Conference report: Humanism & revolution: Eighteenth-century Europe and its transatlantic legacy : [Rice University, Houston, TX, USA, December 11 - 13, 2009]

"Since the events of the eighteenth century, in particular the French and American Revolutions, the concept of revolution has become one of the most important, and most widely used, concepts of modern political and philosophical thought. The revolutions of the eighteenth century are, however, also marked by a temporal logic that questions their radical departure from the past, both intellectually and practically. Indeed, the concept of revolution is often coupled with a renewed interest in ideals of human self-conception, moral beauty and education that are seen as having emerged in the classical antiquity of Greece and Rome. On both sides of the Atlantic, references to classical antiquity support contemporary achievements, on the one hand, and are used to question the existing state of political and intellectual affairs, on the other.

How behavioral economics can help to avoid ‘The last mile problem’ in whole genome sequencing

Editorial summary Failure to consider lessons from behavioral economics in the case of whole genome sequencing may cause us to run into the ‘last mile problem’ - the failure to integrate newly developed technology, on which billions of dollars have been invested, into society in a way that improves human behavior and decision-making

Inconceivable Effects

In Inconceivable Effects, Martin Blumenthal-Barby reads theoretical, literary and cinematic works that appear noteworthy for the ethical questions they raise. Via critical analysis of writers and filmmakers whose projects have changed our ways of viewing the modern world—including Hannah Arendt, Franz Kafka, Walter Benjamin, the directors of Germany in Autumn, and Heiner Müller—these essays furnish a cultural base for contemporary discussions of totalitarian domination, lying and politics, the relation between law and body, the relation between law and justice, the question of violence, and our ways of conceptualizing "the human." A consideration of ethics is central to the book, but ethics in a general, philosophical sense is not the primary subject here; instead, Blumenthal-Barby suggests that whatever understanding of the ethical one has is always contingent upon a particular mode of presentation (Darstellung), on particular aesthetic qualities and features of media. Whatever there is to be said about ethics, it is always bound to certain forms of saying, certain ways of telling, certain modes of narration. That modes of presentation differ across genres and media goes without saying; that such differences are intimately linked with the question of the ethical emerges with heightened urgency in this book. ; In Inconceivable Effects, Martin Blumenthal-Barby reads theoretical, literary and cinematic works that appear noteworthy for the ethical questions they raise. Via critical analysis of writers and filmmakers whose projects have changed our ways of viewing the modern world—including Hannah Arendt, Franz Kafka, Walter Benjamin, the directors of Germany in Autumn, and Heiner Mueller—these essays furnish a cultural base for contemporary discussions of totalitarian domination, lying and politics, the relation between law and body, the relation between law and justice, the question of violence, and our ways of conceptualizing "the human." A consideration of ethics is central to the book, but ethics in a general, philosophical sense is not the primary subject here; instead, Blumenthal-Barby suggests that whatever understanding of the ethical one has is always contingent upon a particular mode of presentation (Darstellung), on particular aesthetic qualities and features of media. Whatever there is to be said about ethics, it is always bound to certain forms of saying, certain ways of telling, certain modes of narration. That modes of presentation differ across genres and media goes without saying; that such differences are intimately linked with the question of the ethical emerges with heightened urgency in this book

Two Types of Autonomy

Although I agree with Sabine Muller’s conclusion that we should first seek to find alternatives to amputation for patients suffering from Body Integrity Identity Disorder (BIID), I disagree with one of the major premises that she uses to argue for her claim. Muller argues that patients with BIID are likely not autonomous when they request that the limb be amputated. Muller’s argument that BIID suffers are not autonomous is flawed because she conflates philosophical conceptions of autonomy with the conception of autonomy that is operative in the context of medicine

The MedSeq Project: a randomized trial of integrating whole genome sequencing into clinical medicine

Background: Whole genome sequencing (WGS) is already being used in certain clinical and research settings, but its impact on patient well-being, health-care utilization, and clinical decision-making remains largely unstudied. It is also unknown how best to communicate sequencing results to physicians and patients to improve health. We describe the design of the MedSeq Project: the first randomized trials of WGS in clinical care. Methods/Design This pair of randomized controlled trials compares WGS to standard of care in two clinical contexts: (a) disease-specific genomic medicine in a cardiomyopathy clinic and (b) general genomic medicine in primary care. We are recruiting 8 to 12 cardiologists, 8 to 12 primary care physicians, and approximately 200 of their patients. Patient participants in both the cardiology and primary care trials are randomly assigned to receive a family history assessment with or without WGS. Our laboratory delivers a genome report to physician participants that balances the needs to enhance understandability of genomic information and to convey its complexity. We provide an educational curriculum for physician participants and offer them a hotline to genetics professionals for guidance in interpreting and managing their patients’ genome reports. Using varied data sources, including surveys, semi-structured interviews, and review of clinical data, we measure the attitudes, behaviors and outcomes of physician and patient participants at multiple time points before and after the disclosure of these results. Discussion The impact of emerging sequencing technologies on patient care is unclear. We have designed a process of interpreting WGS results and delivering them to physicians in a way that anticipates how we envision genomic medicine will evolve in the near future. That is, our WGS report provides clinically relevant information while communicating the complexity and uncertainty of WGS results to physicians and, through physicians, to their patients. This project will not only illuminate the impact of integrating genomic medicine into the clinical care of patients but also inform the design of future studies. Trial registration ClinicalTrials.gov identifier NCT0173656

'Why do you ask?' Revisiting the purpose of eliciting the public's moral judgments about emerging technologies

It is increasingly common for bioethicists to consult with the public to solicit their judgments and attitudes about ethical questions and issues, especially ones that arise with new and emerging technologies. However, it is not always clear what the purpose of this engagement is or ought to be: do bioethicists seek the input of the public to help them arrive at a morally correct justified policy position, or do they seek this input to help them shape and frame their already-established moral position, or something else entirely? In this essay, we discuss four distinct possible functions of collecting moral judgments from the public: issue spotting, messaging for adherence and social stability, substantive moral guidance, and procedural fairness. For each function, we offer core examples from the literature before discussing the strengths and weaknesses attendant to each. We conclude with several preliminary questions bioethicists can ask themselves to clarify their own purpose for soliciting moral judgments from the public

Balancing the presentation of information and options in patient decision aids: An updated review

Background: Standards for patient decision aids require that information and options be presented in a balanced manner; this requirement is based on the argument that balanced presentation is essential to foster informed decision making. If information is presented in an incomplete/non-neutral manner, it can stimulate cognitive biases that can unduly affect individuals' knowledge, perceptions of risks and benefits, and, ultimately, preferences. However, there is little clarity about what constitutes balance, and how it can be determined and enhanced. We conducted a literature review to examine the theoretical and empirical evidence related to balancing the presentation of information and options. Methods: A literature search related to patient decision aids and balance was conducted on Medline, using MeSH terms and PubMed; this search supplemented the 2011 Cochrane Collaboration's review of patient decision aids trials. Only English language articles relevant to patient decision making and addressing the balance of information and options were included. All members of the team independently screened clusters of articles; uncertainties were resolved by seeking review by another member. The team then worked in sub-groups to extract and synthesise data on theory, definitions, and evidence reported in these studies. Results: A total of 40 articles met the inclusion criteria. Of these, six explained the rationale for balancing the presentation of information and options. Twelve defined "balance"; the definition of "balance" that emerged is as follows: "The complete and unbiased presentation of the relevant options and the information about those options-in content and in format-in a way that enables individuals to process this information without bias". Ten of the 40 articles reported assessing the balance of the relevant decision aid. All 10 did so exclusively from the users' or patients' perspective, using a five-point Likert-type scale. Presenting information in a side-by-side display form was associated with more respondents (ranging from 70% to 96%) judging the information as "balanced". Conclusion: There is a need for comparative studies investigating different ways to improve and measure balance in the presentation of information and options in patient decision aids

Public Acceptability in the UK and USA of Nudging to Reduce Obesity: The Example of Reducing Sugar-Sweetened Beverages Consumption.

BACKGROUND: "Nudging"-modifying environments to change people's behavior, often without their conscious awareness-can improve health, but public acceptability of nudging is largely unknown. METHODS: We compared acceptability, in the United Kingdom (UK) and the United States of America (USA), of government interventions to reduce consumption of sugar-sweetened beverages. Three nudge interventions were assessed: i. reducing portion Size, ii. changing the Shape of the drink containers, iii. changing their shelf Location; alongside two traditional interventions: iv. Taxation and v. Education. We also tested the hypothesis that describing interventions as working through non-conscious processes decreases their acceptability. Predictors of acceptability, including perceived intervention effectiveness, were also assessed. Participants (n = 1093 UK and n = 1082 USA) received a description of each of the five interventions which varied, by randomisation, in how the interventions were said to affect behaviour: (a) via conscious processes; (b) via non-conscious processes; or (c) no process stated. Acceptability was derived from responses to three items. RESULTS: Levels of acceptability for four of the five interventions did not differ significantly between the UK and US samples; reducing portion size was less accepted by the US sample. Within each country, Education was rated as most acceptable and Taxation the least, with the three nudge-type interventions rated between these. There was no evidence to support the study hypothesis: i.e. stating that interventions worked via non-conscious processes did not decrease their acceptability in either the UK or US samples. Perceived effectiveness was the strongest predictor of acceptability for all interventions across the two samples. CONCLUSION: In conclusion, nudge interventions to reduce consumption of sugar-sweetened beverages seem similarly acceptable in the UK and USA, being more acceptable than taxation, but less acceptable than education. Contrary to prediction, we found no evidence that highlighting the non-conscious processes by which nudge interventions may work decreases their acceptability. However, highlighting the effectiveness of all interventions has the potential to increase their acceptability.The study was funded by the UK Department of Health Policy Research Programme (Policy Research Unit in Behaviour and Health) (Grant ID: PRUN-0409-10109)This is the final version of the article. It first appeared from the Public Library of Science via http://dx.doi.org/10.1371/journal.pone.015599