Mark Fedyk

• PhD
• Professor (Associate) at University of California, Davis

Introduction Obtaining informed consent for research from patients in medical emergencies remains a challenge, particularly in acute stroke care as treatment must be administered quickly and patients often arrive in the hospital in a state of incapacitation. Adaptations to standard consenting approaches—such as the use of surrogate consent or defer...

Can contemporary cognitive science explain clinical expertise? We argue that the answer could be “no.” In support of this, we provide an analysis of two of the most essential expressions of clinical expertise in nursing and medicine, the ability to run a code blue and the ability to diagnose congestive heart failure. We show how it makes sense to t...

Rationale The evidentiary standards and epistemic models of clinical care, especially those of evidence‐based medicine, are dissimilar to those used in philosophy and examination of how the two systems intersect may help clinicians make more informed treatment decisions. Aims and Objectives This paper examines the use of ethical frameworks in rout...

Advance consent could allow individuals at high risk of stroke to provide consent before they might become eligible for enrollment in acute stroke trials. This survey explores the acceptability of this novel technique to Canadian Research Ethics Board (REB) chairs that review acute stroke trials. Responses from 15 REB chairs showed that majority of...

Introduction Equipoise, generally defined as uncertainty about the relative effects of the treatments being compared in a trial, is frequently referenced as an ethical standard for the conduct of randomized clinical trials. However, it seems to be defined in several different ways and may be used differently by different individuals. We explored ho...

Advance consent presents a potential solution to the challenge of obtaining informed consent for participation in acute stroke trials. Clinicians in stroke prevention clinics are uniquely positioned to identify and seek consent from potential stroke trial participants. To assess the acceptability of advance consent to Canadian stroke clinic physici...

The challenges of conducting hyperacute stroke research and obtaining informed consent have been increasingly recognized within the stroke research community in recent years. Deferral of consent, in which a patient is enrolled in a trial and then provides consent at some point thereafter, is increasingly used to enroll patients into hyperacute stro...

Objectives We set out to identify and count the types of reasons that are used in contemporary scholarship about the ethical permissibility of randomized trials, with the goal of developing a finer-grained taxonomy of reasons than is currently employed by most participants in this literature. Because of its central role in justifying normative conc...

Objective No systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in female patients. In this scoping review, we aimed to identify all randomised controlled trials (RCTs) that reported sex-specific outcomes for patients who underwent carotid revascularisation, and determine whether su...

Background and Purpose: No systematic review of the literature has dedicated itself to looking at the management of symptomatic carotid stenosis in women. In this scoping review, we aimed to identify all randomized controlled trials (RCTs) that reported sex-specific outcomes for patients who underwent carotid revascularization, and determine whethe...

Introduction Women have historically been under-represented in randomised controlled trials (RCTs), including many landmark RCTs that established standards of care. In light of this fact, some modern researchers are calling for replication of earlier landmark trials with women only. This approach is ethically concerning, in that it would require so...

We argue that creative ideas are potentially valuable improbable constructions. We arrive at this formulation of creativity after considering several problems that arise for the theories that suggest that creativity is novelty, originality, or usefulness. Our theory avoids these problems. But since we also derive our theory of creativity from the s...

Explanations of how the brain makes successful predictions should refer to abstracta. But, the mind/brain system is for more than prediction alone. Creativity also plays an important role in supply the mind/brain system with abstracta that serve a number of valuable ends over and above prediction.

Introduction Carotid intervention in the form of endarterectomy or stenting is the current standard of care for the majority of patients with symptomatic high-grade carotid stenosis. However, some randomised controlled trials (RCT) have demonstrated that women benefited significantly less from intervention than men. It is unclear if this is a true...

What are the benefits and harms of carotid revascularization (endarterectomy and/or stenting) for women with symptomatic carotid stenosis? Searches A search strategy will be developed through an iterative process with the review team, including a medical library scientist. We will search Ovid MEDLINE, Embase, and PubMed. We will also search the Coc...

Introduction Randomised controlled trials (RCTs) are widely viewed to generate the most reliable medical knowledge. However, RCTs are not always scientifically necessary and therefore not always ethical. Unfortunately, it is not clear when an RCT is not necessary or how this should be established. This study seeks to systematically catalogue justif...

Background: The concept of “equipoise” is often cited as a prerequisite to the conduct of ethical randomized clinical trials (RCTs). However, significant difficulties persist in determining when it exists around a specific clinical question. This issue has arisen around recent stroke RCTs such as ESCAPE and SWIFT DIRECT. We sought to capture how st...

To the Editor Brain death, as Dr Truog argued in a Viewpoint, is a concept that blends both medical and legal information.¹ He pointed out that while the law often requires drawing bright-line distinctions between categories—guilty and innocent, dead and alive—biological domains tend to be more continuous and less discrete. We would like to suggest...

Rational constructivism is one of the leading theories in developmental psychology. But it is not a purely psychological theory: rational constructivism also makes a number of substantial epistemological claims about both the nature of human rationality and several normative principles that fall squarely into the ambit of epistemology. The aim of t...

In this article, we will argue for three claims. First, that the ethical justification for a therapeutic RCT -- in which a patient is receiving treatment for a specific condition -- is inseparable from the scientific evidence upon which the design of the study is based. Second, therefore, there can be no ethical evaluation of a trial that is logica...

Objective: We have proposed that three scientific criteria are important to the ethical justification of RCTs: (1) they should be designed around a clear hypothesis; (2) uncertainty should exist around that hypothesis; (3) that uncertainty should be as established through a systematic review. We hypothesized that the majority of a sample of recent...

In this book, Mark Fedyk offers a novel analysis of the relationship between moral psychology and allied fields in the social sciences. Fedyk shows how the social sciences can be integrated with moral philosophy, argues for the benefits of such an integration, and offers a new ethical theory that can be used to bridge research between the two. Fedy...

In this book, Mark Fedyk offers a novel analysis of the relationship between moral psychology and allied fields in the social sciences. Fedyk shows how the social sciences can be integrated with moral philosophy, argues for the benefits of such an integration, and offers a new ethical theory that can be used to bridge research between the two. Fedy...

What happens if participants are asked open-ended questions about moral problems? We found that our participants responses fell into four different categories: (1) Explicit Justification: participant makes a clear judgment, and provides a logically coherent justification or explanation for their judgment; (2) Scattershooting: participant works back...

Controversies surrounding brain death determinations, as presented by Wahlster et al., [1] are not unexpected, and assertions that "brain death is death" [2] are unlikely to resolve them. Rather, such controversies exemplify how the diagnosis of brain death signals two separate things: the physiological fact that certain neurological functions have...

Our conscious abilities are learned in environments that have evolved to support them. This insight provides an alternative way of framing Huang & Bargh's (H&B's) provocative hypothesis. To understand the conflict between unconscious goals and consciousness, we can study the emergence of conscious thought and control in childhood. These development...

Evolutionary psychologists often try to “bring together” biology and psychology by making predictions about what specific psychological mechanisms exist from theories about what patterns of behaviour would have been adaptive in the EEA for humans. This paper shows that one of the deepest methodological generalities in evolutionary biology—that prox...

A Challenge to Clinical Equipoise Clinical equipoise links ethically appropriate medical research with medical research that has the reasonable chance of resolving debates. We argue against this principle on the ground that most debates in medicine cannot be resolved by the outcomes of any particular (even extremely rigorous) empirical study. In fa...

We asked college students to make judgments about realistic moral situations presented as dilemmas (which asked for an either/or decision) vs. problems (which did not ask for such a decision) as well as when the situation explicitly included affectively salient language vs. non-affectively salient language. We report two main findings. The first is...

What exactly is a philosophical intuition? And what makes such an intuition reliable, when it is reliable? This paper provides a terminological framework that is able answer to the first question, and then puts the framework to work developing an answer to the second question. More specifically, the paper argues that we can distinguish between two...