Informed consent for functional MRI research on comatose patients following severe brain injury: balancing the social benefits of research against patient autonomy.

Functional MRI shows promise as a candidate prognostication method in acutely comatose patients following severe brain injury. However, further research is needed before this technique becomes appropriate for clinical practice. Drawing on a clinical case, we investigate the process of obtaining informed consent for this kind of research and identify four ethical issues. After describing each issue, we propose potential solutions which would make a patient's participation in research compatible with her rights and interests. First, we defend the need for traditional proxy consent against two alternative approaches. Second, we examine the impact of the intensive care unit environment on the informed consent process. Third, we discuss the therapeutic misconception and its potential influence on informed consent. Finally, we deal with issues of timing in recruiting participants and related factors which may affect the risks of participation.

Cystic fibrosis carrier screening in Veneto (Italy): an ethical analysis.

A recent study by Castellani et al. (JAMA 302(23):2573-2579, 2009) describes the population-level effects of the choices of individuals who underwent molecular carrier screening for cystic fibrosis (CF) in Veneto, in the northeastern part of Italy, between 1993 and 2007. We discuss some of the ethical issues raised by the policies and individual choices that are the subject of this study. In particular, (1) we discuss the ethical issues raised by the acquisition of genetic information through antenatal carrier testing; (2) we consider whether by choosing to procreate naturally these couples can harm the resulting child and/or other members of society, and what the moral implications of such harm would be; (3) we consider whether by choosing to avoid natural procreation carrier couples can harm current or future individuals affected by cystic fibrosis; (4) we discuss whether programs that make carrier testing available can be considered eugenic programs.

Is a shift from research on individual medical error to research on health information technology underway? A 40-year analysis of publication trends in medical journals.

OBJECTIVE: In 1983, McIntyre and Popper underscored the need for more openness in dealing with errors in medicine. Since then, much has been written on individual medical errors. Furthermore, at the beginning of the 21st century, researchers and medical practitioners increasingly approached individual medical errors through health information technology. Hence, the question arises whether the attention of biomedical researchers shifted from individual medical errors to health information technology. We ran a study to determine publication trends concerning individual medical errors and health information technology in medical journals over the last 40 years. METHODS: We used the Medical Subject Headings (MeSH) taxonomy in the database MEDLINE. Each year, we analyzed the percentage of relevant publications to the total number of publications in MEDLINE. The trends identified were tested for statistical significance. RESULTS: Our analysis showed that the percentage of publications dealing with individual medical errors increased from 1976 until the beginning of the 21st century but began to drop in 2003. Both the upward and the downward trends were statistically significant (P < 0.001). A breakdown by country revealed that it was the weight of the US and British publications that determined the overall downward trend after 2003. On the other hand, the percentage of publications dealing with health information technology doubled between 2003 and 2015. The upward trend was statistically significant (P < 0.001). CONCLUSIONS: The identified trends suggest that the attention of biomedical researchers partially shifted from individual medical errors to health information technology in the USA and the UK.

Are 'counter-intuitive' deontological judgments really counter-intuitive? An empirical reply to.

A substantial body of evidence indicates that utilitarian judgments (favoring the greater good) made in response to difficult moral dilemmas are preferentially supported by controlled, reflective processes, whereas deontological judgments (favoring rights/duties) in such cases are preferentially supported by automatic, intuitive processes. A recent neuroimaging study by Kahane et al. challenges this claim, using a new set of moral dilemmas that allegedly reverse the previously observed association. We report on a study in which we both induced and measured reflective responding to one of Greene et al.'s original dilemmas and one of Kahane et al.'s new dilemmas. For the original dilemma, induced reflection led to more utilitarian responding, replicating previous findings using the same methods. There was no overall effect of induced reflection for the new dilemma. However, for both dilemmas, the degree to which an individual engaged in prior reflection predicted the subsequent degree of utilitarian responding, with more reflective subjects providing more utilitarian judgments. These results cast doubt on Kahane et al.'s conclusions and buttress the original claim linking controlled, reflective processes to utilitarian judgment and automatic, intuitive processes to deontological judgment. Importantly, these results also speak to the generality of the underlying theory, indicating that what holds for cases involving utilitarian physical harms also holds for cases involving utilitarian lies.

Post traumatic stress disorder, neuroscience, and the law.

Post-Traumatic Stress Disorder (PTSD) is a complex psychiatric condition, the effects of which can be seriously debilitating. As it originates from a specific traumatic event, it often impacts soldiers and victims of violent crime. It is currently one of the most frequently litigated mental diseases. Neuroscience is slowly discovering the neural bases of PTSD and other psychiatric ailments and is building tests to distinguish actual patients from non-suffering individuals. We examine the current state of neuroscientific research on PTSD and its biomarkers, focusing on a recent experiment by Apostolos Georgopoulos and coworkers. Then we analyze the legal consequences of these scientific advances, both in civil and criminal law, from a comparative perspective. Neuro-technology is likely to provide courts with a new kind of evidence, which will not replace but add to older behavioral evidence. Furthermore, it will weaken the so far standing distinction between physical and emotional harm. However, even extremely sensitive tests (>95%) can have insufficient accuracy if the prevalence of a condition in the tested population is low. Therefore, the law ought to take into account the prevalence of PTSD and other psychiatric conditions when the decision whether to admit neuro-evidence in courts or not is made.