Conflict of interest in medicine in Lithuania: legal and ethical aspects

The current legal framework within the Lithuanian health system is described including a review of the physician’s autonomy, rights and duties, and patients’ rights including the right to reimbursement. The role of ethical codes and the law are discussed. An earlier version of this paper was presented at an International Conference on “Conflict of Interest and its Significance in Science and Medicine” held in Warsaw, Poland on 5–6 April, 2002.     

The Harm Principle

According to the Harm Principle, roughly, the state may coerce a person only if it can thereby prevent harm to others. Clearly, this principle depends crucially on what we understand by harm. Thus, if any sort of negative effect on a person may count as a harm, the Harm Principle will fail to sufficiently protect individual liberty. Therefore, a more subtle concept of harm is needed. I consider various possible conceptions and argue that none gives rise to a plausible version of the Harm Principle. Whether we focus on welfare, quantities of welfare or qualities of welfare, we do not arrive at a plausible version of this principle. Instead, the concept of harm may be moralized. I consider various ways this may be done as well as possible rationales for the resulting versions of the Harm Principle. Again, no plausible version of the principle turns up. I also consider the prospect of including the Harm Principle in a decision-procedure rather than in a criterion of rightness. Finally, in light of my negative appraisal, I briefly discuss why this principle has seemed so appealing to liberals.     

Professional Autonomy and the Normative Structure of Medical Practice

Professional autonomy is often described as a claim of professionalsthat has to serve primarily their own interests. However, it can also beseen as an element of a professional ideal that can function as astandard for professional, i.e. medical practice. This normativeunderstanding of the medical profession and professional autonomy facesthree threats today. 1) Internal erosion of professional autonomy due toa lack of internal quality control by the medical profession; 2)the increasing upward pressure on health care expenses that calls for ahealth care policy that could imply limitations for the professionalautonomy of physicians; 3) a distorted understanding of theprofession as being based on a formal type of knowledge and relatedtechnology, in which other normative dimensions of medical practice areneglected and which frustrates meaningful communication betweenphysicians and patients. To answer these threats a normative structureanalysis of medical practice is presented, that indicates whichprinciples and norms are constitutive for medical practice. It isconcluded that professional autonomy, normatively understood, should bemaintained to avoid the lure of the technological imperative and toprotect patients against third parties' pressure to undertreatment.However, this professional autonomy can only be maintained if members ofthe profession subject their activities and decisions to a criticalevaluation by other members of the profession and by patients and ifthey continue to critically reflect on the values that regulate today'smedicine.     

Tool-use learning in Tonkean macaques (Macaca tonkeana)

The transmission of tool use is a rare event in monkeys. Such an event arose in a group of semi-free-ranging Tonkean macaques (Macaca tonkeana) in which leaning a pole against the parks fence (branch leaning) appeared and spread to several males. This prompted us to test individual and social learning of this behavior in seven young males. In the first experiment, three males learned individually to obtain a food reward using a wooden pole as a climbing tool. They began using the pole to retrieve the reward only when they could alternatively experience acting on the object and reaching the target. In a second experiment, we first tested whether four other subjects could learn branch leaning after having observed a group-mate performing the task. Despite repeated opportunities to observe the demonstrator, they did not learn to use the pole as a tool. Hence we exposed the latter subjects to individual learning trials and they succeeded in the task. Tool use was not transmitted in the experimental situation, which contrasts with observations in the park. We can conclude that the subjects were not able to recognize the target as such. It is possible that they recognized it and learned the task individually when we alternated the opportunity to act upon the object and to reach the reward. This suggests that these macaques could then have associated the action they exercised upon the pole and the use of the pole as a means to reach the reward.     

In search of the enactive: Introduction to special issue on enactive experience

Abstact In the decade and a half since the appearance of Varela, Thompson and Rosch's workThe Embodied Mind,enactivism has helped to put experience and consciousness, conceived of in a distinctive way, at the forefront of cognitive science. There are at least two major strands within the enactive perspective: a broad view of what it is to be an agent with a mind; and a more focused account of the nature of perception and perceptual experience. The relation between these two strands is discussed, with an overview of the papers presented in this volume.     

Central inhibition ability modulates attention-induced motion blindness

Impaired motion perception can be induced in normal observers in a rapid serial visual presentation task. Essential for this effect is the presence of motion distractors prior to the motion target, and we proposed that this attention-induced motion blindness results from high-level inhibition produced by the distractors. To investigate this, we compared the extent of the attention-induced motion blindness effect with performance on central inhibition tasks: Stroop colour naming and negative priming. A negative correlation between Stroop interference and motion performance reflected that low Stroop scores, indicative of strong inhibition ability, was associated with more severe impairments in motion perception. This association could not be explained by individual differences in fluid intelligence, task switching or response speed. Negative priming was not specifically associated with attention-induced motion blindness. The results confirm that attention can modulate motion perception and suggest that the processes involved may be shared with high-level cognitive abilities.     

自强意识的初步调查研究

采用录音访谈和开放式问卷要求200名不同性别、年龄、职业、教育程度的成人对“自强”的含义以及在什么时候、什么心理背景下想到“自强”进行了调查,结果表明：(1)公众的自强观主要是指持久的意志力;(2)自强可分为顺境自强、逆境自强、竞争性自强、成长性自强和他向性自强．逆境自强更为公众所赞同;(3)人们回忆起自强意识产生的时间主要在参加工作以后。     

Towards a research programme for ethics and technology

In this editorial contribution, two issues relevant to the question, what should be at the top of the research agenda for ethics and technology, are identified and discussed. Firstly: can, and do, engineers make a difference to the degree to which technology leads to morally desirable outcomes? What role does professional autonomy play here, and what are its limits? And secondly, what should be the scope of engineers' responsibility; that is to say, on which issues are they, as engineers, morally obliged to reflect? The research agendas proposed by the authors contributing to this special section, implicitly, give different answers to these questions. We suggest that an explicit discussion of these issues would greatly help in constructing a common research agenda.