One of the largest reasons decision-makers make bad decisions (act imprudently)is that the world is full of uncertainty, we feel uncertain about theconsequences of our actions. Participants played a repeated game in whichdecisions were made under various types of uncertainty (either no uncertainty,uncertainty about the present consequences of behaviors, uncertainty about thefuture consequences of behavior, or both types of uncertainty). The gamerequired prudent decision making for success. While playing the game one ofthree types of feedback was placed between trials, either no feedback,behavioral feedback, or behavioral plus outcome feedback. Prudentdecision-making decreased when both types of uncertainty were added. Further,the addition of feedback increased prudent decision-making when futureuncertainty was present. The increase in prudent decisions appears to be fromfeedback’s ability to allow us to create probabilities associated withbehaviors and their consequences, implying that anything that reduces theuncertainty people feel in a world full of uncertainty will increase theirability to make prudent decisions.

The emergence of new technologies might challenge our assumptions about biomedical research: medical progress may not only cure but enhance human capacities. In particular, the emergence of brain-machine interfaces will admittedly allow disabled people to move or communicate again, but also has various military applications, such as remote control of drones and avatars. Although there is no express legal framework pertaining to the experimental phase of human enhancement techniques, they are actually constrained by international law. According to international humanitarian law, civilians and prisoners of war may be subjected to experiments only when required by their state of health or for medical treatment. According to international human rights law, experimentations are permissible when they meet two conditions: (i) free consent, and (ii) proportionality (that is, the adequacy of risk and benefit). In light of these conditions, this article assesses the situations in which experimentation involving brain-computer interfaces would be lawful. It also gives specific attention to those experimentations carried out on members of the armed forces. In fact, owing to the military hierarchy and the unique nature of its mission (to protect national security at the risk of their own lives), it is necessary to determine how the military may comply with this legal framework.

Conducting experiments on humans may subject them to abuse and exploitation. The international community has developed principles, rules and norms that provide for safeguards against exploitative human experimentation. Recruiting a person by illegal means for illicit purposes has been criminalized as human trafficking. This article attempts, for the first time, to address human experimentation as a form of human trafficking. The article advocates for an expansive definition of the concept of human trafficking to include not only sex or labor but also medical or scientific tests that are conducted in violation of the law, also arguing that the international medical ethical principles, rules and norms may be more appropriately analyzed by using the three basic elements of a case of human trafficking, namely: (a) absence of consent; (b) abuse of a position of vulnerability; and (c) exploitation.

Summary

Background and objective: Absorption and disposition kinetics can be studied with a stable-isotope method. The aim of this study was to validate a stable-isotope method for levobupivacaine and to derive the relevant pharmacokinetics after epidural administration.

Methods: Eight volunteers (18–32 yr) received approximately 23 mg of both levobupivacaine and deuterium-labelled levobupivacaine simultaneously by intravenous infusion. Venous blood samples were taken for 8 h. Fifteen patients (23–85 yr) received 19 mL levobupivacaine 0.5% (including a 3 mL test dose) epidurally and, 25 min later, approximately 25 mg deuterium-labelled levobupivacaine (D3-levobupivacaine) intravenously. Arterial blood samples were collected for 24 h. Plasma concentrations were determined using liquid chromatography-mass spectrometry. Plasma concentration–time data were analysed by compartmental and non-compartmental analysis.

Results: Based on the ratio of the normalized areas under the curve of unlabelled and deuterium-labelled levobupivacaine in volunteers, as determined by both compartmental (mean ratio: 1.02, 90% CI: 1.00–1.04) and non-compartmental analysis (mean ratio: 1.02, 90% CI: 1.00–1.03) the two formulations were considered equivalent. In surgical patients the elimination half-life (mean ± SD: 196 ± 65 min), total body clearance (349 ± 114 mL min−1) and volume of distribution at steady state (56 ± 14 L), derived by compartmental analysis, were similar to those obtained by non-compartmental analysis. The absorption was bi-phasic. The fraction absorbed and half-life of the fast absorption process were 0.22 ± 0.06 and 5.2 ± 2.7 min, respectively. The values for the slow absorption process were 0.84 ± 0.14 and 386 ± 91 min, respectively.

Conclusions: D3-levobupivacaine is pharmacokinetically equivalent to unlabelled levobupivacaine and can be used to study the absorption and disposition kinetics after perineural administration of levobupivacaine in a single experiment.