Background: Nursing students on clinical placements as part of their professional training are routinely faced with situations involving ethical conflicts. The initial act of perceiving a situation as causing an ethical dilemma is the result of both the students’ personal values, drawn from their culture and families, and of the professional knowledge and values that they have acquired through training and experience. Objectives: Nursing students’ experiences on clinical placements in primary care settings were investigated in order to identify situations that (...) they perceived as involving ethical conflict and describe the elements they took into consideration during their decision-making processes in these situations. Methods: The research design was qualitative descriptive case study. Around 50 students from three different intakes to a nursing degree answered a questionnaire and discussed it in focus groups. Ethical considerations: The study was designed in accordance with the principles guiding research with human beings and was approved by the Human Research Ethics Committee. Results: Synthesised into two principal axes: (a) ethical conflicts in primary care, linked with the domains of working processes, professional nursing ethics and human and social rights and (b) students’ decision-making processes – realisation, reflection and intervention. Conclusion: The student nurses saw themselves both as actors and spectators in situations involving ethical problems and demanding moral deliberation, demonstrating the ability to base their arguments soundly. They tended to emphasise the possibilities offered by dialogue and that different ethical values must be respected to find fair solutions to ethical problems. (shrink)

This article focuses on the interaction between recipes unearthed from tombs datable to the Han dynasty and the early history of the materia medica. We observed that the two medicographic media, i.e. the materia medica and the recipes, share the following logical structure: [Substance] A [produces] → [effect] B Our arrow indicates a variety of relations, which the present article tries to categorize.

For the philosopher Ivan Illich, society became a set of systems rather than a group of people. As such, society depersonalizes life and brings the need for open non-systematized spaces where people can act and interact outside their typical roles. On the other hand, an absence of formal structures may simply open spaces for the informal reproduction of society’s already well-established structures. Given this conjuncture, can systems be designed to foster personal expression? The answer I found in cybernetics is self-organization, (...) a process of adaptation to a context that can grow different organizations depending on what this context provides. This implies that personal expression is a concern in society’s emergent organizations, calling for meta planning to design the context of some of society’s self-organization processes. The cybernetician Gordon Pask argued that depersonalization follows from non-conversational communications, like the ones that develop in large committees. In response, Pask’s fellow cybernetician Stafford Beer proposed a meeting protocol called Team Syntegrity allowing large groups to subdivide into small integrated discussion groups. While Beer’s work has been extensively discussed in existent literature, this article presents the results of four experiments conducted by using variations of Beer’s protocol to understand both the ease with which it can be adapted to different situations, and the implications of its conversational structure on personal expression. The experiment’s realization demonstrates that the protocol’s preparation is laborious and hard to adapt in a timely manner in situations where participant numbers fluctuate. Automation of these processes, however, offers possibilities to use the approach in loosely organized groups. Automation can also help choosing the most appropriate protocol for particular situations through the manipulation of its configuration. Despite difficulties, the protocol offers promise for different purposes, encouraging personal expression in a way that reverberates with others’ personal perspectives. (shrink)

BackgroundBiobanks and biomedical research data repositories collect their samples and associated data from volunteer participants. Their aims are to facilitate biomedical research and improve health, and they are framed in terms of contributing to the public good. Biobank resources may be accessible to researchers with commercial motivations, for example, researchers in pharmaceutical companies who may utilise the data to develop new clinical therapeutics and pharmaceutical drugs. Studies exploring citizen perceptions of public/private interactions associated with large health data repositories/biobanks indicate that (...) there are sensitivities around public/private and/or non-profit/profit relationships and international sample and data sharing. Less work has explored how biobanks communicate their public/private partnerships to the public or to their potential research participants. MethodsWe explored how a biobank’s aims, benefits and risks, and private/public relationships have been framed in public facing recruitment documents.ResultsBiobank documents often communicate their commercial access arrangements but not the detail about what these interactions would entail, and how risks and benefits would be distributed to the public.ConclusionWe argue that this leads to a polarised discourse between public and private entities and/or activities, and fails to attend to the blurred lines between them. This results in a lack of attention to more important issues such as how risks and benefits in general are distributed to the public. We call for a nuanced approach that can contribute to the much-needed dialogue in this space. (shrink)

Adolescence methamphetamine use is an issue of considerable concern due to its correlation with later delinquency, divorce, unemployment and health problems. Understanding how adolescents initiate methamphetamine abuse is important in developing effective prevention programs. We formulate a mathematical model for the spread of methamphetamine abuse using nonlinear ordinary differential equations. It is assumed that susceptibles are recruited into methamphetamine use through imitation. An epidemic threshold value, Ra\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\mathcal {R}}_a$$\end{document}, termed the abuse reproduction (...) number, is proposed and defined herein in the drug-using context. The model is shown to exhibit the phenomenon of backward bifurcation. This means that methamphetamine problems may persist in the population even if Ra\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\mathcal {R}}_a$$\end{document} is less than one. Sensitivity analysis of Ra\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$${\mathcal {R}}_a$$\end{document} was performed to determine the relative importance of different parameters in methamphetamine abuse initiation. The model is then fitted to data on methamphetamine users less than 20 years old reporting methamphetamine as their primary substance of abuse in the treatment centres of Cape Town and parameter values that give the best fit are chosen. Results show that the proportion of methamphetamine users less than 20 years old reporting methamphetamine as their primary substance of abuse will continue to decrease in Cape Town of South Africa. The results suggest that intervention programs targeted at reducing adolescence methamphetamine abuse, are positively impacting methamphetamine abuse. (shrink)

The Neuzeit is that of "modern Scholasticism", a period rich in the investigation of logical questions, but relatively neglected by historians and philosophers interested in these matters. Hickman here offers a general outline and interpretation of the major tendencies of Neuzeit theories of second intentions through the examination of several characteristic examples. The opening chapter is devoted primarily to an interpretation of modern scholastic predication theory in terms of class membership and class inclusion, following which he proceeds to a discussion (...) of the sense in which "intention" was used by various authors and schools, distinguishing several basic trends, the more detailed analysis of which occupies the greater part of the book. 1) "Psychologistic Conceptualism and Nominalism", is a series of variations on a single theme, represented here chiefly by William of Ockham for the former and John Major for the latter. Hickman notes that albeit one distinguished first and second intentions, the theory did not formally recognise higher level predicates as such, since intentions were understood as psychological entities and though a second intention was thus considered the concept of a concept or sign or a sign, it nonetheless signifies a first level existent, viz., another sign, really existing in the thinker. The tendency was carried even further, Hickman says, by John Major and his disciples, who tended to neglect in practice the distinction between intentions and words. (shrink)

Background It has been suggested that researchers are obliged to offer summary findings to research participants to demonstrate respect for persons, and that this may increase public trust in, and awareness of, the research enterprise. Yet little research explores researchers' attitudes and practices regarding the range of initiatives that might serve these ends. Methods Results of an international survey of 785 eligible authors of genetics research studies in autism or cystic fibrosis are reported. Results Of 343 researchers who completed the (...) survey (44% response rate), the majority agreed that their team should (i) inform participants of summary findings (90.7%) and (ii) ensure they gain an awareness of developments in the field (86.9%). Additionally, the majority reported that in practice, their team (i) informs participants of summary findings (69.4%) and (ii) provides other types of relevant non-results information (eg, state of science in the field, opportunities for research participation) (67.9%). Conclusion Researchers endorsed the obligation of communicating with research participants by providing summary findings and other research-related information in equal measure. In light of these findings, it is suggested that while the provision of summary results may contribute to efforts to discharge the obligation of respect for persons, it may be neither a necessary nor a sufficient means to this end. (shrink)

Objectives To evaluate whether the requirement of “minimal risk and burden” for paediatric research without direct benefit to the subjects compromises the ability to obtain data necessary for improving paediatric care. To provide evidence-based reflections on the EU recommendation that allows for a higher level of risk. Design and setting Systematic analysis of the approval/rejection decisions made by the Dutch Central Committee on Research involving Human Subjects (CCMO). Review methods The analysis included 165 proposals for paediatric research without direct benefit (...) that were reviewed by the CCMO between January, 2000, and July, 2007. A separate, in-depth analysis of all drug studies included 18 early phase drug studies and nine other drug studies without direct benefit. Results 11 out of 165 studies were definitively rejected because the CCMO did not regard the risk and/or burden to be minimal. In three of these 11 cases (including two early phase drug studies) the requirement of minimal risk and burden was cited as the only reason for rejection. Four other early phase drug studies also involved risks and/or burdens that were not regarded to be minimal but were nevertheless approved. Conclusions The requirement of minimal risk and burden, aiming to protect research subjects, occasionally leads to rejection of protocols. Early phase drug studies relatively often do not comply with the requirement. Committees may find ways to approve important studies that formally should be rejected, but that is not a desirable solution. The regulatory framework should be revised to make such occasional exceptions to the requirement legitimate and transparent. (shrink)

(1941). A survey of the growth of knowledge about certain parts of the foetal cardio-vascular apparatus, and about the foetal circulation, in Man and some other mammals. Part I: Galen to Harvey. Annals of Science: Vol. 5, No. 1, pp. 57-89.

This essay deals, mainly, with the notion of representation. Representation is associated with texts and, as such, is contrasted to the true singular statement. It is argued that the relationship between the text and what the text represents can never be modeled on the relationship between a true singular statement and what the statement is true of, and, furthermore, that the former relationship is aesthetic while the latter is epistemological in nature. This aesthetic relationship between the represented and its representation (...) is investigated from the perspective of historical writing. This offers an interesting perspective because historical texts are representations, but they also aim at giving us “the truth” about the past. Historical representation, therefore, is the kind of representation coming closest to the cognitive claims traditionally investigated by epistemology. The notion of aesthetic and historical experience is explored in order to define the relationship between historical representation and what it represents. (shrink)

Many research ethics guidelines now oblige researchers to offer research participants the results of research in which they participated. This practice is intended to uphold respect for persons and ensure that participants are not treated as mere means to an end. Yet some scholars have begun to question a generalised duty to disclose research results, highlighting the potential harms arising from disclosure and questioning the ethical justification for a duty to disclose, especially with respect to individual results. In support of (...) this view, we argue that current rationales for a duty of disclosure do not form an adequate basis for an ethical imperative. We review policy guidance and scholarly commentary regarding the duty to communicate the results of biomedical, epidemiological and genetic research to research participants and show that there is wide variation in opinion regarding what should be disclosed and under what circumstance. Moreover, we argue that there is fundamental confusion about the notion of “research results,” specifically regarding three core concepts: the distinction between aggregate and individual results, amongst different types of research, and across different degrees of result veracity. Even where policy guidance and scholarly commentary have been most forceful in support of an ethical imperative to disclose research results, ambiguity regarding what is to be disclosed confounds ethical action. (shrink)

Plato presents us with two versions of the "third man" argument in the "parmenides": they occur in a tightly-knit passage of reasoning containing four arguments against the theory of forms (130e-133a). The orthodox interpretation is that both versions are attempts to show that certain basic tenets of the theory, including a one-over-many principle, form an inconsistent set. The author argues that this interpretation cannot be correct, since it renders incoherent the train of thought in the wider passage and is unable (...) to explain the occurrence of certain perceptual expressions within the first version of the "third man" argument. The author proposes an alternative reading of this version which avoids these difficulties. (shrink)

Background: Expanded newborn screening generates incidental results, notably carrier results. Yet newborn screening programmes typically restrict parental choice regarding receipt of this non-health serving genetic information. Healthcare providers play a key role in educating families or caring for screened infants and have strong beliefs about the management of incidental results. Methods: To inform policy on disclosure of infant sickle cell disorder (SCD) carrier results, a mixed-methods study of healthcare providers was conducted in Ontario, Canada, to understand attitudes regarding result management (...) using a cross-sectional survey (N = 1615) and semistructured interviews (N = 42). Results: Agreement to reasons favouring disclosure of SCD carrier results was high (65.1%–92.7%) and to reasons opposing disclosure was low (4.1%–18.1%). Genetics professionals expressed less support for arguments favouring disclosure (35.3%–78.8%), and more agreement with arguments opposing disclosure (15.7%–51.9%). A slim majority of genetics professionals (51.9%) agreed that a reason to avoid disclosure was the importance of allowing the child to decide to receive results. Qualitatively, there was a perceived “duty” to disclose, that if the clinician possessed the information, the clinician could not withhold it. Discussion: While a majority of respondents perceived a duty to disclose the incidental results of newborn screening, the policy implications of these attitudes are not obvious. In particular, policy must balance descriptive ethics (ie, what providers believe) and normative ethics (ie, what duty-based principles oblige), address dissenting opinion and consider the relevance of moral principles grounded in clinical obligations for public health initiatives. (shrink)

The main difficulty utilitarians have faced is the problem of reconciling the dictates of utility with what seem clearly to be moral duties, but based on considerations of Justice. John Stuart Mill addressed this problem in his essay,Utilitarianism,and the result has not served to silence the critics of utilitarianism on this score. In part, this is due to the fact that Mill's position in the chapter on Justice is not entirely clear, nor is it entirely convincing where it is clear. (...) Still, I do not think Mill's views on Justice have been given their due. In this essay, I shall try to show that Mill anticipated recently defended principles that rely on appeal to a notion of fairness or fair play, and that these can be given a utilitarian foundation. (shrink)

Readings from a manuscript which once belonged to Rodolphus Agricola and later to Theodore Ryck were well known to and lightly esteemed by the editors of Tacitus from the late seventeenth to mid nineteenth centuries. Ryck cited over 1,200 of them in his edition of 1687. Later the whereabouts of the manuscript remained long unknown, until it was rediscovered by C. W. Mendell as Leidensis BPL 16. B in the University Library at Leiden.

The amplitude and the diversity of Ricoeur’s philosophical production is astonishing. Three factors shed light upon this fact. First, his philosophical career covers seventy years wherein he witnessed the rise and the decline of tlve philosophical -isms. Further, he is a typical dialogical thinker: in conversation with the great classical and modern philosophers, and eager to listen to the methods and results of human an linguistics sciences. A third reason, particularly of differentiation, stems from his double conviction and commitment. On (...) the one hand, he wants to be a rigorous philosopher, even keeping on a methodic agnosticism. On the other hand, however, he is a convinced Christian, and so he also likes to think critically – a rigorous philosophizing here is inappropriate – on religion, belief, and biblical language and topics. Nevertheless, it is only since 2000 that he is getting fully aware of the disintegrated impression many readers have from his publications. In his opinion, this impression is perfectly understandable: a reading public and myself are on completely different wavelengths. From reading my books people spontaneously nurture their own expectation with regard to coming publications, whereas my concern always was: am I answering your questions? So, in four recent articles Ricoeur speaks of his technical philosophy composed of eleven books: from The voluntary and the Involontary to the Course of Recognition . He argues that the continuity of his basic philosophical writings is, each time, determined by a residue, a question the preceding publication left open. But, where to situate then his twenty-two other books into a global and consistent picture? All these other works are explorations of specific philosophical issues, and reflections and topics as prophecy, tragedy and religion bordering philosophy. For this matter, a fully rigorous philosophical discourse is not always possible. These writings, however, find their setting around the hard core of his philosophy. Ricoeur himself only mentions two genres: volumes of articles for a larger audience as History and Truth and university lectures as Lectures on Ideology and Utopia . But other headings need to be added to umbrella other publications: historical and autobiographic writings, collection of articles on political topics, on the sacred and biblical language, on philosophy of law, and on medical ethical issues. On a more remote distance from the heart of his philosophy are located hundred of articles and interviews on philosophical topics, reflections on actual themes, an even some homilies. To amazement of many, two eminent Ricoeur commentators recently characterized his philosophy as “An Ontology of Life”. This is not as strange as it looks! Already in The voluntary and the Involontary. Ricoeur offers a phenomenology of “life, to be in life and birth”. To him, life also is a lived and hard-won value. In fact, belief in life is related to his main category of “originative affirmation” and of “hope”. Hope, however, is never a knowledge but only the regulative idea of my metaphysical thinking, and it remains inextricably bound up with the anguish for a senseless totality. “Nothing is closer to the anguish of nonsense than timid hope.”. (shrink)