The protection of patients’ rights in clinical trials

The Helsinki Declaration is a very important document regarding the protection of patients’ rights in clinical trials and one of the fundamental sources of operational principles for every ethics committee. Although they have been updated, the international guidelines for ethics committees continually fail to address certain issues pertaining to the protection of patients’ rights in clinical trials. These issues include, most significantly, the method of electing ethics committees (a free, secret ballot should be preferred to direct appointment), the avoidance of conflict of interest during the election of ethics committee members, and the necessary insurance coverage for the participants of clinical trials. Polish law should, on the other hand, be developed in such way as to not limit the effectiveness of ethics committees in protecting patients’ rights in clinical trials. The ideal solution would be to draft a uniform law concerning not only clinical trials, but all medical experiments. The opinions of experts who have been reviewing medical research projects for several years may prove to be especially valuable in this setting. This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005. The author is Chairman, Bioethics Committee of the Warsaw Regional Chamber of Physicians and Dentists.     

The mentor and the trainee in academic clinical medicine

Medicine is a scientific discipline, but it is sometimes difficult to separate what is scientific and what is a clinical, practical activity. Man is the object, but he is always the subject of medical research and therefore these two elements become closely bound together by a thread of moral interdependencies. Every mentor of a young academic and all institutions dealing with the teaching of and research into medicine must understand multidimensional, multifaceted, and multilevel aspects of their activity and give them due regard in the educational process. The educational mission of an academic institution and of the teacher working there may be summed up in one phrase: Teach thinking! At the same time, the task of a school and the individual mentor is to teach the student to distinguish personal freedom from a lack of the feeling of responsibility. The medieval principle “Universitas magistrorum et scholarium”, and thus the corporation, the community of teachers and students, has not lost any of its relevance and value today. The situation is, in its far-reaching consequences, tragic in which the “insufficiently tutored teach”. Both physician and teacher, and especially physician-teacher, are not only professions, but also callings. This paper was presented at the 6th International Bioethics Conference on the subject of ‘The Responsible Conduct of Basic and Clinical Research’, held in Warsaw, Poland, 3–4 June 2005.     

In search of shared and nonshared environmental factors in security of attachment: a behavior-genetic study of the association between sensitivity and attachment security

The current article presents results from a twin study of genetic and environmental components of maternal sensitivity and infant attachment and their association. The sample consisted of 136 twin pairs from 2 sites: Leiden, the Netherlands, and London, UK. Maternal sensitivity was assessed in the home at 9-10 months, and infant attachment security was observed in the laboratory at 12 months. The study yielded little evidence that genetic factors are involved in variations between twins in maternal sensitivity ratings but did find that shared variance in maternal sensitivity was able to account for some of the similarity between twins in attachment security. Weak nonshared associations between sensitivity and attachment appeared to suppress the magnitude of the correlation between attachment and sensitivity in twin children. The results could indicate that the attachment security of one twin may depend on the relationship the parent has with the other twin. The results are brought to bear on the validity of attachment theory as a theory of primarily shared environmental effects in children's development and the continuing challenge posed to attachment theory by within-family differences in socioemotional processes.     

Fitch’s paradox and <Emphasis Type="Italic">ceteris paribus</Emphasis> modalities

The paper attempts to give a solution to the Fitch’s paradox though the strategy of the reformulation of the paradox in temporal logic, and a notion of knowledge which is a kind of ceteris paribus modality. An analogous solution has been offered in a different context to solve the problem of metaphysical determinism.     

The limits of definition: Gadamer’s critique of Aristotle’s ethics

ABSTRACT

There is a recent scholarly trend drawing similarities between Aristotle’s conceptions of ethics and demonstrative science. One such similarity has become widely and rightly recognized: for Aristotle both ethics and demonstrative science seek essential definitions of phenomena. The task of the paper is to show that German philosopher and classicist Hans-Georg Gadamer not only prefigured this interpretative trend, he also identified a problematic feature of Aristotle’s method so construed. The problematic feature is semantic. For Aristotle essential definitions must consist of univocal terms, but such univocity cannot be maintained if the definienda and definientes are concepts to be usefully employed in everyday ethical judgements. Gadamer therefore points out a problematic tension in Aristotle’s ethics. On the one hand, ethical inquiry should have practical application, but, on the other hand, the semantic assumptions underlying inquiry imply that it cannot.     

Psychiatry Residents' Attitudes on Ethics and Professionalism: Multisite Survey Results

Recent studies show that psychiatry residents express a relatively greater need for ethics curricula than their colleagues in other specialties. Such studies have been limited in their generalizability because they were conducted at one site. This study of 151 psychiatry residents at seven U.S. psychiatry programs aims to address that limitation. Residents were surveyed on issues pertaining to ethics and professionalism education. Participants were found to support such curricula during training and to value its relevance to the practice of psychiatry. Gender differences and the influence of the “hidden curriculum” on such results merit further study.     

Mass psychology of the led and the leaders

Abstract

Some salient features of a Sullivanian perspective are given as a background for a discussion of the case of Anna. Lived experience is mentioned as of equal importance as fantasy. Technically, analytic inquiry in the form of questions is stressed. In his review of the case presentation, the author observes that too much emphasis is given to content, compared to form. He notes that the therapist does not report key transference and non-transference interactions with the patient and further suggests that the patient still has significant narcissistic problems. He suggests that it is time to confront the patient with her characterological ways of relating to the analyst.