This study describes the results of a retrospective review of patients' charts who had an advanced directive (AD) and who were hospitalized in a tertiary, acute care teaching hospital. The purpose of the review was to understand from clinical, sociological, ethical and legal perspectives the nature and utility of ADs. Findings and implications of the review are discussed in terms of: patient demographics; diagnoses; quality of ADs; influence of ADs on clinical decisions; and legal aspects of ADs.

BackgroundInnovations in technology have contributed to rapid changes in the way that modern biomedical research is carried out. Researchers are increasingly required to endorse adaptive and flexible approaches to accommodate these innovations and comply with ethical, legal and regulatory requirements. This paper explores how Dynamic Consent may provide solutions to address challenges encountered when researchers invite individuals to participate in research and follow them up over time in a continuously changing environment.MethodsAn interdisciplinary workshop jointly organised by the University of Oxford (...) and the COST Action CHIP ME gathered clinicians, researchers, ethicists, lawyers, research participants and patient representatives to discuss experiences of using Dynamic Consent, and how such use may facilitate the conduct of specific research tasks. The data collected during the workshop were analysed using a content analysis approach.ResultsDynamic Consent can provide practical, sustainable and future-proof solutions to challenges related to participant recruitment, the attainment of informed consent, participant retention and consent management, and may bring economic efficiencies.ConclusionsDynamic Consent offers opportunities for ongoing communication between researchers and research participants that can positively impact research. Dynamic Consent supports inter-sector, cross-border approaches and large scale data-sharing. Whilst it is relatively easy to set up and maintain, its implementation will require that researchers re-consider their relationship with research participants and adopt new procedures. (shrink)

Background Research in children is essential for them to benefit from the outcomes of research but involvement must be weighed against potential harms. In many countries and circumstances, medical research legally requires parental consent until the age of 18 years, with poorly defined recommendations for assent prior to this. However, there is little research exploring how these decisions are made by families and the ethical implications of this. Aim To explore key ethical debates in decision-making for participation of children and (...) adolescents in a human papillomavirus (HPV) vaccine trial. Methods Semi-structured interviews were undertaken with Tanzanian girls (aged 9–16 years) who had participated in an HPV vaccine trial (n = 13), their parents or guardians (n = 12), and girls together with their parents (in paired parent-child interviews) (n = 6). The interviews were analysed using thematic analysis. Interview data came from a qualitative acceptability study undertaken as part of the Dose Reduction Immunobridging and Safety Study of Two Human Papillomavirus (HPV) Vaccines in Tanzanian Girls (DoRIS) trial. Results Girls and parents desired collaborative decision-making, with parents ultimately making the decision to consent. However, girls wanted a larger part in decision-making. Decisions to consent involved many people, including extended social networks, the trial team, media outlets and healthcare professionals and this resulted in conflicts to be negotiated. Deciding where to place trust was central in participants and parents considering decisions to consent and overcoming rumours about trial involvement. Conclusions Existing models of decision-making help to understand dynamics between parents, adolescents and researchers but neglect the important wider social impacts and the fundamental nature of trust. Children’s roles in discussions can be evaluated using the principles of consent: autonomy, freedom and information. Concepts such as relational autonomy help to explain mechanisms families use to negotiate complex consent decisions. Whilst interviewees supported the maintenance of legal parental consent, researchers must design consent processes centring the child to ensure that whole family decision-making processes are supported. (shrink)

Self‐management programmes provide strategies to optimise health while educating and providing resources for living with enduring illnesses. The current paper describes the development of a community‐based programme that combines a transdiagnostic approach to self‐management with mindfulness to enhance psychological coping for older people with long‐term multimorbidity. The six steps of intervention mapping (IM) were used to develop the programme. From a needs assessment, the objectives of the programme were formulated; the theoretical underpinnings then aligned to the objectives, which informed programme (...) design, decisions on implementation, programme adoption and evaluation steps. Bandura's social cognitive theory informed the methods and practical strategies of delivery. Among the features addressed with participants are transdiagnostic dimensions such as fatigue, pain, breathlessness, sleep disturbances. The programme utilises mindfulness to aid coping and ameliorate the psychological distresses associated with chronicity. Findings from an initial feasibility study and subsequent pilot assisted in conceptualising our programme. In conclusion, applying IM gave the planners confidence the programme is robust and evidence‐based with clearly articulated links between the behavioural goals and design elements to obtain the desired outcomes. (shrink)

When do data provide good evidence for a hypothesis, evidence that warrants an inference to the hypothesis? Standard answers either reject the legitimacy of induction or else allow warranted inference from data to hypothesis when there are suitable relationships between and among the data and hypotheses. The severity account rejects all of these, maintaining instead that the good evidence relation concerns not only relations between data and hypotheses but also the methods for obtaining the data and the sensitivity of these (...) methods to detecting falsehood. So, for example, the severity account allows two rival hypotheses to fit the data equally well, even to the point of having the same prior and posterior probabilities relative to those data, while the data nonetheless favour one hypothesis over the other by virtue of those data providing a severe test of one hypothesis and not the other. The contributions to Error and Inference variously trace the genesis of the severity account from statistics-oriented sciences, elaborate upon the account’s details, apply the account to various philosophical issues, and offer challenges to the account’s adequacy and replies to major criticisms. The editors have developed the severity account in detail elsewhere, and this anthology is an effort …. (shrink)

We show that if κ is a weakly compact cardinal, then $\left( \matrix \kappa ^{+} \\ \kappa\endmatrix \right)\rightarrow \left(\left( \matrix \alpha \\ \kappa \endmatrix \right)_{m}\left( \matrix \kappa ^{n} \\ \kappa \endmatrix \right)_{\mu}\right)^{1,1}$ for any ordinals α < κ⁺ and µ < κ, and any finite ordinals m and n. This polarized partition relation represents the statement that for any partition $\kappa \times \kappa ^{+}=\underset i<m\to{\bigcup }K_{i}\cup \underset j<\mu \to{\bigcup }L_{j}$ of κ × κ⁺ into m + µ pieces either there (...) are A ∈ [κ]κ, B ∈ [κ⁺]α, and i < m with A × B ⊆ Ki or there are C ∈ [κ]κ, D ∈ [κ⁺]α, and j < μ with C × D ⊆ Lj. Related results for measurable and almost measurable κ are also investigated. Our proofs of these relations involve the use of elementary substructures of set models of large fragments of ZFC. (shrink)

Jebb renders the last clause as follows: ‘The warrior of the white shield, who came from Argos in his panoply, hath been stirred by thee to headlong flight, in swifter career.’ ‘In swifter career’ is a discreet rendering of ., Jebb says, ‘does not mean “in flight swifter than their former approach“ nor “the reins are shaken ever faster on the horses' necks”.’ ‘The Argives’, he writes, ‘began their retreat in the darkness : when the sun rises, the flashing steel (...) of their bridles shows them in headlong flight’. Cf. P. Mazon, R.E.G. xxv , 13. This view is shared by all modern scholars, except that Dain and Mazon put commas after and translate accordingly; which I do not think is an improvement. How to Cite This Article. (shrink)

This article describes our efforts to screen and enrol clinical trial participants conscientiously in the COVID-19 pandemic setting. We present the standard screening and enrolment process prior to, and our process of adapting to, the pandemic. Our goal was to develop a way to screen and enrol people for clinical trials that was both equitable and effective. In addition, we outline the steps our research department took to ensure that ethical, clinical and logistical factors were considered when matching a patient (...) to a clinical trial. (shrink)

Chapter Introduction Hobbes's political doctrine presents the unusual feature that it has given rise to an "official" interpretation, in terms of which, ...

David Conner’s 2022 AFHVS Presidential Address discusses the importance for transdisciplinary partnerships among varied scholars and the co-creation of new knowledge. He suggests that without such co-creation, we will fail to solve wicked problems such as food system sustainability. In this essay, Kelinsky-Jones focuses on requisite changes among universities and federal funding alike to advance food system transformation sustainability and equitably. She argues that without prioritizing transdisciplinary partnerships grounded in principles of epistemic inclusion, we will fail to envision and (...) enact requisite food system transformation. Kelinsky-Jones directs her argument first toward land grant universities by urging them to prioritize agroecology as a transdisciplinary approach of pursuing epistemically inclusive science with society. She offers recommendations for teaching, research, and extension practice. Subsequently, recognizing that funders and universities often work in tandem, Kelinsky-Jones closes with three recommendations derived from her research for how the United States Agency for International Development may equally support and prioritize agroecology. (shrink)

In their article, Pavarani and colleagues offer a vision of evolutionary bioethics that focuses on innovation and empirical research as a means to enrich the field of bioethics. Empirical bi...

This text has already been published in Studies in Philosophy and Education, Feb. 2018, n° 37, p.103–107. As we all know it, writing and reading takes time. In the contemporary social and academic context, often shaped by a destabilizing sense of acceleration and urgency, protecting the moments required for such ‘time-consuming' activities is not something that can be taken for granted anymore. The way we commit to a specific task expresses as much about the meaning it may carry that what (...) we - Débats. (shrink)

The predicate-argument approach, focused on perception, is compared with the ease-of-predication (or predicability) approach, focused on encyclopedic knowledge. The latter offers functional prediction and implementation in connectionist models. However, the two approaches characterise predicates in different ways. They thus resemble predicational cantilevers built out from opposite sides of cognition, with a gap that is yet to be bridged.

Not at all self-evident, the so-called isomorphisms between the phenomenology and physiology of dreams have been interpreted by Hobson et al. in an arbitrary manner to state that dreams are stimulated by chaotic brainstem stimulation (an assumption also adopted by Vertes & Eastman). I argue that this stimulation is not chaotic at all; nor does it occur in the absence of control from the cerebral cortex, which contributes complexity to brainstem activity as well as meaningful information worth consolidating in the (...) brain during sleep. [Hobson et al.; Vertes & Eastman]. (shrink)

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Jones, Kate Too many young people live in aged care nursing homes in Australia because there is a shortage of suitable alternatives. The Young People in Nursing Homes National Alliance confirms this, and advises that one young person is admitted into nursing home care every day. Part two of this article will follow in the next issue of this Bulletin.

The aims of this study were to measure the readability of Australian based informed consent documents and determine whether informed consent readability guidelines have been established by Australian human research ethics committees (HRECs). A total of 20 informed consent documents, 10 HIV/AIDS and 10 type 2 diabetes, were measured for readability using the Simple Measure of Gobbledygook (SMOG) and Gunning Fog Index (Fog). Published guidelines and policy statements of the two local HREC who approved the 20 clinical trials under study (...) where examined to identify whether they had any formal policies/guidelines on the readability of informed consent documents. The two HRECs were contacted via e-mail to also determine whether they utilised any informal readability standards or “rules of thumb” that may not have been mentioned in the published documents. The HIV/AIDS and type 2 diabetes informed consent documents were, on average, written at a grade 13 reading level. Formal readability standards had not been established by the two local HRECs, however, they did verify the use of informal rules for assessing readability of informed consent documents. Based on Australian literacy data, the majority of informed consent documents were written well beyond the reading ability of many Australians. Unreadable informed consent documents may result in patients rejecting trial participation altogether or conversely may result in their participating in a trial with inadequate consent. Therefore, a step toward reducing the complexity of informed consent documents may be to implement objective readability assessments into the human research ethics application and review process. (shrink)

Utilitarian and deontological moral theories are often accused of failing to develop a convincing account of an agent's moral psychology, and so failing to provide an adequate theory of moral motivation that sustains their conception of morality as involving generally overriding moral duties. As a result of this apparent conflict between an agent's psychology and the demands of morality, many suggest making dramatic revisions to our conception of morality. I argue here that a more promising response is to examine where (...) it is that morality fits into human psychology, and then build a theory of moral motivation that sustains ordinary conceptions of morality from this foundation. To do this, I start by looking at Hume's account of moral motivation, which is grounded in a rich and full moral psychology. In an attempt to show that his theory provides a promising foundation for a contemporary theory of moral motivation, I explore his account of acting from duty and develop a new interpretation of his theory of moral motivation that fits most consistently with both his criticism of other accounts and his more general claims about the virtue of justice. I argue that Hume offers an account of justice as being always valuable in virtue of being a necessary condition to the enjoyment of one's good character. I go on to suggest that pride in one's character, what we might now call personal integrity, commits each agent to acting with a sense of duty, and enables her to attain a level of social interaction that is necessary for her psychological development, yet not possible without a commitment to justice. After defending this interpretation of Hume, I extend this basic notion of personal integrity and demonstrate how this idea, combined with the workings of empathy and the psychological need for positive social interaction, generates a viable theory of moral motivation that maintains the common conception of morality as involving generally overriding moral duties while avoiding threats of alienation. (shrink)

This essay explores the original political significance of the posters of May ’68 as a critique of capitalism, as well as extending this approach to a critique of contemporary capitalism in 2020. The slogans of ’68 are deceptively simple and we look to the importance of the political ideas expressed aesthetically as having immediate impact in the late 1960s, but also the underlying Situationist philosophy which influenced them.We also explore the contemporary significance of Situationist theory, especially in the context of (...) the renewal of Marxist thought in the 21st century. This renewed Leftist critique of capitalism emerges as articulated through newer social and political movements of the current times, particularly through the political philosophy of Slavoj Žižek and his auto-critique of the former Yugoslavia. (shrink)