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 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)

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)

Resource allocation is a central part of the decision-making process in any health care system. Resources have always been finite, thus the ethical issues raised are not new. The debate is now more open, and there is greater public awareness of the issues. It is increasingly recognised that it is the technology which determines resources. The ethical issues involved are often conflicting and relate to issues of individual rights and community benefits. One central feature of resource allocation is the basing (...) of decisions on the outcomes of health care and on their subsequent economic evaluation. The knowledge base is therefore of great importance as is the audit of results of clinical treatment. Public involvement is seen as an integral part of this process. For all parts of the process, better methodologies are required. (shrink)

It is shown that a Clifford algebra formalism provides a unifying description of spin-0, -1/2, and-1 fields. Since the operators and operands are both expressed in terms of the same Clifford algebra, the formalism obtains some results which are considerably different from those of the standard formalisms for these fields. In particular, the conservation laws are obtained uniquely and unambiguously from the equations of motion in this formalism and do not suffer from the ambiguities and inconsistencies of the standard methods.

Philosophical Investigations, EarlyView.

In humanities departments across the country Allan Bloom is condemned and reviled—but for what misconduct? The present investigation into our distorted view of Bloom begins by reframing his transgressions. Bloom has offended eminent philosophy professors by boosting students' desire for a philosophic education. He has emboldened promising young people by teaching them to bear up under the deforming forces of convention and corruption and edge their way towards the question, ‘How should I live my life?’ A philosophic education as Bloom (...) sees it ‘means precisely helping students to pose this question to themselves, to become aware that the answer is neither obvious nor simply unavailable, and that there is no serious life in which this question is not a continuous concern’. The philosopher's interests are not shared by most people. Hostility to philosophy is the natural condition of man. This surprising fact, plainly stated, invites so much anger that Bloom—standing in for the philosopher—is forced to defend himself. The story of Bloom, like Socrates', gives an account of philosophy's emergence, distinctive features and always imaginable suppression. Plato's artful writing captured Socrates' way of life for posterity. This essay explores the nature and function of Bloom's bestselling book The Closing of the American Mind (1987), as well as the purpose of Saul Bellow's final novel, Ravelstein (2000), a fictive account of Bloom's life and death. Together these books amount to the true Apology of Allan Bloom. (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)

There are two overarching questions that guide this paper: What are some potential issues with the criterion for judgemental rationality as developed by Bhaskar? How can critical realism itself be justified without foundationalist assumptions or an infinite regress of justification? The paper considers how Bhaskar’s criterion for theory choice – developed in the natural sciences – can also be applied in the social sciences, how a criterion developed within epistemic relativity can be applied to overcome judgemental relativity, and explores justification (...) of critical realism and of research inspired by this philosophy of science. It will be argued that a fractal form of justification can be an important approach to justify critical realist philosophy and its meta-philosophy (or ‘the philosophy of philosophy’). I also seek to demonstrate that such fractal justification, and insights from other fractally coherent philosophies, can be helpful to provide answers to several of the issues with Bhaskar’s criterion for judgemental rationality that are presented. (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)

La présente contribution propose un panorama des représentations géographiques des lettres à Timothée et Tite, aussi appelées les Pastorales. À l’aide du concept de « carte mentale », elle montre comment les trois lettres remanient la perception spatiale du champ d’action paulinien d’est vers l’ouest, au tournant du ier et du IIe siècle. Le déplacement spatial identifié correspond à la majorité des études historiques qui situent les trois lettres parmi les premières réceptions de Paul. Il met également en évidence les (...) soubassements géographiques de la reconfiguration de la notion d’oikos dans ces premières réceptions, souvent occultés dans les études sur l’univers domestique des Pastorales. Cet article pave ainsi la voie à l’étude de la maison romaine dans les trois lettres proposée dans ce numéro par Michael Theobald. (shrink)