severe brain injury. Caregivers held surrogate decision-making status for a patient. Interviews were conducted at two time points for each caregiver. The first interview occurred before the disclosure of neuroimaging results. The second occurred after disclosure. Descriptive analysis was applied to the data of four interview topics: (1) expectations for neuroimaging; (2) reactions to evidence of preserved cognition; (3) reactions to null results; and (4) understanding of the results and study.ResultsTwelve caregivers participated in the study; two caregivers shared surrogate decision-making status for one patient with PDoC. Twenty-one interviews were completed; one caregiver declined to participate in the post-disclosure interview. Three patients with PDoC associated with the study displayed evidence of covert consciousness. Overall, caregivers understood the neuroimaging research and results. Caregivers who received results of covert consciousness were generally pleased. However, there was some variation in expectations and reactions to these data and null results.ConclusionThis study, for the first time, reveals caregiver expectations for and reactions to neuroimaging evidence of covert consciousness in patients with PDoC. Caregivers understood the neuroimaging research and results, casting doubt on speculative ethical concerns regarding therapeutic misconception and false hope. However, disclosure of neuroimaging result could be improved. Pre-disclosure consultations might assist professionals in shaping caregiver expectations. Standardization of disclosure might also improve comprehension of the results. (shrink)

Three experiments with preschool- and young school-aged children (N = 75 and 53) explored the kinds of relations children detect in samples of instances (descriptive problem) and how they generalize those relations to new instances (inferential problem). Each experiment initially presented a perfect biconditional relation between two features (e.g., all and only frogs are blue). Additional examples undermined one of the component conditional relations (not all frogs are blue) but supported another (only frogs are blue). Preschool-aged children did not distinguish (...) between supported and undermined relations. Older children did show the distinction, at least when the test instances were clearly drawn from the same population as the training instances. Results suggest that younger children’s difficulties may stem from the demands of using imperfect correlations for predictions. Older children seemed sensitive to the inferential problem of using samples to make predictions about populations. (shrink)

This chronological collection of Moore's most compelling and dramatic images, taken as the movement progressed through Alabama, Mississippi, Tennessee, and Georgia, highlights activity from 1958 to 1965. Included are the iconic scenes of black protestors huddled in a doorway to escape the crippling blasts of fire hoses in Birmingham; a white bigot swinging a baseball bat seconds before cracking it on the head of a black woman during the desegregation of the Capitol Cafeteria in Montgomery; a young and stunned Dr. (...) Martin Luther King Jr. pinned to the counter of a police precinct, his arm twisted behind his back; the devastating aftermath of "Bloody Sunday" on the Edmund Pettus Bridge in Selma; and Bull Connor's police dogs tearing mercilessly at the legs of a protestor in downtown Birmingham. Celebrity protestors--comedian Dick Gregory, poet Galway Kinnell, singers Joan Baez, Mary Travers, Pete Seeger, and Harry Bellafonte, actor Pernell Roberts, and writer James Baldwin--are featured alongside the many nameless but committed participants and the recognized major leaders of the movement. (shrink)

OBJECTIVE: To apply component analysis, a structured approach to the ethical analysis of risks and potential benefits in research, to published emergency research using a waiver of/exception from informed consent. The hypothesis was that component analysis could be used with a high degree of interrater reliability, and that the vast majority of emergency research would comply with a minimal-risk threshold. METHODS: A Medline search and manual search were done to identify studies using a waiver of/exception from informed consent published between (...) July 1996 and December 2000. A review panel of physicians and bioethicists independently classified nontherapeutic procedures in each study as minimal risk, probably minimal risk, or probably more than minimal risk. RESULTS: Seventy studies using a waiver of/exception from informed consent were identified. A majority of reviewers classified nontherapeutic procedures in 62 studies (88.6%) as minimal risk. Reviewers classified nontherapeutic procedures in six studies (8.6%) as minimal risk or probably minimal risk. In two studies (2.9%), nontherapeutic procedures were classified as probably more than minimal risk. The intraclass correlation coefficient was 0.89 (95% CI = 0.85 to 0.93), indicating very high interrater reliability. CONCLUSIONS: Component analysis can be used with high reliability to review emergency research and may improve the consistency of institutional review board review of emergency research. The vast majority of published emergency research performed using a waiver of/exception from consent complies with a properly-applied minimal-risk threshold. A minimal-risk threshold for nontherapeutic procedures protects subjects better than current U.S. regulations while permitting important emergency research to continue. (shrink)

After severe brain injury, one of the key challenges for medical doctors is to determine the patient’s prognosis. Who will do well? Who will not do well? Physicians need to know this, and families need to do this too, to address choices regarding the continuation of life supporting therapies. However, current prognostication methods are insufficient to provide a reliable prognosis. -/- Functional Magnetic Resonance Imaging (MRI) holds considerable promise for improving the accuracy of prognosis in acute brain injury patients. Nonetheless, (...) research on functional MRI in the intensive care unit context is ethically challenging. These studies raise several ethical issues that have not been addressed so far. In this article, Prof. Charles Weijer and his co-workers provide a framework for researchers and ethics committees to design and review these studies in an ethically sound way. (shrink)

pt. I. The mystical ambition.--pt. II. Revelation.--pt. III. Religion and morality.

Objective Cluster randomised trial (CRT) investigators face challenges in seeking informed consent from individual patients (cluster members). This study examined associations between reporting of patient consent in healthcare CRTs and characteristics of these trials. Study design Consent practices and study characteristics were abstracted from a random sample of 160 CRTs performed in primary or hospital care settings that were published from 2000 to 2008. Multivariable logistic regression was used to examine associations between reporting of patient consent and methodological characteristics, as (...) well as publication features such as date and journal of publication. Results 82 (53.8%) of 160 studies reported obtaining informed consent from individual patients. Reporting of patient consent was independently and positively associated with: smaller cluster size, the evaluation of experimental interventions targeted at patients, data collection from individual patients, publication later than 2004 and publication in higher-impact journals. Conclusions Reporting of consent practices in published CRTs should be improved. Consent practices in published CRTs appear to be related to the type of interventions under study, as well as journal impact and trends in research ethics practices. These findings will inform best practices in trial conduct and ethics review, remediation of errors in consent practices and ethics review and the development of regulatory guidance for CRTs. (shrink)

Using data collected from 280 full-time employees from a variety of organizations, this study examined the effects of employee perceptions of the behavioral integrity (BI) of their supervisors on job tension. The moderating effect of procedural justice (PJ) on this relationship also was examined. Substitutes for leadership theory (Kerr and Jermier, 1978) and psychological contract theory (Rousseau, Empl Responsib Rights J 2:121–139, 1989) were used as the theoretical foundations for the hypothesized relationships. Results indicated a negative relationship between BI and (...) job tension. PJ moderated this relationship such that it was weakened under conditions of high PJ. Implications for research and managers are discussed. (shrink)

Emergency medicine research requires the enrollment of subjects with varying decision-making capacities, including capable adults, adults incapacitated by illness or injury, and children. These different categories of subjects are protected by multiple federal regulations. These include the federal Common Rule, the Department of Health and Human Services (DHHS) regulations for pediatric research, and the Food and Drug Administration's (FDA) Final Rule for the Exception from the Requirements of Informed Consent in Emergency Situations. Investigators should be familiar with the relevant federal (...) research regulations to optimally protect vulnerable research subjects, and to facilitate the institutional review board (IRB) review process. IRB members face particular challenges in reviewing emergency research. No regulations exist for research enrolling incapacitated subjects using proxy consent. The wording of the Final Rule may not optimally protect vulnerable subjects. It is also difficult to apply conflicting regulations to a single study that enrolls subjects with differing decision-making capacities. This article is intended as a guide for emergency researchers and IRB members who review emergency research. It reviews the elements of Federal Regulations that apply to consent, subject selection, privacy protection, and the analysis of risks and benefits in all emergency research. It explores the challenges for IRB review listed above, and offers potential solutions to these problems. (shrink)

This book is about the respective roles of intuition and reasoning in ethics. It responds to a number of well-known philosophers and psychologists, and proposes a new perspective – radical in its moderation. It examines in depth the work of the philosopher Joshua Greene and the psychologist Jonathan Haidt. With the so-called empirical turn in ethics, much work has been done to try to isolate the role of reason and intuition in forming our moral judgements, with Haidt and Greene leading (...) the research programmes and attracting much of the professional and public attention, and many others following. The current view – shared by both camps – is that intuition is largely the driver of our moral judgements – a view summed up in Haidt’s slogan ‘intuition first, strategic reasoning second’. Haidt believes we have to live with this and accept it. Greene does not: he contends that our intuitions, while suitable for the environments in which we evolved, are worthless in the modern, global, technological age, and to avoid ethical disaster we must learn to adopt reason as the arbiter of moral truth. This book steers a middle course between these two positions and is therefore of great interest to philosophers and psychologists alike. (shrink)

Mareschal and his colleagues argue that cognition consists of partial representations emerging from organismic constraints placed on information processing through development. However, any notion of constraints must consider multiple sensory modalities, and their gradual integration across development. Multisensory integration constitutes one important way in which developmental constraints may lead to enriched representations that serve more than immediate behavioural goals.

Badiou's philosophy of the ‘event’ has itself become an event of sorts for contemporary social and political theory. It has broken radically with a set of propositions concerning the operation of power, the status of knowledge, and the possibility of action that were for some time considered nearly unquestionable, in many ways defining what Badiou might call ‘the state of the situation’. After briefly outlining the manner in which Badiou's reinvigoration of the concept of ‘truth’ constitutes a serious challenge for (...) the politics of difference and the ethics of alterity, this paper explores the significance for educational philosophy of what, borrowing from Jacques Rancière, Badiou calls the ‘axiom of equality’, or the notion that, in democratic politics, ‘equality must be postulated not willed’. I suggest that this axiom is best understood when read in relation to Rancière's The Ignorant Schoolmaster, and thus explore an intrinsic link between Badiou's more obscure philosophical claims and political assertions on the one hand, and the question of education on the other. I further propose that the limitations of Badiou's criticism of Rancière's work, which suggests that he stops short of locating an effective political subject who might oppose the parliamentary state, are revealed most explicitly when we reassess Rancière's approach to education in The Ignorant Schoolmaster, and in his more recent work on political aesthetics. Ultimately, however, I conclude that a truly democratic approach to education will have to learn from both Badiou and Rancière, and take seriously the ‘axiom of equality’. (shrink)

This chapter contains sections titled: Out of Order The Axiom of Equality Ignorant Schoolmasters Political Aesthetics Democratic Education References.