Driving advisement with the Elemental Driving Simulator (EDS): When less suffices

The Elemental Driving Simulator (EDS) is a PC-based software and hardware system for advising people with known or suspected cognitive impairment. It is elemental in its simplicity and in its simulation of the elements of driving-related cognitive abilities. The EDS explicitly addresses metacognition and quantitatively relates it to performance. A neuropsychological case example, with an EDS Personal Report, is complemented by statistical findings from (1) working-age drivers (norms), (2) patients with central nervous system impairment seeking driver rehabilitation, and (3) a large sample of older drivers. The EDS proved to be a challenging procedure that all the normals completed more consistently, efficiently, and accurately than the other groups. Clinically, it discriminated extreme cases and, for those who fell in between, it helped focus the issues for further assessment and intervention. The discussion addresses how much realism is necessary, as well as the psychometric limitations of on-road testing.     

Rethinking Research Ethics

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research.     

Thinking critically in medicine and its ethics: relating applied science and applied ethics

ABSTRACT While interest in philosophy and medicine has burgeoned in the past two decades, there remains a need for an analysis of the intellectual activity embodied in good medical practice. In this setting, ethical and scientific decision-making are complexly interrelated. The following paper, collaboratively written by physicians and philosophers, presents a view of applied (clinical) science and applied ethics. Making extensive use of illustrations drawn from routine case material, we seek to indicate a variety of philosophic issues to be found in daily practice, elucidate various levels of critical reasoning within the medical setting, and demonstrate a remarkable similarity between medical and ethical decision-making.