Value theory and the best interests standard

The idea of a patient's best interests raises issues in prudential value theory–the study of what makes up an individual's ultimate (nonmoral) good or well-being. While this connection may strike a philosopher as obvious, the literature on the best interests standard reveals almost no engagement of recent work in value theory. There seems to be a growing sentiment among bioethicists that their work is independent of philosophical theorizing. Is this sentiment wrong in the present case? Does value theory make a significant difference in interpreting best interests? In pursuing this question, I begin with a quick sketch of broad kinds of value theories, identifying representatives that are plausible enough to count as contenders. I then explore what each account suggests in (1) neonatal treatment decisions, and (2) decisions for patients in persistent vegetative states. I conclude that while these accounts converge somewhat in their interpretations of best interests, they also have importantly different implications.     

Taking the best for learning

Examples of how animals learn when multiple, sometimes redundant, cues are present provide further examples not considered by Hutchinson and Gigerenzer that seem to fit the principle of taking the best. "The best" may the most valid cue in the present circumstances; evolution may also produce species-specific biases to use the most functionally relevant cues.     

Use and abuse of the quasi-steady-state approximation

The transient kinetic behaviour of an open single enzyme, single substrate reaction is examined. The reaction follows the Van Slyke-Cullen mechanism, a spacial case of the Michaelis-Menten reaction. The analysis is performed both with and without applying the quasi-steady-state approximation. The analysis of the full system shows conditions for biochemical pathway coupling, which yield sustained oscillatory behaviour in the enzyme reaction. The reduced model does not demonstrate this behaviour. The results have important implications in the analysis of open biochemical reactions and the modelling of metabolic systems.     

The common property resource problem and the creation of limited property rights

Fish resources are generally considered common property and open to any user. This, the assumption goes, makes them susceptible to the tragedy of the commons in which selfish users are both the villains and the victims. While it is true that wild fish populations cannot readily be privatized, it hardly follows that they are completely open-access. In addition to social controls found in many traditional fishing communities, amply documented by anthropologists, many administrative controls in contemporary fisheries management also create limited property rights over fishery resources. This study focuses on Great Lakes fisheries of Ontario in Lakes Erie and St. Clair, and the kinds and diversity of limited property rights instituted in these areas: the formal and informal allocation of fishing areas, and the allocation of quantitative fishing rights (quotas), all of which serve as mechanisms to solve the common property resource problem. The Great Lakes fisheries suggest certain generalizations about the management of common property resources. The paper offers a life-cycle model of living resources use.     

Costs versus benefits: best possible and best practical treatment regimens for HIV

Current HIV therapy, although highly effective, may cause very serious side effects, making adherence to the prescribed regimen difficult. Mathematical modeling may be used to evaluate alternative treatment regimens by weighing the positive results of treatment, such as higher levels of helper T cells, against the negative consequences, such as side effects and the possibility of resistance mutations. Although estimating the weights assigned to these factors is difficult, current clinical practice offers insight by defining situations in which therapy is considered “worthwhile”. We therefore use clinical practice, along with the probability that a drug-resistant mutation is present at the start of therapy, to suggest methods of rationally estimating these weights. In our underlying model, we use ordinary differential equations to describe the time course of in-host HIV infection, and include populations of both activated CD4⁺ T cells and CD8⁺ T cells. We then determine the best possible treatment regimen, assuming that the effectiveness of the drug can be continually adjusted, and the best practical treatment regimen, evaluating all patterns of a block of days “on” therapy followed by a block of days “off” therapy. We find that when the tolerance for drug-resistant mutations is low, high drug concentrations which maintain low infected cell populations are optimal. In contrast, if the tolerance for drug-resistant mutations is fairly high, the optimal treatment involves periods of reduced drug exposure which consequently boost the immune response through increased antigen exposure. We elucidate the dependence of the optimal treatment regimen on the pharmacokinetic parameters of specific antiviral agents.     

First is best

We experience the world serially rather than simultaneously. A century of research on human and nonhuman animals has suggested that the first experience in a series of two or more is cognitively privileged. We report three experiments designed to test the effect of first position on implicit preference and choice using targets that range from individual humans and social groups to consumer goods. Experiment 1 demonstrated an implicit preference to buy goods from the first salesperson encountered and to join teams encountered first, even when the difference in encounter is mere seconds. In Experiment 2 the first of two consumer items presented in quick succession was more likely to be chosen. In Experiment 3 an alternative hypothesis that first position merely accentuates the valence of options was ruled out by demonstrating that first position enhances preference for the first even when it is evaluatively negative in meaning (a criminal). Together, these experiments demonstrate a "first is best" effect and we offer possible interpretations based on evolutionary mechanisms of this "bound" on rational behavior and suggest that automaticity of judgment may be a helpful principle in clarifying previous inconsistencies in the empirical record on the effects of order on preference and choice.