Informed consent for anesthesia is an ethical and legal requirement. A patient must have adequate decision-making capacity (DMC) as a prerequisite to informed consent. In determining whether a patient has sufficient DMC, anesthesiologists must draw on their knowledge of DMC. Knowledge gaps regarding DMC may result in incorrect assessments of patients’ capacity. This could translate to an informed consent process that is ethically and legally unsound. This study examined the DMC-related knowledge of anesthesiologists in a group of four university-affiliated hospitals. (...) The findings suggest that anesthesiologists have several areas of knowledge deficiency regarding DMC and DMC assessment. These findings could inform the development of undergraduate and postgraduate curricula. (shrink)

This w ork starts from a reali t y , that of the immense number of forced mi g rants/ refugees w ho, as victims of forces th e y cannot control resulting from the mass i v e economic, social and political uphe a v als, go to and fro in rapid and ceaseless m o v ement. This fl o w of millions of ind i viduals is not e f fect i v e l y r e (...) gulated b y the states. The l e gal-political inst r uments, w hich in the past confronted on l y v ague l y similar pro b lems, are tod a y complete l y inadequate. The concept of citizenship based on national identity is un a b le to sol v e the di f f iculties arising from a g r o wing demand for justice, for rights, b y a population that w ants to stop being treated as an object but that does not belong to a speci f ic identity nor desires it . Th e solution proposed is the defense of a un i v ersal conception of human rights requiring inte r national cou r ts capa b le of enforcing them. (shrink)

_BMC Medical Ethics_ is an open access journal publishing original peer-reviewed research articles in relation to the ethical aspects of biomedical research and clinical practice, including professional choices and conduct, medical technologies, healthcare systems and health policies. _BMC __Medical Ethics _is part of the _BMC_ series which publishes subject-specific journals focused on the needs of individual research communities across all areas of biology and medicine. We do not make editorial decisions on the basis of the interest of a study or (...) its likely impact. Studies must be scientifically valid; for research articles this includes a scientifically sound research question, the use of suitable methods and analysis, and following community-agreed standards relevant to the research field. Specific criteria for other article types can be found in the submission guidelines. _BMC series - open, inclusive and trusted_. (shrink)

Reviews : Gregor McLennan, Marxism and the Methodologies of History,, pp. 272. Anthony Giddens, A Contemporary Critique of Historical Materialism,, pp. 294. Raphael Samuel, ed., People's History and Socialist Theory. History Workshop Series,, pp. vi + 417. G. Osborne and W. F. Mandle, eds., New History Studying Australia Today,, pp. 216.

The coming of bioethics to Singapore / W. Calvin Ho and Sylvia S.N. Lim -- The impact of the bioethics advisory committee on the research community in Singapore / Charmaine K.M. Chan and Edison T. Liu -- Engaging the public : the role of the media / Chang Ai-Lien and Judith Tan -- Confucian trust and the biomedical regulatory framework in Singapore / Anh Tuan Nuyen -- The clinician-researcher : a servant of two masters? / Alastair V. Campbell, Jacqueline (...) Chin, and Teck Chuan Voo -- The US model for oversight of human stem cell research / Lindsay Parham and Bernard Lo -- Genetics and stem cell research : models of international policy-making / Bartha Maria Knoppers, Emily Kirby and Rosario Isasi -- Public engagement and bioethics commissions / Thomas H. Murray and Ross S. White -- Norm-making on human-animal chimeras and hybrids in Singapore, the United Kingdom and the international domain / W. Calvin Ho and Martin Bobrow -- How will future bioethical issues engage Singapore? / John Elliott. (shrink)

The use of biological samples in research raises a number of ethical issues in relation to consent, storage, export, benefit sharing and re-use of samples. Participant perspectives have been explored in North America and Europe, with only a few studies reported in Africa. The amount of research being conducted in Africa is growing exponentially with volumes of biological samples being exported from the African continent. In order to investigate the perspectives of African research participants, we conducted a study at research (...) sites in the Western Cape and Gauteng, South Africa. (shrink)

Biobanks are precariously situated at the intersection of science, genetics, genomics, society, ethics, the law and politics. This multi-disciplinarity has given rise to a new discourse in health research involving diverse stakeholders. Each stakeholder is embedded in a unique context and articulates his/her biobanking activities differently. To researchers, biobanks carry enormous transformative potential in terms of advancing scientific discovery and knowledge. However, in the context of power asymmetries in Africa and a distrust in science born out of historical exploitation, researchers (...) must balance the scientific imperative of collecting, storing and sharing high quality biological samples with obligations to donors/participants, communities, international collaborators, regulatory and ethics authorities. To date, researcher perspectives on biobanking in South Africa have not been explored and documented. In-depth qualitative interviews were conducted with a purposive sample of 21 researchers – 8 in the Western Cape, 3 in Gauteng and 10 in Kwa-Zulu Natal. Interviews lasted approximately 40–60 min and were audiotaped with consent. Thematic analysis of the transcribed interviews was conducted by the co-authors. Researchers articulated serious concerns over standardised regulatory approaches that failed to consider the heterogeneity of biobanks. Given that biobanks differ considerably, guidelines and RECs need to stratify risk accordingly and governance processes and structures must be flexible. While RECs were regarded as an important component of the governance structure researchers expressed concern about their expertise in biobanking. Operational management of biobanks was regarded as an ethical imperative and a pre-requisite to building trust during consent processes. While broad general consent was preferred, tiered consent was thought to be more consistent with respect for autonomy and building trust. Material Transfer Agreements were often lacking when biosamples were exported and this was perceived to impact negatively on trust. On the other hand, researchers believed that authentic community engagement would help to build trust. Building trust will best be achieved via a system of governance structures and processes that precede the establishment of a biobank and monitor progress from the point of sample collection through to future use, including export. Such governance structures must be robust and must include comprehensive national legislation, policy and contextualised guidelines. Currently such governance infrastructure appears to be lacking in many African countries including South Africa. Capacity development of all stakeholders including REC members will enhance expeditious and efficient review of biobanking protocols which in turn will reinforce trust in the researcher-donor relationship. Science translation and community engagement in biobanking is integral to the success of biobanking in South Africa. (shrink)

BackgroundThe COVID-19 pandemic presents significant challenges to research ethics committees (RECs) in balancing urgency of review of COVID-19 research with careful consideration of risks and benefits. In the African context, RECs are further challenged by historical mistrust of research and potential impacts on COVID-19 related research participation, as well as the need to facilitate equitable access to effective treatments or vaccines for COVID-19. In South Africa, an absent National Health Research Ethics Council (NHREC) also left RECs without national guidance for (...) a significant duration of the COVID-19 pandemic. We conducted a qualitative descriptive study that explored the perspectives and experiences of RECs regarding the ethical challenges of COVID-19 research in South Africa.MethodsWe conducted in-depth interviews with 21 REC chairpersons or members from seven RECs at large academic health institutions across South Africa that were actively involved in the review of COVID-19 related research from January to April 2021. In-depth interviews were conducted remotely via Zoom. Interviews (60–125 min) were conducted in English using an in-depth interview guide, until data saturation was achieved. Audio-recordings were transcribed verbatim and field notes were converted into data documents. Line-by-line coding of transcripts was performed, and data were organised into themes and sub-themes. An inductive approach to thematic analysis was used to analyse data.ResultsFive main themes were identified, namely: rapidly evolving research ethics landscape, extreme vulnerability of research participants, unique challenges to informed consent, challenges to community engagement during COVID-19, and overlapping research ethics and public health equity issues. Sub-themes were identified for each main theme.ConclusionsNumerous, significant ethical complexities and challenges were identified by South African REC members in the review of COVID-19 related research. While RECs are resilient and adaptable, reviewer and REC member fatigue were major concerns. The numerous ethical issues identified also highlight the need for research ethics teaching and training, especially in informed consent, as well as the urgent requirement for the development of national guidelines for research ethics during public health emergencies. Further, comparative analysis between different countries is needed to develop the discourse around African RECs and COVID-19 research ethics issues. (shrink)

The Covid‐19 pandemic has sparked rapid and voluminous production of bioethics commentary in popular media and academic publications. Many of the discussions are new twists on an old theme: how to fairly allocate scarce medical resources, such as ventilators and intensive care unit beds. In this essay, we do not add another allocation scheme to the growing pile, partly out of appreciation that such schemes should be products of inclusive and transparent community engagement and partly out of recognition of their (...) limited utility for physicians working in the field. Instead, we make the more modest claim that context matters when making such decisions and, more specifically, that recommendations from high‐income countries about fair allocation during Covid‐19 should not be cut and pasted into low‐income settings. We offer a few examples of why seemingly universal, well‐intentioned ethical recommendations could have adverse consequences if unreflectively applied in sub‐Saharan Africa. (shrink)

Background and objectives: There are few insights from sub-Saharan Africa on research participants’ experiences of the informed consent process, particularly in the context of randomised controlled trials, where issues of randomisation and the use of placebos may be confusing concepts for participants. This study investigated the knowledge and perceptions of the informed consent process among individuals participating in influenza vaccine trials in two disadvantaged communities in South Africa.Method: Four to 12 months after completion of the trials, participants were contacted to (...) return to participate in the informed consent study. The semistructured questionnaire administered to assess recall of trial procedures and the informed consent process covered key issues including: purpose of the study; awareness that the study was not part of routine treatment; voluntary nature of participation and freedom to withdraw; randomisation; placebos; and remuneration.Results: A total of 334 participants completed the questionnaire. Only 21% were able to recall that they were allocated randomly to the different treatment arms. Only 19% of those involved in the placebo controlled study had interpreted the concept of placebo as an inactive medication.Conclusion: Although a good general recall of trial concepts was demonstrated, only a small proportion of the participants correctly interpreted and recalled the concepts of randomisation and placebos. Informed consent in this and similarly disadvantaged communities may often be inadequate and new ways to improve understanding of the research process should be explored. (shrink)

BackgroundBiobanking provides exciting opportunities for research on stored biospecimens. However, these opportunities to advance medical science are fraught with challenges including ethical and legal dilemmas. This study was undertaken to establish perspectives of South African stakeholders on the ethico-legal dimensions of biobanking.MethodsAn in-depth exploratory study was conducted with 25 purposively selected biobankers, clinicians, researchers, postgraduate students in biobanking research, and research ethics committee (REC) members in South Africa. Potential study participants were recruited through known hubs for biobanking in the country, (...) online searches and the snowball sampling technique. A semi-structured face-to-face or Skype interview was arranged. Data was analysed using thematic analysis.ResultsThe emergent themes included: inconsistency in understanding consent models, disconnect between biobank researchers and biosample donors, inadequate processes to support re-consenting minors, inconsistent governance processes for biobanking research; challenges with sample and data sharing, and suboptimal strategies for benefit sharing and return of results. Biobanking practice in general appeared to be inconsistent and fragmented. While the need for consent in research is explicitly outlined in legislative documents, some respondents were unclear on the type of consent model to apply in biosample collection. They also reported inconsistencies in research participants’ understanding of consent. Furthermore, these respondents’ own understanding of consent and consent models were dependent on where they were positioned in biobanking practice (roles occupied). Respondents were unsure about the process to follow to re-consent child participants once the age of majority (≥ 18 years) was reached. It was not surprising that consent was identified as one of the major ethical challenges in biobanking practice. In certain settings, some respondents reported suboptimal governance processes for sample collection. Participants were generally unsure about how to operationalise benefit sharing and how to approach the idea of returning results to research participants and biobank donors.ConclusionThe study findings indicated inconsistencies in stakeholder understanding of ethico-legal considerations related to biobanking in South Africa. A need for ongoing ethics capacity development among stakeholders was identified. Improving understanding of the ethics of biobanking could be facilitated by acknowledging the disconnect created by biosamples in the relationship between biobank researchers and donors. (shrink)

Background Clinical Ethics Committees are well established at healthcare institutions in resource-rich countries. However, there is limited information on established CECs in resource poor countries, especially in Africa. This study aimed to establish baseline data regarding existing formal CECs in Africa to raise awareness of and to encourage the establishment of CECs or Clinical Ethics Consultation Services on the continent. Methods A descriptive study was undertaken using an online questionnaire via SunSurveys to survey healthcare professionals and bioethicists in Africa. Data (...) were subjected to descriptive analysis and Fischer's exact test was applied to determine associations. Texts from the open-ended questions were thematically analysed. Results In total 109 participants from 37 African countries completed the survey in December 2019. A significant association was found between participants’ bioethics qualification or training and involvement in clinical ethics. All participants were familiar with Research Ethics Committees, and initially conflated RECs with CECs. When CECs were explained in detail, approximately 85.3% reported that they had no formal CECs in their institutions. The constraints to developing CECs included lack of training, limited resources, and lack of awareness of CECs. However, the majority of participants were interested in establishing CECs. Participants listed assistance required in establishing CECs including funding, resources, capacity building and collaboration with other known CECs. The results do not reflect CECs established since the onset of COVID-19 in Africa. Conclusions This study provides a first look into CECs in Africa and found very few formal CECs on the continent indicating an urgent need for the establishment of CECs or CESs in Africa. While the majority of healthcare professionals and bioethicists are aware of ethical dilemmas in healthcare, the concept of formal CECs is foreign. This study served to raise awareness of CECs. Research ethics and RECs overshadow CECs in Africa because international funders from the global north support capacity development in research ethics and establish RECs to approve the research they fund in Africa. Raising awareness via educational opportunities, research and conferences about CECs and their role in improving the quality of health care in Africa is sorely needed. (shrink)

Concerns have been raised around the alleged commercialisation of South African genetic material by various research institutes nationally and abroad. We consider whether the Protection of Personal Information Act in South Africa will conflict with or complement existing protections in health law and research ethics. The Act is not applicable to de‐identified samples that cannot be re‐identified but we question whether genetic samples can ever be truly de‐identified. The research participants in this matter provided consent for use of their samples (...) for research but did not consent to commercialisation by global research institutions, and neither did the researchers. We suggest that consent models incorporating broad consent as an option should include explicit discussions around benefit sharing and commercialisation. Mistrust between researchers and participants impedes scientific research and can harm relationships built up over the years between South African researchers and local communities. (shrink)

Background HIV prevention research has been fraught with ethical concerns since its inception. These concerns were highlighted during HIV vaccine research and have been elaborated in microbicide research. A host of unique ethical concerns pervade the microbicide research process from trial design to post-trial microbicide availability. Given the urgency of research and development in the face of the devastating HIV pandemic, these ethical concerns represent an enormous challenge for investigators, sponsors and Research Ethics Committees (RECs) both locally and internationally. Discussion (...) Ethical concerns relating to safety in microbicide research are a major international concern. However, in the urgency to develop a medically efficacious microbicide, some of these concerns may not have been anticipated. In the risk-benefit assessment of research protocols, both medical and psycho-social risk must be considered. In this paper four main areas that have a potential for medical and/or psycho-social harm are examined. Male partner involvement is controversial in the setting of covert use of microbicides. However, given the long-term exposure of men to experimental products, this may be methodologically, ethically and legally important. Covert use of microbicides may impact negatively on relationship dynamics leading to psychosocial harm to varying extents. The unexpectedly high rates of pregnancy during clinical trials raise important methodological and ethical concerns. Enrollment of adolescents without parental consent generates ethical and legal concerns that must be carefully considered by RECs and trial sites. Finally, paradoxical outcomes in recent trials internationally have advanced the debate on the nature of informed consent and responsibility of researchers to participants who become HIV positive during or after trials. Summary Phase 3 microbicide trials are an undisputed research and ethical priority in developing countries. However, such trials must be conducted with attention to both methodological and ethical detail. It is imperative that guidelines are formulated to ensure that high ethical standards are maintained despite the scientific urgency of microbicide development. Given the controversy raised by emergent ethical issues during the course of microbicide development, it is important that international consensus is reached amongst the various ethics and regulatory agencies in developing and developed countries alike. (shrink)

BackgroundThe ethical concerns associated with HIV prevention and treatment research have been widely explored in South Africa over the past 3 decades. However, HIV cure research is relatively new to the region and significant ethical and social challenges are anticipated. There has been no published empirical enquiry in Africa into key informant perspectives on HIV cure research. Consequently, this study was conducted to gain preliminary data from South African HIV clinicians, researchers and activists.MethodsIn-depth interviews were conducted on a purposive sample (...) of fourteen key informants in South Africa. Audiotaped interviews were transcribed verbatim with concurrent thematic analysis. The perspectives of HIV clinicians, researchers and activists were captured. Analyst triangulation occurred as the data were analysed by three authors independently.ResultsThe rapid evolution of HIV cure research agendas was prominent with participants expressing some concern that the global North was driving the cure agenda. Participants described a symbiotic relationship between cure, treatment and prevention research necessitating collaboration. Assessing and managing knowledge and expectations around HIV cure research emerged as a central theme related to challenges to constructing ‘cure’ - how patients understand the idea of cure is important in explaining the complexity of cure research especially in the South African context where understanding of science is often challenging. Managing expectations and avoiding curative misconception will have implications for consent processes. Unique strategies in cure research could include treatment interruption, which has the potential to create therapeutic and ethical conflict and will be perceived as a significant risk. Ethical challenges in cure research will impact on informed consent and community engagement.ConclusionsIt was encouraging to note the desire for synergy amongst researchers and clinicians working in the fields of prevention, treatment and cure. Translation of complex HIV cure science into lay language is critical. Moving forward, RECs must be adequately constituted with scientific expertise and community representation when reviewing cure protocols. It is hoped that knowledge and resource sharing in the context of collaboration between research scientists working in cure and those working in treatment and prevention will accelerate progress towards cure. (shrink)

The COVID‐19 pandemic has raised important universal public health challenges. Conceiving ethical responses to these challenges is a public health imperative but must take context into account. This is particularly important in sub‐Saharan Africa (SSA). In this paper, we examine how some of the ethical recommendations offered so far in high‐income countries might appear from a SSA perspective. We also reflect on some of the key ethical challenges raised by the COVID‐19 pandemic in low‐income countries suffering from chronic shortages in (...) health care resources, and chronic high morbidity and mortality from non‐COVID‐19 causes. A parallel is drawn between the distribution of severity of COVID‐19 disease and the classic “Fortune at the bottom of the pyramid” model that is relevant in SSA. Focusing allocation of resources during COVID‐19 on the ‘thick’ part of the pyramid in Low‐to‐Middle Income Countries (LMICs) could be ethically justified on utilitarian and social justice grounds, since it prioritizes a large number of persons who have been economically and socially marginalized. During the pandemic, importing allocation frameworks focused on the apex of the pyramid from the global north may therefore not always be appropriate. In a post‐COVID‐19 world, we need to think strategically about how health care systems can be financed and structured to ensure broad access to adequate health care for all who need it. The root problems underlying health inequity, exposed by COVID‐19, must be addressed, not just to prepare for the next pandemic, but to care for people in resource poor settings in non‐pandemic times. (shrink)

Trial participation in the proposed HIV Vaccine Trials in South Africa is discussed in the context of the ethical tension that exists between international ethical research standards and local standards of care and cultural norms in the Third World. The important concepts of informed consent, risk-benefit ratio and fair treatment of trial participants are interpreted differently in traditional, rural African communities, where a moderate form of communitarianism referred to as "Ubuntu" or "communalism" is still prevalent. Research is an altruistic endeavor (...) that benefits communities and societies as a result of risks taken by individuals. Universal ethical guidelines that are highly individualistic and fail to emphasize communalism may represent serious problems for the sort of research needed in Africa today. (shrink)

Consent processes for clinical trials involving HIV prevention research have generated considerable debate globally over the past three decades. HIV cure/eradication research is scientifically more complex and consequently, consent processes for clinical trials in this field are likely to pose a significant challenge. Given that research efforts are now moving toward HIV eradication, stakeholder engagement to inform appropriate ethics oversight of such research is timely. This study sought to establish the perspectives of a wide range of stakeholders in HIV treatment (...) and research to inform consent processes for cure research. In total, 68 South African stakeholders participated in two qualitative research modalities. In-depth interviews were conducted with a purposive sample of 42 individuals - audiotaped with consent. Twenty-six stakeholders participated in three focus group discussions. Thematic analysis of transcribed IDIs and FGDs was conducted. The majority of respondents indicated that there could be unique challenges in HIV cure research requiring special attention. In particular, given the complexity of cure science, translation of concepts into lay language would be critical for potential participants to adequately appreciate risks and benefits in early phase research with experimental interventions. Furthermore, to aid understanding of risks and benefits against a background of desperation for a cure, specially trained facilitators would be required to assist with a psychological assessment prior to consent to avoid curative misconceptions. Long-term participant engagement to assess durability of a cure would mean that the consent process would be prolonged, necessitating annual re-consent. Building trust to maintain such long-term relationships would be critical to retain study participants. Unique consent requirements for cure research in South Africa would include significant efforts to maximise understanding of trial procedures, risks and the need for long-term follow-up. However, the psychological dimension of cure must not be underestimated. Beyond an understanding of cure science, the emotional impact of HIV cure advances the discourse from cure to healing. Consequently, the consent process for cure research would need to be enhanced to include psychological support and counselling. This has several important implications for research ethics review requirements for consent in HIV cure research. (shrink)

Traditional male circumcision is a deeply entrenched cultural practice in South Africa. In recent times, there have been increasing numbers of botched circumcisions by untrained and unscrupulous practitioners, leading to genital mutilation and often, the need for penile amputation. Hailed as a world’s first, a team of surgeons conducted the first successful penile transplant in Cape Town, South Africa in 2015. Despite the euphoria of this surgical victory, concerns about the use of this costly intervention in a context of severe (...) resource constraints have been raised. In this paper, we explore some of the ethical implications of penile transplants as a clinical and public health response to the adverse consequences of traditional male circumcision. Given the current fiscal deficits in healthcare and public health sectors, how can one justify costly, high-technology interventions for conditions affecting a small section of the population? Since botched traditional male circumcisions are preventable, is a focus on penile transplantation as a form of treatment reasonable? Finally, do such interventions create undue expectations and false hope among a highly vulnerable and stigmatised group of young men? In this paper, we argue that given limited healthcare resources in South Africa and competing healthcare needs, prevention is a more appropriate response to botched traditional circumcisions than penile transplants. (shrink)

Doing philosophy for/with children and exposing students to multiple perspectives, exemplified within the Austrian Centre of Philosophy with Children’s implementation project of the Philosophical Enquiry Advancing Cosmopolitan Engagement (PEACE) curriculum in schooling, may offer a valuable written, taught, and tested curriculum for democratic citizenry. This paper provides an analysis that seeks to present, describe, critique, and make recommendations on the PEACE curriculum. The paper asks the question: In what ways does the Philosophical Enquiry Advancing Cosmopolitan Engagement as a 21st century (...) curriculum address education for democratic citizenry? In this evaluation the ways in which issues of culture and identity, human rights and democracy are perceived and addressed, along with issues of critical thinking and reasoning in verbal and non-verbal language are attended. Concepts of collaboration, cooperation, teacher support and development are also critiqued. This critique is based on a ten-day Austrian Center of Philosophy with Children conference and training course on the PEACE curriculum, and consists of open-ended interviews, personal observations, and published reports on pre- and post-test results of the PEACE curriculum. Exploring the integration of the Austrian Center of Philosophy with Children PEACE curriculum and the Philosophy for/with Children methodology, this paper utilizes Hansen’s (1995) five principles for guiding curriculum development practice as a framework for analysis. It is hoped that findings and recommendations from this study may stir further exploration and contribute to the work of Philosophy for/with Children in democratic education for 21st century citizenry worldwide. (shrink)

Higher education institutions play a pivotal role in knowledge creation and distribution. Teacher education is at the forefront of this engagement. The role of teacher educators is significant in engaging teacher knowledge for shaping and informing ways of being and doing in the world. In recent years higher education has undergone considerable transformation. In South Africa there is a call for real-world transformation in pedagogical practices to address academic, socio-economic, and cultural inclusion and emancipation. As a human right for enabling (...) student voices, a key issue for engaging relevant and fair pedagogical practices is critical thinking. Critical thinking is a rich concept and an attribute of consciousness required in all human activity. It is exercised through sound reasoning and dialogue. Critical thinking is also associated with understanding and engaging deep issues of socio–cultural and political domains of power and justice. However, engaging and enabling critical thinking pedagogy in education is complex and contradictory in nature. Conceptualizing critical thinking is expedient as an initial stage. The objective of this article, part of a larger study, is to provide a conceptualisation of critical thinking pedagogy toward addressing: In what ways is critical thinking pedagogy engaged in South African teacher education? Here, this article aims to address the question: what is critical thinking and critical thinking pedagogy? Methodologically, an interdisciplinary psycho–social philosophic educational documentary design is employed based on a selection of key critical thinking proponents. It further presents a conceptualisation of critical thinking pedagogy underpinned in critical theory especially those of Freire and Foucault. This article aims to spotlight the need for engaging critical thinking through a conceptualisation of critical thinking pedagogy in teacher education required for addressing new ways of teaching today. (shrink)

One of the currently popular dogmata of anti-consequentialism is that consequentialism doesn't respect, recognize, or in some important way account for what is referred to as the The charge is often made, but rarely explained in any detail, much less argued for. In this paper I explain what I take to be the most plausible interpretation of the separateness of persons charge. I argue that the charge itself can be deconstructed into at least two further objections to consequentialist theories. These (...) objections amount to (i) the rejection of axiological aggregation, and (ii) the rejection of deontic aggregation. Of these two objections, I argue that the first one, though often made, is untenable. I also argue that the second objection, in its various forms, relies on distinctions whose moral significance is vigorously denied by almost all consequentialist theorists. I thus argue that the separateness of persons objection poses no special threat to consequentialism. (shrink)

The apartheid ideology in South Africa had a pervasive influence on all levels of education including medical undergraduate training. The role of the health sector in human rights abuses during the apartheid era was highlighted in 1997 during the Truth and Reconciliation Commission hearings. The Health Professions Council of South Africa subsequently realised the importance of medical ethics education and encouraged the introduction of such teaching in all medical schools in the country. Curricular reform at the University of Stellenbosch in (...) 1999 presented an unparalleled opportunity to formally introduce ethics teaching to undergraduate students. This paper outlines the introduction of a medical ethics programme at the Faculty of Health Sciences from 2003 to 2006, with special emphasis on the challenges encountered. It remains one of the most comprehensive undergraduate medical ethics programmes in South Africa. However, there is scope for expanding the curricular time allocated to medical ethics. Integrating the curriculum both horizontally and vertically is imperative. Implementing a core curriculum for all medical schools in South Africa would significantly enhance the goals of medical education in the country. (shrink)

On Humour and the Comic in the Hebrew Bible. Edited by Y. T. Radday and A. Brenner.The Trouble With Kings: The Composition of rhe Book of Kings in the Deuteronomistic History. By Steven L. McKenzie.Sacred Space: An Approach to the Zheology of the Epistle to the Hebrews. By Marie E. Isaacs.Fourth Ezra: A Commentary on the Book of Fourth Ezra. By Michael Edward StonePaul the Convert: iShe Apostolate and Apostasy of Saul the Pharisee. By Alan F. Segal.Creative Biblical Exegesis: Christian (...) and Jewish Hermeneutics through the Centuries. Edited by Benjamin Uffenheimer and Henning Graf Reventlow.The Hope of the Early Church: A Handbook of Patristic Escharology. By Brian E. Daley.The Emergence of the Laity in the Early Church. By Alexandre Faivre, translated by David Smith.Pastoral Life and Practice in the Early Church. By Carl A. Volz.The Making of the Creeds. By Frances Young.La correzione fratenia in s. Agosrino. By Agostino Clerici.Beaup and Revelation in the Thought of St Augustine. By Carol Harrison.Grace, Politics and Desire. Edited by Hugo Meynell.Boerhius and Aquinas. By Ralph McInerny.The Weight of Glory. A Vision and Practice for Christian Faith: The Future of Liberal Theology. Edited by D. W. Hardy and P. H. Sedgwick.Atonenrent and Incarnation. By Vernon White.Tragic Method and Tragic Theology: Evil in Contemporary Drama and Religious Thought. By L. D. Bouchard.Parmenides of Elea, Fragments: A Text and Translation, with an Introduction. By David Gallop.Language, Thought and Falsehood in Ancient Greek Philosophy. By Nicholas Denyer.Weakness of the Will. By Justin Gosling.Knowledge and the Sciences in Medieval Philosophy. Vol. I, edited by Monica Asztalos, John E. Murdoch and Ilkka Niiniluoto.Episcopal Power and Norenrine Sociev. 1000–1320. By George W. Dameron.Matins, Lauds and Vespers for St David's Day. By Owain Tudor Edwards.More's ‘Utopia’. By Dominic Baker‐Smith.Frontiers of Heresy: The Spanish Inquisitionfrom the Basque Lands to Sicily. By William Monter.Inquisition and Society in the Kingdom of Valencia, 1478–1834, By Stephen Haliczer.The Fear of Hell: Images of Damnation and Salvation in Early Modern Europe. By Piero Camporesi, translated by Lucinda Byatt.Lucrecia's Dreams: Politics and Prophecy in Sixteenth‐Centun Spain. By Richard L. Kagan.Heresy and Mysticism in Sixteenth‐Century Spain: The Alumbrados. By Alastair Hamilton.Japan's Encounter with Christianiry: The Catholic Mission in Pre‐Modern Japan. By Neil S. Fujita.Galileo, Bellannine and the Bible. By Richard J.Augustine Baker's Inner Light: A Study in English Recusant Spirituality. By James Gaffney.The Prorestarit Evaqelical Awakening. By W. R. Ward.The Study of Anglicanism. Edited by Stephen Sykes and John Booty.The Anglican Tradition: A Handbook of Sources. Edited by G. R. Evans and J. Robert Wright.The Restoration Church of England, 1646‐1689. By John Spurr.Awash in a Sea of Faith: Christianizing the American People. By Jon Butler.A Woman Styled Bold: The Life of Cornelia Connelly, 1809–1879. By Radegunde Flaxman.Cane Ridge: America's Pentecost. By Paul K. Conkin.Revivalism and Social Change: Christianio, Nation Building and the Market in the Nineteenth‐Century United States. By George M. Thomas.Church and State: The English Experience. By Adrian Hastings.Evelyn Underhill: Artist of the Infinite Life. By Dana Greene.Northern Ireland: Fairh and Faction. By Maurice Irvine.The Tragedy of Belief: Division, Politics, arid Religion in Ireland. By John Fulton.Shattered Vows: Exodus from the Priesthood. By David Rice.Making Saints: Inside the Vatican: Who Become Saints, Who Do Not, and Why. By Kenneth L. Woodward.Ecclesiae Memoria: Miscellanea in onorr del R. P. Josef Metzler, O. M. I. Edited by Willi Henkel. (shrink)

This article explores the concept of the “scholar as activist” in the context of postcolonial feminist film practice, and the successes and shortcomings of a research design conceptualised to explore the potential that self-reflexive filmmaking offers to articulate the narratives of South African Hindu women (and other suppressed groups). My point of departure was a strong sense of the misrecognition of my own identity as a South African Hindu woman of Indian descent, in stereotypical representations of Hindu women in mainstream (...) film. South African Hindu women, and suppressed groups by extension, have stories that need to be told. The question emerged of how such stories could be told through the medium of film. Could the interface between the medium of self-reflexive film, the academic filmmaker and the narratives of South African Hindu women translate into meaningful social action that would offer a platform for resistance to mainstream (mis)representations? A critical reflection on my initial filmmaking process, and an analysis of the film text itself, illustrated that as an academic with various platforms of expression at my disposal, I had assumed a superficial similarity to and yet privileged position over those whose story I attempted to tell. How then could women use self-reflexive filmmaking to tell their own stories that resist limited mainstream gendered representations and reclaim their own identities? In a play between an academic register and an overtly self-reflexive narrative style, I thus explicate the organic process of developing a revised methodological approach for the postcolonial “scholar as activist”. (shrink)

Healthcare Ethics, Law and Professionalism: Essays on the Works of Alastair V Campbell features 15 original essays on bioethics, and healthcare ethics specifically. The volume is in honour of Professor Alastair V Campbell, who was the founding editor of the internationally-renowned Journal of Medical Ethics, and the founding director of three internationally leading centres in bioethics, in Otago, New Zealand, Bristol, UK, and Singapore. Campbell was trained in theology and philosophy and throughout his career worked with colleagues from (...) various disciplines, including law and various branches of healthcare. The diversity of topics and depth of contributors' insights reflect the breadth and impact of Campbell's philosophical work and policy contributions to healthcare ethics. Throughout his long academic career, Campbell's emphasis on healthcare ethics being practice-oriented, yet driven by critical reflection, has shaped the field in vital ways. The chapters are authored by leading scholars in healthcare ethics and law. Directly engaging with Campbell's work and influence, the essays discuss essential questions in healthcare ethics relating to its methodology and teaching, its intersection with law and policy, medical professionalism, religion, and its translation in different cultural settings. Chapters also grapple with specific enduring topics, such as the doctor-patient relationship, justice in health and biomedical research, and treatment of the human body and the dead. (shrink)

Biological sample and data transfer within and out of Africa is steeped in controversy With the H3Africa project now aiming to establish biobanks in Africa, it is essential that there are ethical and legal governance structures in place to oversee the operation of these biobanks. Such governance is essential to ensuring that donors are protected, that cultural perspectives are respected and that researchers have a ready availability of ethically sourced biological samples.

There is a systematic and suggestive analogy between grounding and causation. In my view, this analogy is no coincidence. Grounding and causation are alike because grounding is a type of causation: metaphysical causation. In this paper I defend the identification of grounding with metaphysical causation, drawing on the causation literature to explore systematic connections between grounding and metaphysical dependence counterfactuals, and I outline a non-reductive counterfactual theory of grounding along interventionist lines.

Book Review by Prevan Moodley: Reflective Lifeworld Research Dahlberg, K., Dahlberg, H., & Nyström, M. (2008). Reflective Lifeworld Research (2nd ed.). Lund, Sweden: Studentlitteratur. Soft Cover (370 pages) ISBN: 978-91-44-04925-0.

Background Despite the growth of biomedical research in South Africa, there are few insights into the operation of Research Ethics Committees (RECs) in this setting. We investigated the composition, operations and training needs of health RECs in South Africa against the backdrop of national and international guidelines. Methods The 12 major health RECs in South Africa were surveyed using semi-structured questionnaires that investigated the composition and functions of each REC as well as the operational issues facing committees. Results Health RECs (...) in SA have an average of 16 members and REC members are predominantly male and white. Overall, there was a large discrepancy in findings between under-resourced RECs and well resourced RECs. The majority of members (56%) are scientists or clinicians who are typically affiliated to the same institution as the health REC. Community representatives account for only 8% of membership. Training needs for health REC members varied widely. Conclusion Most major health RECs in South Africa are well organized given the resource constraints that exist in relation to research ethics in developing countries. However, the gender, racial and occupational diversity of most of these RECs is suboptimal, and most RECs are not constituted in accordance with South African guidelines. Variability in the operations and training needs of RECs is a reflection of apartheid-entrenched influences in tertiary education in SA. While legislation now exists to enforce standardization of research ethics review systems, no provision has been made for resources or capacity development, especially to support historically-disadvantaged institutions. Perpetuation of this legacy of apartheid represents a violation of the principles of justice and equity. (shrink)

BackgroundThe use of a Community Advisory Board is one method of ensuring community engagement in community based research. To identify the process used to constitute CABs in Zambia, this paper draws on the perspectives of both research team members and CAB members from research groups who used CABs in Lusaka. Enabling and restricting factors impacting on the functioning of the CAB were identified.MethodsAll studies approved by the University of Zambia Bioethics Research Committee from 2008 – 2012 were reviewed to identify (...) those studies that were likely to include a CAB. Eight teams with studies that included a CAB were identified. For each of these studies, consent was obtained to conduct an informal interview with a research team member and to obtain contact details for one CAB member. In total 14 interviews were conducted with 8 research team members and 6 CAB members from 12–30 August 2013.ResultsIdentification of potential CAB members from the community and their participation in developing the terms of reference for CABs was perceived to have contributed to the success of the CAB. Due to the trust that the community had in members of their community the CABs were then in a stronger position to influence community participation in the research. Training of CAB members was identified as a factor that enhanced the functioning of a CAB. Lack of commitment and low literacy levels of CAB members posed a threat to the role of the CAB. Although compensation in the form of a stipend was not provided, CAB members were provided with transport reimbursements for attending meetings.ConclusionsSelection of CAB members from within the community contributed to community confidence in the CAB, enhancing its ability to act as an effective link between study team and community. This contributed positively to the conduct of the study and enhanced community awareness and acceptance of the research. However, establishment of study specific CABs has the potential to compromise CAB independence due to support provided by the research team in the form of transport reimbursements and other forms of support. Consideration should be given to establishing community wide Community Advisory Boards that could function across a range of studies to increase independent objective decision-making. (shrink)

This book defends a radical new theory of contingency as a physical phenomenon. Drawing on the many-worlds approach to quantum theory and cutting-edge metaphysics and philosophy of science, it argues that quantum theories are best understood as telling us about the space of genuine possibilities, rather than as telling us solely about actuality. When quantum physics is taken seriously in the way first proposed by Hugh Everett III, it provides the resources for a new systematic metaphysical framework encompassing possibility, necessity, (...) actuality, chance, counterfactuals, and a host of related modal notions. -/- Rationalist metaphysicians argue that the metaphysics of modality is strictly prior to any scientific investigation; metaphysics establishes which worlds are possible, and physics merely checks which of these worlds is actual. Naturalistic metaphysicians respond that science may discover new possibilities and new impossibilities. This book's quantum theory of contingency takes naturalistic metaphysics one step further, allowing that science may discover what it is to be possible. As electromagnetism revealed the nature of light, as acoustics revealed the nature of sound, as statistical mechanics revealed the nature of heat, so quantum physics reveals the nature of contingency. (shrink)

Alastair Norcross argues that the basic judgments of morality are essentially comparative: alternatives are judged to be better or worse than each other. Notions such as right and wrong are not part of the fundamental subject matter of moral theory, but are constructed in a context-relative fashion out of the basic comparative judgments.

Compensation for research related injuries is a subject that is increasingly gaining traction in developing countries which are burgeoning destinations of multi center research. However, the existence of disparate compensation rules violates the ethical principle of fairness. The current paper presents a comparison of the policies of Brazil, Russia, India, China and South Africa. A systematic search of good clinical practice guidelines was conducted employing search strategies modeled in line with the recommendations of ADPTE Collaboration. The search focused on three (...) main areas namely bibliographic data bases, clinical practice guidelines data bases and a restricted internet search. A manual search of references cited in relevant guideline documents was also conducted. The search terms, Medical Subject Headings and key words were developed for a PubMed platform and then adapted for all other data bases. The search terms were kept constant for each country with the only difference being the country name. The documents so obtained were subjected to systematic content analysis. The study revealed that there is vast panoply of regulations which exist on a continuum. On one extreme is India with comprehensive regulations that are codified into law, and on the other end there is China which does not have specific laws regulating research related injuries. There are a number of differences and similarities such as mandatory insurance requirements, existence of no fault compensation, compensable injuries and the role of research ethics committees. It is imperative to enact legislations that protect participants without stifling the research enterprise. There is need for consistency and ideally harmonization of such regulations at a global level. A model policy on compensation for research related injuries should borrow from the best aspects of the different country policies and should be informed by the cardinal ethics principles of autonomy, justice and beneficence. (shrink)

Back in 2017, Moodley and Rennie published a paper in the Journal of Medical Ethics entitled ‘Penile transplantation as an appropriate response to botched traditional circumcisions in South Africa: an argument against.’1 As the title suggests, we took a critical view towards penile transplantation as a way of responding to the problem of young men in South Africa experiencing genital mutilation and amputation as a result of traditional circumcision practices. Our main conclusion was that prevention is key: social, cultural (...) and political strategies to prevent mutilations and amputations should be prioritised, rather than surgical solutions, particularly in low-resource communities. Van der Merwe, who led the surgical team for the first successful penile transplantation in Stellenbosch, South Africa, has responded to our views, and in what follows, we will distill and evaluate his main arguments. Cost and access to services : Van der Merwe states that our position is mostly based on costs, that is, that penile transplantation is expensive and it is unrealistic to think that young men in traditional communities will be able to avail themselves of such services. Against this, Van Der Merwe argues that the actual cost of penile transplantation can be favourably compared with another, more established medical intervention, that is, renal transplantation. Of course, cost comparisons are difficult with a new intervention when it is …. (shrink)

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

This paper outlines a non-reductive counterfactual account of grounding along interventionist lines, and uses the account to argue that taking grounding seriously requires ascribing non-trivial truth-conditions to a range of counterpossible counterfactuals. This result allows for a diagnosis of a route to scepticism about grounding, as deriving at least in part from scepticism about non-trivial counterpossible truth and falsity.

This article explores three ways in which physics may involve counterpossible reasoning. The first way arises when evaluating false theories: to say what the world would be like if the theory were true, we need to evaluate counterfactuals with physically impossible antecedents. The second way relates to the role of counterfactuals in characterizing causal structure: to say what causes what in physics, we need to make reference to physically impossible scenarios. The third way is novel: to model metaphysical dependence in (...) physics, we need to consider counterfactual consequences of metaphysical impossibilities. Physics accordingly bears substantial and surprising counterpossible commitments. (shrink)