As a gynecologic surgeon with a focus on infertility, I frequently hold complex discussions with patients, exploring with them the risks and benefits of surgical options. In the past, we physicians may have expected our patients to simply defer to our expertise and choose from the options we presented. In our contemporary era, however, patients frequently request options not favored by their physicians and even some they've found themselves online. In reproductive endocrinology and infertility, the range of options that may (...) be offered or that patients may themselves seek out is continuously widening. Physicians certainly seek to find the option that will result in the best outcome for their patients, but the information to guide us in achieving the best outcome can be vague or conflicting. Add to this the financial and emotional pressures bearing on patients seeking assisted reproduction. In this essay, I explore the extent to which clinicians in reproductive medicine should follow patient requests with which they disagree or instead try to persuade the patient to do something else or simply refuse outright to meet the request. And if persuasion is to be used, what would be legitimate methods? Clearly, coercion is unacceptable, but the line between persuasion and coercion can be elusive. At what point can or should clinicians resist such requests—and to what degree? (shrink)

This book evaluates some of the most common ethical issues confronted by reproductive endocrinologists, embryologists, and their teams. The authors apply core ethical principles and approaches to problem solving to each of the cases raised. This work is a guide for both those on the front lines of patient care as well as for students in the field, whatever their background. By outlining sample cases, the book is an instigator for ethical discussions among ethicists, medical practitioners and students.

The majority of obstetrician‐gynecologists in practice operate very infrequently. Most residents graduate with strong surgical skill sets, given residency requirements. Nonetheless, their practices become dominated by obstetrics, and their gynecologic surgical skills deteriorate. While cesarean sections are surgical in nature, the skill sets needed in these surgeries differ from the skills used in general gynecologic surgery. As gynecology has taken a back seat to obstetrics in our specialty, not only surgical skills but also diagnostic and management skills have deteriorated.

Decision making during reproduction is complex for a variety of medical and social reasons. Anyone who has had a conversation with a family member about the “best time” to have a baby can attest to this — there is no “best time” or “best way.” Multiple pressures from any number of sources combine in a minefield of hazards made ever more complicated by restrictive laws in the US. Add to this a screening result of potential chromosomal aneuploidy and decision making (...) becomes ever more complex. Societal stigma and lack of adequate and accurate information during counseling certainly plays a role in the high number of terminations in the setting of diagnosed chromosomal aneuploidy, yet other factors also push families in this direction including medical considerations and the abysmal lack of social support programs. (shrink)

Respect for autonomy is a central value in reproductive ethics, but it can be a challenge to fulfill and is sometimes an outright puzzle to understand. If a woman requests the transfer of two, three, or four embryos during fertility treatment, is that request truly autonomous, and do clinicians disrespect her if they question that decision or refuse to carry it out? Add a commitment to justice to the mix, and the challenge can become more complex still. Is it unfair (...) for insurance policies to exclude from coverage the costs of giving fertility to those who lack it or restoring fertility in those who have lost it? What does “just reproduction” look like in the face of multifarious understandings of both justice and autonomy and in light of increasingly complex and costly reproductive technologies? In today's dialogue about reproduction, medicine, and ethics in the United States, old ethical issues—such as whether women ought to be allowed to access pregnancy termination—are more contested than they have been in decades, while new technologies—like those used to edit the genes of human embryos—suggest that our species could face unprecedented questions about who should exist. As we considered the discussions accompanying these issues and contemplated a special report responding to them, we found ourselves consistently circling back to two ethical commitments: respect for autonomy and the pursuit of justice. As one of the nine essays in this collection asks, why should certain women receive help to establish a pregnancy while others are thrown in jail when they miscarry or their child is stillborn? Respect for autonomy is required where individuals have the ability to make fully informed and voluntary choices. Yet does respecting autonomy require acceding to all the choices of patients or consumers of medical care? We consider these and related questions in this special report from the Hastings Center Report. (shrink)

Reading Henry Greely's wonderful book, The End of Sex and the Future of Human Reproduction, while riding public transport sparked awkward looks and equally awkward discussions. I thought of removing the dust jacket, yet I was reminded that Greely's stated purpose in writing the book was to spark conversation. The title is, of course, intentionally provocative. Greely does not, in fact, believe that humans will stop having sex for the multitude of reasons that we do already. Quite the contrary; he (...) proposes that sex for reproduction will become a technical endeavor, while sex for pleasure or other purposes beyond reproduction will remain as it is. In a not-too-distant future, advances in genomics and assisted reproduction, especially preimplantation genetic diagnosis, will allow us to control the genetic makeup of embryos. To a limited degree, PGD already makes this possible, but what Greely proposes is slightly different. His vision of the future depends on the potential for further advances of today's already fairly complex biotechnology. Greely does an excellent job of making this cutting-edge science easy to understand. (shrink)

Research involving human participants has been conducted in the Philippines since the beginning of the Spanish colonial period. Such studies are expected to adhere to internationally accepted ethical guidelines. This paper discusses trends in clinical research ethics in the Philippines during the American colonial period (1898‐1946). Specifically, studies were assessed on: 1) their observance of ethical protocols, including review; 2) identification of inclusion and exclusion criteria in the selection of participants; 3) use of vulnerable subjects; and 4) practice of the (...) informed consent process. Only the informed consent process had a significant logistic correlation with progression of years. Recruitment of vulnerable groups was common during this period; children and prisoners were the most common participants. Trends in medical ethics in the Philippines reflected those in the United States prior to the publication of the Nuremberg Code, which served as a milestone in the protection of human welfare in clinical research. (shrink)

The theories of reasoned action and planned behaviour have fundamentally changed the view that attitudes directly translate into behaviour by introducing intentions as a crucial intervening stage. Much research across numerous ethical contexts has drawn on these theories to offer a better understanding of how consumers form intentions to act in an ethical way. Persistently, researchers have suggested and discussed the existence of an intention–behaviour gap in ethical consumption. Yet, the factors that influence the extent of this gap and its (...) magnitude have not been systematically examined. We, therefore, contribute to the debate on the intention–behaviour gap by reviewing the empirical TRA/tpb studies that have assessed both intention and behaviour in ethical contexts. The findings from our review show that few studies assessed the intention–behaviour relationship and as a result, there is limited empirical evidence to date to quantify more accurately the intention–behaviour gap in ethical consumption. Our second contribution aims to provide an empirical case study which assesses the magnitude of the intention–behaviour gap in the context of avoidance of sweatshop clothing and to assess the roles of planning and actual behavioural control in potentially reducing the intention–behaviour gap. The findings of our case study suggest that there is indeed a large gap between intention and behaviour, and we conclude by calling for more empirical longitudinal studies to assess the complex nature of the relationship between intention and behaviour. (shrink)

The dual-use issue is often framed as a series of paralyzing ‘dilemmas’ facing the scientific community as well as institutions which support innovation. While this conceptualization of the dual-use issue can be useful in certain contexts its usefulness is more limited when reflecting on the governance and politics of the dual-use issue. Within this paper, key shortcomings of the dilemma framing are outlined. It is argued that many of the issues raised in the most recent debates about ‘dual-use’ bird flu (...) research remain unresolved. This includes questions about the trajectories of certain lines of research, as well as broader trends in the practice and governance of science. This leads to difficult questions about current approaches to the dual-use issue within the US, as well as internationally. (shrink)

As the usual regulatory framework did not fit well during the last Ebola outbreak, innovative thinking still needed. In the absence of an outbreak, randomised controlled trials of clinical efficacy in humans cannot be done, while during an outbreak such trials will continue to face significant practical, philosophical, and ethical challenges. This article argues that researchers should also test the safety and effectiveness of novel vaccines in wild apes by employing a pluralistic approach to evidence. There are three reasons to (...) test vaccines in wild populations of apes: i) protect apes; ii) reduce Ebola transmission from wild animals to humans; and iii) accelerate vaccine development and licensing for humans. Data obtained from studies of vaccines among wild apes and chimpanzees may even be considered sufficient for licensing new vaccines for humans. This strategy will serve to benefit both wild apes and humans. (shrink)

Linguists rely on intuitive conceptions of structure when comparing expressions and languages. In an algebraic presentation of a language, some natural notions of similarity can be rigorously defined (e.g. among elements of a language, equivalence w.r.t. isomorphisms of the language; and among languages, equivalence w.r.t. isomorphisms of symmetry groups), but it tums out that slightly more complex and nonstandard notions are needed to capture the kinds of comparisons linguists want to make. This paper identihes some of the important notions of (...) structural similarity, with attention to similarity claims that are prominent in the current linguistic tradition of transformational grammar. @ 2002 Elsevier Science B.V. All rights reserved. (shrink)

Saul Kripke has proposed an argument to show that there is a serious problem with many computational accounts of physical systems and with functionalist theories in the philosophy of mind. The problem with computational accounts is roughly that they provide no noncircular way to maintain that any particular function with an infinite domain is realized by any physical system, and functionalism has the similar problem because of the character of the functional systems that are supposed to be realized by organisms. (...) This paper shows that the standard account of what it is for a physical system to compute a function can avoid Kripke's criticisms without being reduced to circularity; a very minor and natural elaboration of the standard account suffices to save both functionalist theories and computational accounts generally. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Notes and Discussions AGOSTINO NIFO'S EARLY VIEWS ON IMMORTALITY Various historians of Renaissance philosophy have taken some notice of the prolific author and important philosopher of the late 15th and early 16th centuries, Agostino Nifo (1470-1538), x but no one has yet studied his writings in a methodical and exhaustive fashion. 2 He not only published philosophical works in logic, physics, psychology and metaphysics, but he also authored treatises (...) on humanist topics? Recent scholars have tended to concentrate their attention on his psychological doctrines, no doubt because he was one of the major opponents of Pietro Pomponazzi (1462-1525) during the immortality controversy.4 Nifo published his De Immortalitate Animae in 1518 as a reply to the De lmmortalitate Ardmae, On the year of Nifo)s birth, see Bruno Nardi, Saggi sull'aristotelismo padovano dal secolo xav al xvl ('Florence, 1958), p. 284, n. 8. There is contemporary evidence that he died on January 18, 1538. See Bartolommeo Capasso, "Le cronache de li antiqui ri del regno di Napoli di D. Gaspare Fuscolill0," Archivio storico per le province napoletane, I (1876), p. 538. The standard bio-bibliography still remains Pasquale Tuozzi, "Agostino Nifo 9 le sue opere," Atti e memorie della R. Accademia di Scienze, Lettere ed Arti in Padova, Nuova scrie, XX (Padua, 1904), pp. 63-86. But see also Giuseppr Tommasino, Tra umanisti e filosoft (Maddaloni, 1921), Porte I, pp. 123-147; and Edward P. Mahoney, "A Note on Agostino Nifo," Philological Quarterly (forthcoming). z See Franeeseo Fiorentino, Pietro Pomponazzi; Studi storici su la scuola bolognese e padovana del secolo xvI (Florence, 1868); Carlo Giacon, La seconda scolastica: 1 grandi commentatori di San Tommaso (Milan, 1944); Etienne Gilson, "L'affaire de l'immortalit6 de l'fime ~t Venise at* d6but du xvIe si~ele," in Umanesirno europeo e uraanesimo veneziano, ed. Vittore Branea (Florence, 1963), pp. 31-61; Miehele Giorgiantonio, "Un nostro filosofo dimentieato dcl '400 (Luea Prassicio e Agostino Nifo)," Sophia, XVI (1948), pp. 212-214 and 303-312; Bruno Nardi, Saggi sulraristotelismo padovano dal secolo x]v al xvI (Florence, 1958); idem, Sigieri di Brabante nel pensiero del Rinascimento Italiano (Rome, 1945); Giovanni di NapoH, L'immortalitd delranima nel Rinascimento ('Turin, 1963); John Herman Randall, Jr., The School of Padua and the Emergence of Modern Science (Padua, 1961); Wilhelm Risse, Die Logik der Neuzeit, I (Stuttgart, 1964); Eugenio Garin, La cultura [ilosofica del Rinascimento Italiano (Florence, 1961); idem, Storia della filosofia italiana, II (Turin, 1966). See Nifo's De Armorum Literarumque Comparatione Commentariolus (Naples, 1526); De Pulchro et Amore (Rome, 1531); De Re Aulica (Naples, 1534); and Prima Pars Opusculorum (Venice, 1535). The second of these works has been studied by Jules Houdoy, La beaut~ des femmes dans la litt#rature et darts rart du xII" au xvIe si~cle; Analyse du livre de A. Niphus du Beau et de l'amour (Paris, 1876). 4 For recent discussion of the immortality controversy, see Etienne Gilson, "Autour de Pomponazzi, ProbMmatique de l'immortalit~ de l'~me en Italic au d~but du xvIe si~.cle," Archives d'histoire doctrinale et litt~raire du moyen dge, Ann6e 1961, pp. 163-179; Giovanni di Napoli, op. cit., especially pp. 227-338; Paul Oskar Kristeller, Eight Philosophers of the Italian Renaissance (Stanford, 1964), pp. 72-90; Bruno Nardi, Studi su Pietro Pomponazzi (Florence, 1965); Martin Pine, "Pomponazzi and the Problem of 'Double Truth'," Journal ot the History of Ideas, XXIX (1968), pp. 163-176; Harold Shulsky, "Paduan Epistemology and the Doctrine of the One Mind," lournal of the History of Philosophy, VI (1968), pp. 341-361. [451] 452 HISTORY OF PHILOSOPHY (1516) of Pomponazzi, who had argued that personal immortality cannot be philosophically demonstrated, s But while these scholars correctly point out that Nifo abandoned an Averroist interpretation of Aristotle concerning the unity of the intellect and the immortality of the soul for the position which they assume to be Thomistic, they are not precise as to just when Nile made the shift.6 They have not observed that in his first two printed works, namely, the commentary on Averroes' Destructio Destructionum (1497) and the early commentary on the De Anima (1503), Nifo explicitly accepts Averroes as the... (shrink)

The heme‐containing cytochromes P‐450 are a ubiquitous family of monooxygenase isozymes responsible for the oxidative metabolism of a wide variety of endogenous as well as exogenous compounds. Many of the compounds metabolized by this enzyme system are effectively detoxified and converted to derivatives more easily eliminated from the organism. However, some compounds can be activated to reactive species capable of eliciting a cascade of toxic lesions, including cancer. Since its discovery nearly 30 years ago, the cytochrome P‐450 enzyme system has (...) received a great deal of attention, particularly in the areas of their mechanisms of metabolism, range of substrate specificity, the purification and characterization of the multiple isozymes and, more recently, the regulation of expression of specific forms. This review will discuss current notions concerning the expression of at least one cytochrome P‐450 isozyme and future directions that should lead to a more complete understanding of cytochrome P‐450 gene expression in general, particularly as it impacts upon biochemical pharmacology. (shrink)

While researchers have examined the types of ethical issues that arise in long-term care, few studies have explored long-term care nurses’ experiences of moral distress and fewer still have examined responses to initial moral distress. Using an interpretive description approach, 15 nurses working in long-term care settings within one city in Canada were interviewed about their responses to experiences of initial moral distress, resources or supports they identified as helpful or potentially helpful in dealing with these situations, and factors that (...) hindered nurses in their responses. Using a thematic analysis process, three major themes were identified from the nurses’ experiences: (i) the context of the situation matters; (ii) the value of coming together as a team; and (iii) looking for outside direction. The work of responding to initial moral distress was more fruitful if opportunities existed to discuss conflicts with other team members and if managers supported nurses in moving their concerns forward through meetings or conversations with the team, physician, or family. Access to objective others and opportunities for education about ethics were also identified as important for dealing with value conflicts. (shrink)

In the majority of academic institutions nursing and medical students receive a traditional education, the content of which tends to be specific to their future roles as health care professionals. In essence, each curriculum design is independent of each course. Over the last decade, however, interest has been accumulating in relation to interprofessional and multiprofessional learning at student level. With the view that learning together during their student training would not only encourage and strengthen future collaboration in practice settings but (...) also enhance patient care, the University of Dundee decided to run a pilot study to explore shared teaching in ethics between medical and nursing students. This article presents a report on the reasons for selecting health care ethics as a precursor for shared teaching, the educational tool used for the sessions, and the results of student and facilitator evaluation of the short course. Overall, despite problems such as poor attendance by some students, and facilitation and timetable difficulties, most of the feedback from students and facilitators has been positive. In essence the ‘idea’ has gone from strength to strength and there are now three levels of shared teaching in ethics between nursing and medical students, with plans to include further sessions with students from other disciplines. Within the text, ‘health care ethics’ will be referred to as ‘ethics’; nursing students/nurses encompasses midwifery students/midwives. (shrink)

I argue that we can explain how we acquire knowledge from what a speaker tells us by appealing to facts about the speaker's reasons for telling. That is because (1) among our reasons for telling somebody that P can be the fact that P; and (2) these reasons that are facts can be made manifest to our audiences by our telling them that P.

In this paper, we argue that there are important differences between playing and non-playing roles in sport. The relevance of sex differences poses genuine philosophical and ethical difficulties for feminism in the context of playing sport. In the case of non-playing roles in general, and officiating in particular, we argue that reference to essential differences between men and women is irrelevant. Officiating elite men?s football is not a role for which ?essential? (psychological and biological) differences are causally implicated neither in (...) competence nor excellence. Reference to such purported differences to justify the exclusion of women from roles such as officiating is unfounded and sexist. (shrink)

This study focuses on the managerial issue of should social enterprises become more marketing oriented. It adapts the Kohli et al. MARKOR marketing orientation scale to measure the adoption of marketing by SEs. The items capture Vincentian-based values to leverage business in service to the poor as a measure of a Vincentian marketing orientation. A VMO is an organisational wide value-driven philosophy of management that focuses a SE on meeting its objectives by adopting a more marketing orientated approach to serve (...) the needy and poor in a just and sustainable manner. SEs that exhibit a VMO seek to understand and respond to both the needs of their beneficiaries and stakeholders. They are constantly generating, disseminating, and responding to environmental, beneficiary, and stakeholder information and develop their business propositions to more effectively and efficiently meet the needs of the poor, while guided by a philosophy of leveraging business for social good. This study of SEs in Australia found that a VMO is strongly and positively correlated with social, economic, and environmental performance. These findings suggest that SEs may benefit by leveraging marketing capabilities to better serve their beneficiaries and stakeholders. (shrink)

Historical studies may become classics for the wrong reasons, as did Henry Thode's Francis of Assisi or Michelet's Joan of Arc, which we now regard as cultural icons in their own right, emblems of specific elements of the cultures of the era in which they were written. We do not, however, read them for the insight they provide into their declared subjects, nor are their conclusions those of current scholarship. Other studies become classics for the right reasons. The year 1999 (...) marks the eightieth anniversary of the publication of Johan Huizinga's Herfsttij der Middeleeuwen: Studie over levens- en gedachtenvormen der veertiende en vijftiende eeuw in Frankrijk en de Nederlanden, “The Autumn [or Harvest, or Waning, or Decline, or Evening] of the Middle Ages: A Study of the Forms of Life and Thought in the Fourteenth and Fifteenth Centuries in France and the Netherlands [or the Low Countries, or the Burgundian Low Countries].”. (shrink)

Is truth itself natural? This is an important question for both those working on truth and those working on naturalism. For theorists of truth, answering the question of whether truth is natural will tell us more about the nature of truth (or lack of it), and the relations between truth and other properties of interest. For those working on naturalism who wish to have truth as part of the natural order, answering this question is of paramount importance. In this chapter, (...) we focus primarily on the kinds of theory of truth that occupy the central positions in current debates about truth, namely correspondence theories, deflationary theories, epistemic theories, and pluralist theories, and aim to discern the extent to which truth is a natural property on each view. (shrink)