Assessing the Ethics of Medical Research in Emergency Settings: How Do International Regulations Work in Practice?

Different ethical principles conflict in research conducted in emergency research. Clinical care and its development should be based on research. Patients in critical clinical condition are in the greatest need of better medicines. The critical condition of the patient and the absence of a patient representative at the critical time period make it difficult and sometimes impossible to request an informed consent before the beginning of the trial. In an emergency, care decisions must be made in a short period of time, and the more time is wasted, the more the risk of death or severe tissue damage and incapacity increases. Consent requests take time, and so the time period before treatment might put the patient’s life in jeopardy. Not requesting consent before a trial is also contradictory. A person should not be forced to participate in a trial against his or her will. Due to the dark history of medical research previously, international declarations and conventions have set up ethical principles for medical research. They emphasize the autonomy of the research participant—or his or her legal representative—to give a free and informed consent prior to the initiation of research. In the case of a critical emergency, the unconscious state of the patient, the emotional stress of family members or the lack of time to start life-sustaining measures may often restrict the possibilities of communicating with the patient or his/her representative. Therefore, written informed consent is difficult to achieve, and its voluntariness in emergency situations is, at best, open to question. The mortality of patients is high without clinical interventions in emergency research. Random selection of patients is difficult and requires extra work from personnel in the emergency rooms. Recruitment, information and asking for consent may also take time, postpone the initiation of treatment and increase the risk of death and irreversible tissue and organ damage, and therefore be risky for the patient. It is therefore essential that the health care professionals recruiting suitable research participants are well motivated and well trained. Medical research in an emergency setting should always be regarded as an exceptional situation requiring special provisions. Only such research should be done as cannot be done in other conditions. An independent body must approve the research protocol and the ways in which the consent of the participant or proxy are to be sought. In addition, the trial must be expected to result in direct and significant benefit for the research participants. If research without prior consent is not approved, the development of emergency care is threatened. On the other hand, if prior consent is not required, a person could be recruited into a clinical trial against his or her will. Doing good and avoiding harm, and respecting the autonomy of the patient are in conflict in the context of emergency medical research. To develop better medicines for patients experiencing acute medical emergencies, research into such conditions should be allowed. Research participants should have the possibility to participate or refuse to participate in research that may benefit them and other patients. The risk of irreversible damage occurring as the consequence of time delays for seeking consent is unacceptable. A prior wish about participation in clinical trials should be respected, if known. The conditions under which medical research in emergencies can be considered acceptable can be determined and agreed upon nationally and internationally. An earlier version of this paper was presented at The 7th International Conference on Bioethics on “The Ethics of Research in Emergency Medicine”, held on June 2, 2006, Warsaw, Poland.     

Clinical Ethics: Theory Or Practice?

This article starts with a brief historical account of the ongoing debate about the status of clinical ethics: theory of practice. The author goes on to argue that clinical ethics is best understood as a practice. However, its practicality should not be measured by the extent to which clinical-ethical consultants manage to mediate or negotiate resolutions to ethical conflicts. Rather, clinical ethics is practical because it is characterized by a profound concern for the well-being of individual patients as well as the moral parameters of swift and urgent medical action in the face of limited supportive information.     

How Do Creative Experts Practice New Skills? Exploratory Practice in Breakdancers

How do expert performers practice as they develop creatively? This study investigated the processes involved in the practice of new skills by expert breakdancers. A great deal of evidence supports the theory of “deliberate practice” (Ericsson, Krampe, & Tesch‐Römer, 1993, Psychological Review, 100, 363) in skill acquisition; however, expert creative performers may emphasize other forms of practice for skill development. Four case studies collected through fieldwork and laboratory observation were analyzed to evaluate expert dancers’ practice processes as they developed proficiency in new, specific skills. We focused on three aspects of learning: the degree of skill acquisition, the content of skills included in practice, and dancers’ stated purposes for practicing. The results showed that dancers’ practice improved skills (as suggested by deliberate practice) and engaged the exploration of new, original skills, along with coordinating skills within performance. In their practice, these dance experts went beyond deliberative practice to highly exploratory processes for skill development.     

Is Moral Theory Harmful in Practice?—Relocating Anti-theory in Contemporary Ethics

In this paper I discuss the viability of the claim that at least some forms of moral theory are harmful for sound moral thought and practice. This claim was put forward by e.g. Elisabeth Anscombe (1981(1958)) and by Annette Baier, Peter Winch, D.Z Phillips and Bernard Williams in the 1970’s–1980’s. To this day aspects of it have found resonance in both post-Wittgensteinian and virtue ethical quarters. The criticism has on one hand contributed to a substantial change and broadening of the scope of analytic moral philosophy. On the other hand it is, at least in its most strongly anti-theoretical formulations, now broadly considered outdated and—to the extent that it is still defended—insensitive to the changes that have occurred within the field in the last 20–30 years. The task of this paper is to relocate the anti-theoretical critique into the field of analytic ethics today.     

How Kantian Must Kantian Constructivists Be?

Kantian constructivists locate the source of normativity in the rational nature of valuing agents. Some further argue that accepting this premise thereby commits one to accepting the intrinsic or unconditioned value of rational nature itself. Whereas much of the critical literature on this “regress on conditions” argument has focused either on the cogency of the inference from the value‐conferring capacity of the will to the unconditional value of that capacity itself or on the plausibility of the initial constructivist premise, my aim is to press the argument from a different direction by asking just how Kantian the constructivist needs to be in order to support a regress on conditions argument. Specifically, I maintain that the argument succeeds only given a full‐fledged Kantian moral psychology, including a presupposition of transcendental freedom. If correct, this could have implications regarding the compatibility of Kantian ethics and philosophic naturalism.     

How Much Jungian Theory Is There in My Practice?

This non-clinical paper consists of the author's subjective and personal value judgements on theory and practice. He discusses nine topics: I) What is analysis and why do people seek therapy? 2) Dangers of reification and hypostatizing: reinforcement of narcissistic defences and schizoid unrelatedness. 3) The problems of archetypal psychology and amplification. 4) The cultural and political aspects of the unconscious psyche, and the value of studying the philosophical background to the psychodynamic approach. 5) Criticism of the classical Jungian over-emphasis of the intrapsychic at the expense of the interpersonal. 6) Psychosomatic healing through experience and interpretation of psychosomatic identity in the transference/countertrans-ference; idea of the ‘animating body’. 7) Dangers of theoretical hndamentalism and crusading among Jungian schools: envy and intolerance. 8) The need for the analyst to have enough good objects. 9) An acknowledgement of theoretical influences other than Jung on the author's practice; although Jung's ideas facilitate a personal pluralism - the spirit of Jung.     

Do You See What I See? Patient and Clinician Perceptions of Underlying Dimensions of Suicidality

The clinical suicidology literature strongly emphasizes the importance of risk assessment. However, limited empirical data are available about the assessment process. The present study investigated the ways in which clinicians and patients perceive several theoretical dimensions related to suicide: psychological pain, external pressures/stressors, agitation/emotional upsetness, self-regard, and hopelessness. Data from the current sample suggest that clinicians and parasuicidal patients independently perceived most of these dimensions similarly, with the exception of agitation/emotional upsetness (perturbation). The implications of these findings are discussed.     

Companion Animal Ethics: A Special Area of Moral Theory and Practice?

Considerations of ethical questions regarding pets should take into account the nature of human-pet relationships, in particular the uniquely combined features of mutual companionship, quasi-family-membership, proximity, direct contact, privacy, dependence, and partiality. The approaches to ethical questions about pets should overlap with those of animal ethics and family ethics (and, for veterinary issues, with healthcare ethics), and so need not represent an isolated field of enquiry, but rather the intersection of those more established fields. This intersection, and the questions of how we treat our pets, present several unique concerns and approaches for focused examination.     

Do You See What I See? An Exploration of Congruence in Ratings From Multiple Perspectives1

This paper provides a comparative analysis of behavioral observations made on 152 service providers in a business advisory and professional services firm from 5 distinctly different ratings sources (self, direct reports, peers, supervisor, and clients). Results focused on differences in ratings level and degree of congruence with self-assessments by observer type. The data suggested that service providers and their clients may have a different perceptual frame of reference than do internal observers (e.g., direct reports, peers, and supervisors). Moreover, congruence in self-others' ratings was found to be a significant predictor of performance assessments from the same observer source. Implications of these results for the use of multirater appraisal systems are discussed.     

Ethics in the Pulpit?

Abstract: What is the place of ethics and politics in the pulpit—especially in the post September 11th United States? This article argues that preachers must learn to bring the deepest wisdom of the biblical texts to bear on the most intractable issues of the present. Scripture gives preachers insight into the “ethics of God” and empowers them to step beyond a hermeneutics of narcissism. Silence and Attention prepare the preacher to hear the Word of God, and prayerful listening is crucial to seeing and hearing where God may be working in the present moment. In this way preachers help facilitate the conversation between the congregation and God and this conversation continues after the sermon. Politics should not take over the pulpit or be entirely absent from it. Discernment is the key. Regardless of political standing, all preachers have the obligation to bring the Word of God to bear on the problems of the world.     

How has Philosophical Applied Ethics Progressed in the Past Fifty Years?

Applied ethics is relatively new on the philosophical scene, having grown out of the various civil rights movements of the 1950s and 1960s, as well as the student demand that college courses be relevant. Even today, there are those who think that there are no philosophically interesting practical ethical questions, and that applied ethics is not a branch of philosophy at all. This article rejects that view, both because some of the most interesting and respectable philosophers in the world have worked in applied ethics and because applied ethics has been the source of many difficult conceptual questions in theoretical ethics and even metaphysics. These include the grounds for moral status, human identity, how to conceive rights in general and the right to life in particular, the question whether existence itself can be a harm (the nonidentity problem), and the nature of moral principles.     

How Can Experts See the Invisible? Reply to Bilalić and Gobet

Experts in all fields are able to see what is invisible to others. Experts are also able to see what is visible to all—and this is explored by Bilalić and Gobet. We question the method of normalizing all subjects in an experimental condition, and asking experts to behave as if they were novices. We claim that method leads Bilalić and Gobet to a nonsequitur .     

How Did You Like This Course? The Advantages and Limitations of Reaction Criteria in Ethics Education

Ethics courses are most commonly evaluated using reaction measures. However, little is known about the specific types of reaction data being collected (e.g., content relevance, course satisfaction) and how these reaction data relate to improvements in trainee performance (e.g., knowledge, moral reasoning). Using a sample of 381 ethics training sessions, major reaction data categories were identified. Content and course satisfaction were the most frequently collected types of reaction criteria. Furthermore, content relevance (r = .84) and course satisfaction (r = .79) showed strong, positive relationships with performance criteria, whereas content satisfaction demonstrated a moderate, negative relationship (r = –.28). These results and future directions for ethics training evaluation are discussed.     

How Shall We Read the History of Ethics?

This response suggests that in writing the history of ethics, it is important to take seriously what the principals wrote and believed, distinguishing it carefully from our own responses to their writings, or from subsequent uses to which their writings may have been put. For example, when reading Thomas Aquinas and Francisco de Vitoria on just war against non‐Christian peoples, forcible conversion and conquest are clearly condemned. Whatever the attitudes of their contemporaries, not to mention later thinkers up to the present, there is no foundation in Aquinas and Vitoria for holy war or “exceptionalism,” American or otherwise.     

Where is Safeguarding in Sport Psychology Research and Practice?

Recent cases of sexual abuse of athletes have drawn significant concern amongst stakeholders in sport and the public at-large. The fact that the perpetrators in many cases of athlete abuse had numerous victims over the span of several years raises questions of who might have known or suspected that athletes were being harmed. Sexual abuse cases should serve as an impetus for all of us in sport psychology to interrogate our roles and responsibilities as consultants and researchers in the protection of athletes. We propose that future research in applied sport psychology and education of consultants address maltreatment and safeguarding.

Lay Summary: In the following article, we propose that more attention in the research and practice of sport psychology should be devoted to understanding maltreatment of athletes and ways to protect athletes from harm.