The essay discusses the presumption of one's singularity, the uniqueness of one's time, the picturesqueness of one actions, and the capacity of human beings, whether corporately or individually, to begin everything or indeed anything again from scratch. Such presumptions are indeed present in some varieties of contemporary fanaticism, but, more to the point, it is suggested that the feeling of doing something for the first time is the oldest feeling in the world.

The history of the National Health Service research ethics system in the UK and some of the key drivers for its change into the present system are described. It is suggested that the key drivers were the unnecessary delay of research, the complexity of the array of processes and contradictions between research ethics committee (REC) decisions. It is then argued that the primary drivers for this change are and will be replicated by the systems of research ethics review being put (...) in place at UK universities in response to the Economic and Social Research Council research ethics framework. It is argued that this is particularly problematic for multi-centre review and for researchers who switch institutions. Finally, some potential solutions to this problem and their feasibility are discussed. (shrink)

Presently, there is a movement in the UK research governance framework towards what is referred to as proportional ethical review. Proportional ethical review is the notion that the level of ethical review and scrutiny given to a research project ought to reflect the level of ethical risk represented by that project. Relatively innocuous research should receive relatively minimal review and relatively risky research should receive intense scrutiny. Although conceptually attractive, the notion of proportional review depends on the possibility of effectively (...) identifying the risks and ethical issues posed by an application with some process other than a full review by a properly constituted research ethics committee. In this paper, it is argued that this cannot be achieved and that the only appropriate means of identifying risks and ethical issues is consideration by a full committee. This implies that the suggested changes to the National Health Service research ethics system presently being consulted on should be strenuously resisted. (shrink)

The current system of ethical review for medical research in the United Kingdom is changing from the current system involving large committees of 7–18 members reviewing every individual application to a system involving pre-review by small sub-committees of National Research Ethics Officers , who have a remit to approve studies if they believe there are no material ethical issues imposed by the research. The reliability of this new system depends on the reliability of the NREAs and in particular the ability (...) of small groups to effectively identify and appropriately assess the seriousness of all the material ethical issues that may be posed by an application. There is anecdotal evidence to suggest that many individual research ethics committee members have had experience of believing that a study presents no material ethical concerns, then on reaching the committee and discussing the application they realise that the committee feels it does present significant ethical concerns. If this is the case then this casts doubt on the reliability of NREAs or small groups to effectively identify ethically problematic research and appropriately respond to this to protect research participants. In this paper we describe a small questionnaire based piece of research carried out to assess how common this and other relevant experiences are. (shrink)

This paper looks at the issue of consent from children and whether the test of Gillick competency, applied in medical and healthcare practice, ought to extend to participation in research. It is argued that the relatively broad usage of the test of Gillick competency in the medical context should not be considered applicable for use in research. The question of who would and could determine Gillick competency in research raises further concerns relating to the training of the researcher to make (...) such a decision as well as to the obvious issue of the researcher’s personal interest in the project and possibility of benefiting from the outcome. These could affect the judgment of Gillick competency if the researcher is charged with making this decision. The above notwithstanding, there are two exceptional research situations in which Gillick competency might be legitimately applied: when the research is likely to generate significant advantages for the participants while exposing them to relatively minor risks, and when it is likely to generate great societal benefit, pose minimal risks for the participants and yet raise parental objection. In both cases, to ensure that autonomy is genuinely respected and to protect against personal interest, Gillick competency should be assessed by an individual who has no interest or involvement in the research. (shrink)

Significant changes are proposed for the research ethics system governing the review of the conduct of medical research in the UK. This paper examines these changes and whether they will meet the aimed-for goal of improving the efficiency of the research ethics system. The author concludes that, unfortunately, they will not and thus should be rejected.

The Jesus Sutras: Rediscovering the lost religion of Taoist Christianity. Martin Palmer. Piatkus, London 2001. xvi, 270 pp. £17.99. ISBN 0 7499 2250 8.

At the 5th International Conference on Priorities in Health Care in Wellington, New Zealand, 2004, one resonating theme was that for priority setting to be effective, it has to include clinicians in both decision making and the enforcement of those decisions. There was, however, a disturbing undertone to this theme, namely that doctors, in particular, were unjustifiably thwarting good systems of prioritising scarce healthcare resources. This undertone seems unfair precisely because doctors may, and in some cases do, feel obligated by (...) their professional ethics to remain uninvolved either in deciding priorities and in some cases in enforcing them. I will argue that the professional role of a doctor ought not be considered inconsistent with the role of a priority setter or enforcer, as long as one crucial element is in place, a rationally coherent and broadly justifiable regime for prioritising healthcare. Given this I conclude both that prioritisation and doctoring are not incompatible under certain conditions, and that the education of healthcare professionals ought to include material on distributive justice in healthcare. (shrink)

This paper discusses the notion of using international shipping legislation to provide healthcare technologies to inhabitants of a country on a ship in international waters based just outside the country’s border. This allows technologies that would otherwise be unavailable, regulated or banned to the citizens of a particular nation to be available, just offshore. This is because in international waters ships are governed by the laws of their home nation not those they are nearby. We focus on the example suggested (...) recently in the UK of “sperm ships”, flying Danish flags to circumvent IVF regulation in the UK. While we acknowledge that this general strategy could be used to do good by providing healthcare where it would not be otherwise available, it also provides a significant challenge to the effective sovereignty of the state and its ability to regulate healthcare technologies for the benefit of its citizens. We discuss this challenge to the regulation of healthcare and suggest a few tentative solutions. (shrink)

In their thoughtful article, Malm and Navin (2020) raise concerns about a potentially unjust generational welfare tradeoff between children and adults when it comes to chicken pox. We share their c...

Racism is a complex problem in the US that is institutionalized, personally mediated, and internalized. Within medical education the recognition and response to structural racism is be...

En distinguant trois types de substance, à savoir, Dieu, le Christ et les créatures, et en considérant les substances créées comme individuelles, Conway estime que chaque individu possède une sorte de corporéité. En abordant les concepts de « corps » et d’« individu » constitués par Anne Conway, cet article cherche à mettre en lumière la relation implicite entre ces deux notions. Dans le cadre métaphysique élaboré par Conway, le corps participe non seulement de manière particulière au processus d’individuation des (...) substances créées, mais il constitue également l’expression de leur individualité. Cependant, la conception de l’esprit et du corps chez Conway, ainsi que sa théorie de la transmutation, rendent problématique le principe de l’individualité en question. (shrink)

The syllabus presented here is designed for use in the training of researchers and research ethics committee members throughout the European Union and beyond. It is intended to be accessible to scientific and lay readers, including those with no previous experience of ethical theory and analysis. The syllabus will cover key issues in the ethics of research involving human participants, including the ethical issues associated with new technologies.

Advocacy is an important concept in nursing practice; it is frequently used to describe th nurse-client relationship. The term advocacy, however, is subject to ambiguity of interpretation. Such ambiguity was evidenced recently in criticisms levelled at the nursing profession by hospital ethicist Ellen Bernal. She reproached nursing for using 'patient rights advocate' as a viable role for nurses. We maintain that, for nursing, patient advocacy may encompass, but is not limited to, patient rights advocacy. Patient advocacy is not merely the (...) defence of infringements of patient rights. Advocacy for nursing stems from a philosophy of nursing in which nursing practice is the support of an individual to promote his or her own well-being, as understood by that individual. It is an ethic of practice. La défense des malades joue un grand rôle dans la pratique des infirmiers/ères. Le terme est souvent utilisé pour définir les rapports entre malades et soignants. Le mot 'defénse' pourtant, peut être mal compris. Une ambiguïté était évidente récemment dans la critique de la profession infirmière faite par la philosophe éthique Ellen Bernal. Elle reproche à la profession d'utiliser le terme 'avocat des droits des malades' pour désigner le rôle primordial des infirmiers/ères. Nous croyons que pour les soignants, la défense des malades peut comprendre le rôle 'd'avocat des droits des malades' mais elle ne s'y borne pas. La défense n'est pas limitée à la défense des infractions des droits des malades. La défense dans la profession infirmière est basée sur une philosophie où la pratique infirmière est le soutien des malades dans leur quête de promouvoir leur propre bien-être. Die Fürsprache spielt eine wichtige Rolle in der Krankenpflege. Sie wird oft als kennzeichnend für die Beziehung zwischen Patient und Pflegepersonal beschrieben. Der Ausdruck 'Fürsprache' kann aber auch mehrdeutig interpretiert werden. Das wurde letzthin in der Kritik der Ethikerin Ellen Bernal an der Krankenpflege sichtbar. Sie machte den Pflegenden den Vorwurf, dass sie sich die Rolle des 'Rechts-Advokat des Patienten' aneignen. Wir sind der Meinung, dass es die Aufgabe des Pflegepersonals ist, auch die Rechte der Patienten zu vertreten, aber dass das nur ein Teil der Fürsprache ist. Sie ist nicht nur Verteidignung von verletzten Patientenrechten. Die Fürsprache in der Krankenpflege stammt von einer Philosophie, deren Ausübung die Unterstützung der Patienten für ihr Wohlergehen zum Ziel hat, so wie die Patienten selbst ihr Wohlergehen verstehen. Sie ist eine Ethik der Tat. (shrink)

This study throws new light on the composition of Boyle's Free Enquiry into the Vulgarly Receiv'd Notion of Nature ; it also draws more general conclusions about Boyle's methods as an author and his links with his context. Its basis is a careful study of the extant manuscript drafts for the work, and their relationship with the published editions. Section 2 describes Boyle's characteristic method of composition from the late 1650s onwards, involving the dictation of discrete sections of text to (...) amanuenses; it also assesses the effect this had on the structure and presentation of Boyle's writings. Section 3 considers the published text section by section and indicates which parts were written when; it also surveys unpublished draft material relating to the work. Section 4 places the work in context, considering the intellectual threats that Boyle sought to confront in it, both when he initially composed it in the 1660s and when he rewrote it c. 1680. It thus anchors him more precisely than hitherto in the intellectual debates of his day. (shrink)

Clinical trials for acute conditions such as myocardial infarction and stroke pose challenges related to informed consent due to time limitations, stress, and severe illness. Consent processes shou...

“Guy Bennett-Hunter dans «Tillich and Divine lneffabililty» affirme l‘étroite correlation entre l’affirmation tillichienne de l’ineffabilité divine et le rejet de l’ontothéologie. L’affirmation de leur incompatibilité lui semble une contribution majeure de Tillich à la pensée religieuse. Guy Bennett-Hunter part des déclarations bien connues où Tillich affirme que l’on ne saurait, à proprement parler, attribuer l’existence a Dieu puisque Dieu est «être même au-delà de l’essence et de l’existence». En d’autres termes, Dieu «mystére de l’être», «fondement et abîme de (...) la raison», résiste à la connaissance coneeptuelle et à l’articulation linguistique.” — Anne Marie Reijnen & France Farago. (shrink)

Volume 20, Issue 8, August 2020, Page W12-W13.

There is a growing body of evidence that points to an important role for modification of lifestyle factors and promotion of health-related quality of life in the secondary prevention of disease progression in multiple sclerosis ( D’Hooghe et al., 2010 ; Weiland et al., 2014 ; Hadgkiss et al., 2015 ). As a clinical psychologist diagnosed with multiple sclerosis in 2012 I have gained a unique insight into ways in which people living with MS and clinicians can usefully integrate evidence-based (...) lifestyle modifications that enhance self-efficacy and self-management to improve wider psychological and physical health. The framework presented here enables clinicians to engage in salutogenic health promotion by placing value upon the importance of healthy, evidence-based behavior change. Furthermore, the framework provides a structure which can empower and provide guidance for people living with MS on what and how to implement and sustain behavior change and emotional wellbeing in the face of this life-changing diagnosis. (shrink)

This paper argues that Vattel's Droit des gens cannot be adequately interpreted as based on a philosophical principle, whether of universal justice or of raison d'état. Rather, Vattel unfolds his law of nations within a casuistical discourse where inconsistent principles are deployed strategically. This forms an ethical space in which universal justice can be continuously adapted to the exigencies of national self-interest as interpreted by the diplomat of a Protestant republican nation.