Background Inadequate knowledge among health care providers (HCPs) and parents of affected children limits the understanding and utility of secondary genetic findings (SFs) in under-represented populations in genomics research. SFs arise from deep DNA sequencing done for research or diagnostic purposes and may burden patients and their families despite their potential health importance. This study aims to evaluate the perspective of both groups regarding SFs and their choices in the return of results from genetic testing in the context of orofacial (...) clefts.Methods Using an online survey, we evaluated the experiences of 252 HCPs and 197 parents across participating cleft clinics in Ghana and Nigeria toward the return of SFs across several domains.Results Only 1.6% of the HCPs felt they had an expert understanding of when and how to incorporate genomic medicine into practice, while 50.0% agreed that all SFs should be returned to patients. About 95.4% of parents were willing to receive all the information from genetic testing (including SFs), while the majority cited physicians as their primary information source (64%).Conclusions Overall, parents and providers were aware that genetic testing could help in the clinical management of diseases. However, they cited a lack of knowledge about genomic medicine, uncertain clinical utility, and lack of available learning resources as barriers. The knowledge gained from this study will assist with developing guidelines and policies to guide providers on the return of SFs in sub-Saharan Africa and across the continent. (shrink)

Clinical red blood cell transfusion guidelines have been widely adopted in clinical practice, resulting in standardized transfusion practices in hospitalized patients with anemia. Standardization of transfusion practice has been welcomed by clinicians and health systems as a mechanism for reducing unnecessary, harmful, and costly practice variation that results in healthcare disparities. However, overzealously applied guidelines can have deleterious consequences for individual patients, ultimately resulting in and/or exacerbating healthcare disparities, rather than resolving them. This article provides empirical examples of the adverse (...) consequences from the well-meaning attempt to standardize transfusion practice based on clinical practice guidelines and discusses the ethical implications of standardized transfusion practice. (shrink)

Cet article fournit les principaux résultats de la mission effectuée en mai 2011 dans le cadre du projet concernant la sculpture architecturale byzantine de la côte occidentale de la mer Noire. La première partie présente et décrit les ensembles architecturaux d’où proviennent les sculptures sur lesquelles ont été prélevés des échantillons de marbre. La seconde partie a trait aux caractéristiques spécifiques des marbres analysés : vingt échantillons de marbre prélevés sur des sculptures provenant surtout de Sozopol, mais aussi d’Obzor et (...) de Pomorie, ont été analysés afin de connaître leur provenance. Les différentes méthodes d’analyses ont montré que la majorité des échantillons étaient issus de l’île de Proconnèse. Néanmoins, quatre des vingt échantillons présentent une composition minéralogique et chimique différente de celle des marbres de Proconnèse : deux sont en marbre pentélique, un autre en marbre de Thasos et le dernier est très probablement en marbre local. (shrink)

Today’s business students are tomorrow’s business leaders. To ensure they have skills in creating profitable, pro-social, ethical organizations, we need to consider alternative methods of teaching CSR. In this proposed symposium, we will present different approaches to international CSR/Service-Learning.

The Cambridge Handbook of Thinking and Reasoning is the first comprehensive and authoritative handbook covering all the core topics of the field of thinking and ...

The ethical treatment of cancer patientsparticipating in clinical trials requiresthat patients are well-informed about thepotential benefits and risks associated withparticipation. When patients enrolled in phaseI clinical trials report that their chance ofbenefit is very high, this is often taken as evidence of a failure of the informed consent process. We argue, however, that some simple themes from the philosophy of language may make such a conclusion less certain. First, the patient may receive conflicting statements from multiple speakers about the expected (...) outcome of the trial. Patients may be reporting the message they like best. Second, there is a potential problem of multivocality. Expressions of uncertainty of the frequency type can be confused with expressionsof uncertainty of the belief type. Patients may be informed using frequency-type statements and respond using belief-type statements. Third, each speech episode involving the investigator and the patient regarding outcomes may subservemultiple speech acts, some of which may beindirect. For example, a patient reporting ahigh expected benefit may be reporting a beliefabout the future, reassuring family members,and/or attempting to improve his or her outcome by apublic assertion of optimism. These sources oflinguistic confusion should be considered injudging whether the patient's reported expectation isgrounds for a bioethical concern that there hasbeen a failure in the informed consent process. (shrink)

Aim: This study explores priority dilemmas in dialysis treatment and care offered elderly patients within the Norwegian public healthcare system.Background: Inadequate healthcare due to advanced age is frequently reported in Norway. The Norwegian guidelines for healthcare priorities state that age alone is not a relevant criterion. However, chronological age, if it affects the risk or effect of medical treatment, can be a legitimate criterion.Method: A qualitative approach is used. Data were collected through semistructured interviews and analysed through hermeneutical content analysis. (...) The informants were five physicians and four nurses from dialysis wards.Findings: Pressing priority dilemmas centre around decision-making concerning withholding and withdrawal of dialysis treatment. Advanced age is rarely an absolute or sole priority criterion. It seems, however, that advanced age appears to be a more subtle criterion in relation with, for example, comorbidity, functional status and cognitive impairment. Nurses primarily prioritise specialised dialysis care and not comprehensive nursing care. The complex needs of elderly patients are therefore often not always met.Conclusions: Clinical priorities should be made more transparent in order to secure legitimate and fair resource allocation in dialysis treatment and care. Difficult decisions concerning withholding or withdrawal of dialysis ought to be openly discussed within the healthcare team as well as with patients and significant others. The biomedical focus and limitations on comprehensive care during dialysis should be debated. (shrink)

Philosophers have hitherto only interpreted the world in various ways; the point is to change it.Karl marx’s distinction between interpreting the world and changing it points by extension to the state of contemporary philosophy and psychiatry. The 1990s resurgence of interdisciplinary work in this area was driven equally by phenomenological scholarship and by initiatives in analytic philosophy. The former reflected the focus in phenomenology on ‘what it is like’ to experience a given mental symptom with the aim of reconstructing the (...) life-worlds of people experiencing mental disorders, while the latter reflected directly or indirectly the influence of J. L. Austin and others from... (shrink)

My mother is losing her mother to Alzheimer's disease. Although my mother feels loss, I am connecting through my grandmother to our ancestors, including a deceased father and paternal grandmother. I am also connecting to a daughter who has lost her mother, through a grandmother who, through her loss of memory, is more open to kin networks than my mother. Through deepening connections to my maternal grandmother and to my daughter, I feel I am losing my mother. I look to (...) revolutionary mothering as a way to reconnect shattered bonds and find lost mothers. This article honors the important work of Saidiya Hartman, Dorothy Roberts, and countless revolutionary mothers. (shrink)

Objective: To provide an ethical analysis of whether the Ethiopian and Tanzanian national HIV/AIDS treatment guidelines can be considered legitimate and fair rationing tools.Method: Qualitative study and ethical analysis involving guideline documents and interviews with nine key members involved in the development of the guidelines. The analysis followed an editing organising style. The theoretical framework was a guideline-specific framework based on theories of just resource allocation in healthcare and conditions that ensure fair processes in guideline development. According to this framework, (...) legitimate rationing requires reasons for patient selection to be explicit, public and relevant, and decisions must be open to question and revision.Results: The only explicit rationing criteria that both guidelines recommended were clinical antiretroviral treatment indications. Explicit non-clinical rationing criteria were expressed in a separate Ethiopian implementation guideline. Neither of the guideline development processes fully satisfies minimal requirements of procedural fairness. There is a lack of transparency. The reasons for decisions are rarely given and are not publicly available. This reduces the opportunity for public questioning, debate and revisions. The guidelines were based on expert opinion and consensus. Recommendations from the WHO were copied without much discussion, disagreement or adjustment.Conclusions: The two national HIV treatment guidelines discussed are de facto mechanisms for rationing but were developed using methods that do not fully satisfy the requirements of fair processes. (shrink)

The European Clinical Trials Directive was issued in 2001 and aimed to simplify and harmonise the regulatory framework of clinical trials throughout Europe, thus stimulating European research. However, significant complexity and inconsistency remains due to disparate interpretation by EU member states. Critical care research has been particularly impacted due to variable and often restrictive consenting procedures for incapacitated subjects, with some countries requiring a court-appointed representative, while others recognise consent from family members and occasionally professional representatives. Furthermore, the absence of (...) a waiver of consent threatened to put an end to emergency research in Europe and was met with varied responses. Approval procedures by ethics committees are equally inconsistent, particularly those relating to provision of a single opinion for multi-centre trials. Although evidence is somewhat mixed, this complexity as well as a general increase in administrative and financial burden following the Directive has been shown to cause a reduction in clinical trial activity in Europe, particularly academic trials. We aim to clarify some of these inconsistent procedures, particularly those relating to informed consent of incapacitated subjects, as well as discussing some general weaknesses and possible improvements of the Directive ahead of its planned revision in 2011. (shrink)

Thomas Kuhn was never a player in the contemporary realism/anti-realism debates, the debate that gained momentum around 1980 or so, with the publication of Bas van Fraassen’s Scientific Image and Larry Laudan’s “Confutation of Convergent Realism”. But I argue that Kuhn had a significant influence on these debates. Kuhn played a significant role in focusing philosophers’ attention on a different issue than the focus of the realism/anti-realism debate of the 1950s and 1960s. Instead of focusing on the meaning of theoretical (...) terms, philosophers of science turned their attention to the problems raised by changes of theory. The particular shape of the contemporary debate thus owes something to the publication of Structure of Scientific Revolutions. (shrink)

_Purpose._ The authors aim to disclose the anthropological dimension of ecocide during and after Russia’s war against Ukraine, relying on the multidisciplinary practices and intellectual production of ecofeminist women thinkers, including philosophers, sociologists, historians, psychologists, and others. _The theoretical basis_ methodological approaches in philosophical anthropology, phenomenology, analytical philosophy, communicative philosophy, existentialism, ethics of justice, and ethics of care determine the study’s theoretical basis._ Originality._ For the first time, a systematic analysis of the anthropological dimension of ecocide has been carried out (...) based on ecofeminist methodology. The specifics of the Ukrainian resistance to ecocide were revealed as part of a single struggle – an anti-imperial and ecological struggle for independence and prosperity. It is emphasized that during the war, the opposition to ecocide is a component of the fight for national sovereignty and territorial integrity of the country, and therefore, the ideas of pacifism in this period are subordinated to this primary goal. After the war, preventing threats of ecocide should become an integral part of the struggle for stable peace and prosperity. Ecofeminist pacifist perspectives should be a priority among the most essential goals for that period. _Conclusions._ Ecofeminist methodological assessments offer valuable insights into the anthropological dimension of ecocide in wartime and post-war contexts, highlighting the complex interplay between gender, violence, and environmental destruction. By focusing on the experiences and perspectives of women and marginalized communities, ecofeminist analyses contribute to a more holistic understanding of ecocide and its impacts on both human populations and ecosystems. (shrink)

This study, based on the phenomenological approach, was aimed at exploring the meaning of privacy for forensic psychiatric patients. The narratives of two such patients, diagnosed with schizophrenia and hospitalized on a forensic unit because of a killing offence, were analysed by means of qualitative content analysis. The study was conducted in a Swiss psychiatric clinic with forensic units. The results demonstrated that ‘privacy’ is not a question of luxury but a very basic human right. The ethical implications for nurses (...) acting as key workers in such situations are highlighted. Recommendations for practice are detailed. (shrink)