Vilius Dranseika

In this article, we seek to contribute to the debate on the requirement of disclosure in the context of informed consent for research. We defend the subjective standard of disclosure and describe ways to implement this standard in research practice. We claim that the researcher should make an effort to find out what kinds of information are likely to be relevant for those consenting to research. This invites researchers to take empirical survey information seriously, attempt to understand the cultural context, talk to patients to be better able to understand what can be potentially different concerns and interests prevalent in the target population. The subjective standard of disclosure should be seen as a moral ideal that perhaps can never be perfectly implemented but still can and should be used as a normative ideal guiding research practice. In the light of these discussions, we call for more empirical research on what considerations are likely to be perceived as relevant by potential research participants recruited from different socio-economic and cultural groups.

Imagination and other forms of mental simulation allow us to live beyond the current immediate environment. Imagination that involves an experience of self further enables one to incorporate or utilize the contents of episodic simulation in a way that is of importance to oneself. However, the simulated self can be found in a variety of forms. The present study provides some empirical data to explore the various ways in which the self could be represented in observer-perspective imagination as well as the potential limits on such representations. In observer-perspective imagination, the point of view or perspective is dissociated from the location of one’s simulated body. We have found that while there are different ways to identify with oneself in an observer-perspective imagination, the identification is rarely dissociated from first-person perspective in imagination. Such variety and limits pave the way for understanding how we identify with ourselves in imagination. Our results suggest that the first-person perspective is a strong attractor for identification. The empirical studies and analysis in this paper demonstrate how observer-perspective episodic simulation serves as a special case for research on identification in mental simulation, and similar methods can be applied in the studies of memory and future thinking.

Epidemiological research is subject to an ethics review. The aim of this qualitative review is to compare existing ethical guidelines in English for epidemiological research and public health practice in regard to the scope and matter of an ethics review. Authors systematically searched PubMed, Google Scholar and Google Search for ethical guidelines. Qualitative analysis was applied to categorize important aspects of the an ethics review process. Eight ethical guidelines in English for epidemiological research were retrieved. Five main categories that are relevant to the review of epidemiological research by Institutional Review Boards/Research Ethics Committees were distinguished. Within the scope of main categories, fifty-nine subcategories were analyzed. There are important differences between the guidelines in terms of the scope and matter of an ethics review. Not all guidelines encompass all identified ethically important issues, and some do not define precisely the scope and matter of an ethics review, leaving much to the ethics of the individual researchers and the discretion of IRBs/RECs.

Two decades have passed since the first attempts were made to establish systematic ethical review of human research in the Baltic States. Legally and institutionally much has changed. In this paper we provide an historical and structural overview of ethical review of human research and identify some problems related to the role of ethical review in establishing quality research environment in these countries. Problems connected to (a) public availability of information, (b) management of conflicts of interest, (c) REC composition and motivation of REC members, and (d) differing levels of stringency of ethical review for different types of studies, are identified. Recommendations are made to strengthen cooperation among the Baltic RECs.

We analyse the system of ethical review of human research in the Baltic States by introducing the principle of equivalent stringency of ethical review, that is, research projects imposing equal risks and inconveniences on research participants should be subjected to equally stringent review procedures. We examine several examples of non-equivalence or asymmetry in the system of ethical review of human research: (1) the asymmetry between rather strict regulations of clinical drug trials and relatively weaker regulations of other types of clinical biomedical research and (2) gaps in ethical review in the area of non-biomedical human research where some sensitive research projects are not reviewed by research ethics committees at all. We conclude that non-equivalent stringency of ethical review is at least partly linked to the differences in scope and binding character of various international legal instruments that have been shaping the system of ethical review in the Baltic States. Therefore, the Baltic example could also serve as an object lesson to other European countries which might be experiencing similar problems.

Biomedical research involving human subjects is an arena of conflicts of interests. One of the most important conflicts is between interests of participants and interests of future patients. Legal regulations and ethical guidelines are instruments designed to help find a fair balance between risks and burdens taken by research subjects and development of knowledge and new treatment. There is an universally accepted ethical principle, which states that it is not ethically allowed to sacrifice individual interests for the sake of society and science. This is the principle of precedence of individual. But there is a problem with how to interpret the principle of precedence of individual in the context of research without prospect of future benefit involving children. There are proposals trying to reconcile non-beneficial research involving children with the concept of the best interests. We assert that this reconciliation is flawed and propose an interpretation of the principle of precedence of individual as follows: not all, but only the most important interests of participants, must be guaranteed; this principle should be interpreted as the secure participant standard. In consequence, the issue of permissible risk ceiling becomes ethically crucial in research with incompetent subjects.

A striking feature of our memories of the personal past is that they involve different visual perspectives: one sometimes recalls past events from one’s original point of view (a field perspective), but one sometimes recalls them from an external point of view (an observer perspective). In philosophy, observer memories are often seen as being less than fully genuine and as being necessarily false or distorted. This paper looks at whether laypeople share the standard philosophical view by applying the methods of experimental philosophy. We report the results of five studies suggesting that, while participants clearly categorize both field and observer memories as memories, they tend to judge that observer memories are slightly less accurate than field memories. Our results suggest, however, that in lay thought, the difference between field and observer memories is not nearly as clear-cut as philosophers have generally taken it to be.

People across cultures consider everyday choices in the context of perceived various external life-determining forces: such as fate and gods (two teleological forces) and such notions as luck and chance (two non-teleological forces). There is little cross-cultural evidence (except for a belief in gods) showing how people relate these salient notions of life-determining forces to prosociality and a sense of well-being. The current paper provides preliminary cross-cultural data to address this gap. Results indicate that choice is the most important life-determining factor. Regression analyses indicate that choice and belief in gods and fate emerged as significant predictors of prosociality towards strangers. Moreover, luck was a significant predictor of decreased prosociality. A relation between life-determining forces and life satisfaction followed the same pattern: choice, gods, and fate emerged as significant predictors of greater life satisfaction, whereas luck was associated with decreased life satisfaction. The overall pattern of results indicates that participants across different cultures might sense being bounded to share or not to care depending on the perceived intentional agency and meaning in the external forces.

In his paper “The challenge of brain death for the sanctity of life ethic”, Peter Singer advocates two options for dealing with death criteria in a way that is compatible with efficient organ transplantation policy. He suggests that we should either redefine death as cortical death or go back to the old cardiopulmonary criterion and scrap the Dead Donor Rule. We welcome Singer’s line of argument but raise some concerns about the practicability of the two alternatives advocated by him. We propose adding a third alternative that also – as the two previous alternatives – preserves and extends the possibility of organ transplantation without using anyone without their consent. Namely, we would like to draw readers’ attention to a proposal by Robert Veatch, formulated 42 years ago in his 1976 book “Death, dying, and the biological revolution” and developed further in his later publications. Veatch argues for a conscience clause for the definition of death that would permit people to pick from a reasonable range of definitional options. This autonomy-based option, we believe, is more likely to be practicable than the two options advocated by Singer. Furthermore, we present data from a study with Lithuanian participants that suggest that there is quite pronounced variation of preferences concerning death determination.

Several authors in bioethics literature have expressed the view that a whole brain conception of death is philosophically indefensible. If they are right, what are the alternatives? Some authors have suggested that we should go back to the old cardiopulmonary criterion of death and abandon the so-called Dead Donor Rule. Others argue for a pluralist solution. For example, Robert Veatch has defended a view that competent persons should be free to decide which criterion of death should be used to determine their death. However, there is very little data on people’s preferences about death determination criteria. We conducted online vignette-based survey with Latvian participants (N = 1416). The data suggest that the pluralist solution fits best with the way our study participants think about death determination—widely differing preferences concerning death determination criteria were observed. Namely, most participants choose one of the three criteria discussed in the literature: whole brain, higher brain, and cardiopulmonary. Interestingly, our data also indicate that study participants tend to prefer less restrictive criteria for determination of their own deaths than for determination of deaths of their closest relatives. Finally, the preferences observed in our sample are largely in accord with the Dead Donor Rule for organ procurement for transplantation.

In this article we attempt to answer the question of how the ethical and conceptual framework (ECF) for a learning health‐care system (LHS) affects some of the main controversies in research ethics by addressing five key problems of research ethics: (a) What is the difference between practice and research? (b) What is the relationship between research ethics and clinical ethics? (c) What is the ethical relevance of the principle of clinical equipoise? (d) Does participation in research require a higher standard of informed consent than the practice of medicine? and (e) What ethical principle should take precedence in medicine? These questions allow us to construct two opposite idealized positions on the distinction between research and practice: the integration model and the segregation model of research and practice. We then compare the ECF for an LHS with these two idealized positions. We argue that the ECF for a LHS does not, in fact, solve these problems, but that it is a third, separate position in the relationship between research ethics and clinical ethics. Moreover, we suggest that the ECF for a LHS raises new ethical problems that require additional ethical analysis and justification. Our article contributes to the discussion on the relationship between research ethics and clinical ethics, revealing that although a learning health‐care system may significantly change the landscape of health care, some ethical dilemmas still require resolving on both theoretical and policy‐making levels.

A cross-cultural survey experiment revealed a dominant tendency to rely on a rule’s letter over its spirit when deciding which behaviors violate the rule. This tendency varied markedly across (k = 15) countries, owing to variation in the impact of moral appraisals on judgments of rule violation. Compared with laypeople, legal experts were more inclined to disregard their moral evaluations of the acts altogether and consequently exhibited stronger textualist tendencies. Finally, we evaluated a plausible mechanism for the emergence of textualism: in a two-player coordination game, incentives to coordinate in the absence of communication reinforced participants’ adherence to rules’ literal meaning. Together, these studies (total n = 5,794) help clarify the origins and allure of textualism, especially in the law. Within heterogeneous communities in which members diverge in their moral appraisals involving a rule’s purpose, the rule’s literal meaning provides a clear focal point—an identifiable point of agreement enabling coordinated interpretation among citizens, lawmakers, and judges.

Epidemiological studies usually do not pose high risk to participants. At the same time they provide valuable knowledge and improve public and individual health. In many countries, studies involving human subjects are subject to ethics review. Research shows that the process of obtaining ethical approval from institutional research boards or research ethics committees is sometimes costly, time-consuming and seriously delays important research projects. In this article we consider arguments against and in favor of ethics review of epidemiological studies. On the one hand, it seems that minimal risk epidemiological studies should not be a subject to ethics review, since any delay of an important study has its death toll and health costs. In this perspective, the calculus of costs and benefits supports rejecting the whole existing approach. Nevertheless, we argue that institutional research boards or ethics research committees protect research participants from wrongs and up till now are the best tools of social and political control over the research enterprise.

Occasional reports in the literature suggest that biological samples collected and stored for scientific research are sometimes accessed and used for a variety of forensic purposes. However, donors are almost never informed about this possibility. In this paper we argue that the possibility of forensic access may constitute a relevant consideration at least to some potential research subjects in deciding whether to participate in research. We make the suggestion that if some type of forensic access to research collections is likely to be perceived by the subjects as a reason against donating their biological materials, there are good ethical reasons to make this type of access impossible or at least severely restricted. We also provide an ethical argument for the claim that, if a total ban on this type of forensic access cannot be achieved, potential research subjects should be informed about the extent to which this type of forensic access is possible.

Kokie veiksmai yra kognityviškai raiškiausi, labiausiai prototipiški moralės transgresijų pavyzdžiai? Deja, šiuo metu yra labai nedaug tyrimų, siekiančių sistemiškai nagrinėti šį klausimą. Šiuo straipsniu siekiame prisidėti prie šio klausimo sprendimo pristatydami preliminarius tyrimo duomenis apie tai, kurie veiksmai tyrimo dalyviams lietuviams buvo raiškiausi. Pirmajame tyrime pritaikius kognityvinės antropologijos metodus buvo nustatyti tyrimo dalyviams iš Lietuvos raiškiausi moralinių transgresijų atvejai. Antrajame tyrime dalyvių buvo prašoma šiuos veiksmus suskirstyti į kategorijas, paimtas iš Haidto moralės pagrindų teorijos. Paėmus kartu, šie tyrimai suteikia preliminarių duomenų, paremiančių idėją, kad labiausiai kognityviškai raiškioms moralės transgresijoms būdinga tai, kad jos susijusios su žala ir šiek tiek mažiau – su neteisingumu. Rezultatai aptariami skirtingų moralės sritį aprašančių teorijų kontekste.

My aim in this paper is to explore the idea of human moral responsibility for (the outcomes) of natural disasters. First, I discuss the claim that there is often a human causal contribution to negative outcomes of even such paradigmatic natural disasters as earthquakes, typhoons, and volcano eruptions. Second, I attempt to move away from discussions attributing human causal responsibility to discussions attributing human moral responsibility for such outcomes (and to the obstacles to such attributions). I suggest that in most (perhaps even all) cases of moral responsibility for the outcomes of natural disasters moral responsibility is grounded in culpable negligence, including culpable failure to prevent the side-effects of our actions or omissions.

Clinicians and administrators have a professional obligation to contribute to improvement of healthcare quality. At the same time, participation in embedded research poses risks to healthcare institutions. Disclosure of an institution’s sensitive information could endanger relationships with patients and undermine its reputation. The existing ethical framework for learning healthcare systems does not address the conflict between the OTC and institutional interests. Ethical guidance and policy regulation are needed to create a safe environment for embedded research. In this article we analyse the EF for LHSs and the concept of professionalism. We suggest that the EF should be supplemented with an obligation to protect provider’s legitimate interests. We define legitimate interests as those that enable providers to discharge their primary duties. We argue that both the OTC and the obligation to protect legitimate interests are grounded in the concept of medical professionalism and can be understood as a matter of contract between a democratic society and medical professionals. The proposed supplemented EF can be implemented into a regulatory system in three different ways: the self-regulating: where providers decide themselves how to balance the ethical claims, the centralised: where a governmental institution decides the right balance between providers’ interests and interests of a health system; and the mediating: where medical professionals, the state and patients negotiate their interests. Our article contributes to the discussion on ethical relevance of providers’ interests and the regulatory model for weighing opposite interests in LHSs.

Digitization of a health record changes its accessibility. An electronic health record (EHR) can be accessed by multiple authorized users. Health information from EHRs contributes to learning healthcare systems’ development. The objective of this systematic review is to answer a question: What are ethical issues concerning research using EHRs in the literature? We searched Medline Ovid, Embase and Scopus for publications concerning ethical issues of research use of EHRs. We employed the constant comparative method to retrieve common ethical themes. We descriptively summarized empirical studies. The study reveals the breadth, depth, and complexity of ethical problems associated with research use of EHRs. The central ethical question that emerges from the review is how to manage access to EHRs. Managing accessibility consists of interconnected and overlapping issues: streamlining research access to EHRs, minimizing risk, engaging and educating patients, as well as ensuring trustworthy governance of EHR data. Most of the ethical problems concerning EHR-based research arise from rapid cultural change. The framing of concepts of privacy, as well as individual and public dimensions of beneficence, are changing. We are currently living in the middle of this transition period. Human emotions and mental habits, as well as laws, are lagging behind technological developments. In the medical tradition, individual patient’s health has always been in the center. Transformation of healthcare care, its digitalization, seems to have some impacts on our perspective of health care ethics, research ethics and public health ethics.

In this paper we report a study conducted in Mongolia on the scope of morality, that is, the extent to which people moralize different social domains. Following Turiel’s moral-conventional task, we characterized moral transgressions (in contrast to conventional transgressions) in terms of two dimensions: authority independence and generality of scope. Different moral domains are then defined by grouping such moral transgressions in terms of their content (following Haidt’s classification of morally relevant domains). There are four main results of the study. First, since all five Haidtian domains were moralized by the Mongolian participants, the study provides evidence in favour of pluralism about moral domains. However, the study also suggests that the domain of harm can be reduced to the fairness domain. Furthermore, although the strong claim about reduction of all moral domains to the domain of fairness does not seem to hold a significant number of participants did indicate considerations of fairness across domains. Finally, a significant amount of participants moralized conventional transgressions a la Turiel, but it did not reach a statistical significance.

Šio straipsnio tikslas – bendrais bruožais aptarti reduktyvizmo raišką šiuolaikinėje analitinėje sąmonės, moralės, veiksmo ir priežastingumo filosofijoje bei įvertinti redukcijos strategijų šiose filosofijos šakose panašumus ir skirtumus. Straipsnyje aptariamos šešios reduktyvizmo strategijos – sąvokų sinonimija paremta redukcija, a posteriori tapatybės tezė, analitinis funkcionalizmas, anomalusis monizmas, analizė pasitelkiant pareities sąvoką, konceptualinė analizė be sąvokų sinonimijos – ir konstatuojama, kad skirtingose filosofijos srityse šios strategijos reiškiasi skirtingai, taip pat yra skirtingai kritikuojamos ir interpretuojamos. Straipsnyje mėginama paaiškinti kai kuriuos šių skirtumų ir daroma išvada, kad šiuolaikinėje analitinėje filosofijoje neperspektyvu kalbėti apie reduktyvizmą apskritai, kaip vieną visas sritis apimantį reiškinį, paremtą visas reduktyvistines koncepcijas vienijančiu reduktyvizmo modeliu, forma ar vizija.

This Open Access Book is the first to examine disasters from a multidisciplinary perspective. Justification of actions in the face of disasters requires recourse both to conceptual analysis and ethical traditions. Part 1 of the book contains chapters on how disasters are conceptualized in different academic disciplines relevant to disasters. Part 2 has chapters on how ethical issues that arise in relation to disasters can be addressed from a number of fundamental normative approaches in moral and political philosophy. This book sets the stage for more focused normative debates given that no one book can be completely comprehensive. Providing analysis of core concepts, and with real-world relevance, this book should be of interest to disaster scholars and researchers, those working in ethics and political philosophy, as well as policy makers, humanitarian actors and intergovernmental organizations..

When a terminally ill patient kills herself, using a drug prescribed by a physician for this purpose, in bioethical literature this would be described as a case of physician-assisted suicide. This would also be a case of suicide according to the standard account of suicide in the philosophical literature. However, in recent years, some authors have argued that terminally ill self-killing in fact should not be considered suicide. In this paper, we don’t try to address the philosophical merits of such arguments. Instead, we ask whether these considerations align with the way non-philosophers think about suicide. We present empirical evidence from four studies that address different concerns raised about terminally ill self-killing being a suicide. We conclude that the raised concerns cannot be supported by the folk understanding of suicide.