This paper is a personal account of the events associated with the author’s work at the University of Toronto’s Hospital for Sick Children on a drug, deferiprone, for the treatment of thalassaemia. Trials of the drug were sponsored by the Canadian Medical Research Council and a drug company which would have been able, had the trials been successful, to seek regulatory approval to market the drug. When evidence emerged that deferiprone might be inadequately effective in a substantial proportion of patients, (...) the drug company issued legal threats when the author proposed informing her patients and the scientific community. Until protests were made by international authorities in her field of research, the hospital and university did not adequately support the author’s academic freedom and responsibilities as a medical practitioner. It is argued that underlying cause of this, and of other similar cases, is the political philosophy which is driving the commercialisation of universities and bringing about the deregulation of drug approval procedures. Together these changes constitute a serious threat to the public good. (shrink)

One could only suppose that the apparently forgotten beginning of any story was unforgettable; perpetually one was subject to the sense of there having had to be a beginning somewhere. Like the lost first sheet of a letter or missing first pages of a book, the beginning kept on suggesting what must have been its nature. One never was out of reach of the power of what had been written first. Call it what you liked, call it a miscarried love, (...) it imparted, or was always ready and liable to impart, the nature of an alternative, attempted recovery or enforced second start to whatever followed. The beginning, in which was conceived the end, could not but continue to shape the middle part of the story, so that none of the realisations along that course were what had been expected, quite whole, quite final. (shrink)

Then we Bishops appeared and took our seats on the tribunal of the cathedral. Clotild was called before us. She showered abuse on her Abbess and made a number of accusations against her. She maintained that the Abbess kept a man in the nunnery, dressed in woman's clothing and looking like a woman, although in effect there was no doubt that he was a man. His job was to sleep with the Abbess whenever she wanted it. “Why! There's the fellow!” (...) cried Clotild, pointing with her finger. Thereupon a man stepped forward, dressed in woman's clothing as I have told you. Everyone stared at him. He said that he was impotent and that that was the reason why he dressed himself up in this way. He maintained that he had never set eyes on the Abbess, although, of course, he knew her by name. He had never spoken to her in his life, and, in any case, he lived more than forty miles out of Poitiers. Clotild failed to prove her Abbess guilty on this count. (shrink)

Transgender and gender expansive (TGE) youth often seek a variety of gender-affirming healthcare services, including pubertal suppression and hormone therapy requiring that TGE youth and their parents participate in informed consent and decision making. While youth must demonstrate the ability to understand and appreciate treatment options, risks, benefits, and alternatives as well as make and express a treatment choice, standardized approaches to assess the capacity of TGE youth to consent or assent in clinical practice are not routinely used. This scoping (...) review identified the currently available data regarding adolescent capacity to consent to gender-affirming medical treatments. Articles relevant to assessing adolescent capacity for clinical decision-making were identified using OVID Medline, Web of Science, and PubMed. Articles were reviewed and thematically analyzed. Eight relevant articles were identified using three tools for measuring adolescent clinical decision-making capacity: Measure of Understanding, Measure of Competence, and MacArthur Competence Assessment Tool (MacCAT). These studies explored hypothetical treatment decisions, mental health treatment decisions, HIV treatment decisions, genetic testing decisions, and gender-affirming medical decisions. Only one study specifically examines the capacity of TGE youth to consent to medical treatments. Age was correlated with capacity in most, but not all studies. Other studies found cognitive measures (IQ, literacy, numeracy) may impact important aspects of capacity (understanding and reasoning). For clinicians caring for TGE youth, tools such as the MacArthur Competence Assessment Tool for Treatment (MacCAT-T) may prove useful, in conjunction with consideration of youth developmental abilities and utilization of shared decision-making practices. A standardized, collaborative approach to assessing TGE youth capacity would benefit TGE youth and their parents, and allow clinicians to more easily resolve ethical concerns. (shrink)

The data produced by the scientific community impacts on academia, clinicians, and the general public; therefore, the scientific community and other regulatory bodies have been focussing on ethical codes of conduct. Despite the measures taken by several research councils, unethical research, publishing and/or reviewing behaviours still take place. This exploratory study considers some of the current unethical practices and the reasons behind them and explores the ways to discourage these within research and other professional disciplinary bodies. These interviews/discussions with PhD (...) students, technicians, and academics/principal investigators were conducted mostly in European higher education institutions including UK, Italy, Ireland, Portugal, Czech Republic and Netherlands.Through collegiate discussions, sharing experiences and by examining previously published/reported information, authors have identified several less reported behaviours. Some of these practices are mainly influenced either by the undue institutional expectations of research esteem or by changes in the journal review process. These malpractices can be divided in two categories relating to methodological malpractices including data management, and those that contravene publishing ethics. The former is mostly related to “committed bias”, by which the author selectively uses the data to suit their own hypothesis, methodological malpractice relates to selection of out-dated protocols that are not suited to the intended work. Although these are usually unintentional, incidences of intentional manipulations have been reported to authors of this study. For example, carrying out investigations without positive controls; but including these from a previous study. Other methodological malpractices include unfair repetitions to gain statistical significance, or retrospective ethical approvals. In contrast, the publication related malpractices such as authorship malpractices, ethical clearance irregularities have also been reported. The findings also suggest a globalised approach with clear punitive measures for offenders is needed to tackle this problem. (shrink)

Nancy Gayer, M F Burnyeat; Play and Pleasure, Journal of Philosophy of Education, Volume 5, Issue 1, 30 May 2006, Pages 29–36, https://doi.org/10.1111/j.1467-97.

As concerns about the negative health effects of unhealthy eating, overweight and obesity have increased, so too have policy efforts to promote healthy eating. Federal, state, and local governments have proposed and implemented a variety of healthy eating policies. Many of these policies are controversial, facing objections that range from the practical (e.g., the policy won’t succeed at improving people’s diets) to the ethical (e.g., the policy is paternalistic or inequitable). Especially controversial have been policies limiting the options offered in (...) the marketplace, limiting access to certain options, or providing disincentives for the purchase of certain options. Examples of such policies include proposed .. (shrink)

We performed three experiments to investigate whether adjectives can modulate the sensorimotor activation elicited by nouns. In Experiment 1, nouns of graspable objects were used as stimuli. Participants had to decide if each noun referred to a natural or artifact, by performing either a precision or a power reach‐to‐grasp movement. Response grasp could be compatible or incompatible with the grasp typically used to manipulate the objects to which the nouns referred. The results revealed faster reaction times (RTs) in compatible than (...) in incompatible trials. In Experiment 2, the nouns were combined with adjectives expressing either disadvantageous information about object graspability (e.g., sharp) or information about object color (e.g., reddish). No difference in RTs between compatible and incompatible conditions was found when disadvantageous adjectives were used. Conversely, a compatibility effect occurred when color adjectives were combined with nouns referring to natural objects. Finally, in Experiment 3 the nouns were combined with adjectives expressing tactile or shape proprieties of the objects (e.g., long or smooth). Results revealed faster RTs in compatible than in incompatible condition for both noun categories. Taken together, our findings suggest that adjectives can shape the sensorimotor activation elicited by nouns of graspable objects, highlighting that language simulation goes beyond the single‐word level. (shrink)

Background There is ongoing debate regarding how moral distress should be defined. Some scholars argue that the standard “narrow” definition overlooks morally relevant causes of distress, while others argue that broadening the definition of moral distress risks making measurement impractical. However, without measurement, the true extent of moral distress remains unknown. Research aims To explore the frequency and intensity of five sub-categorizations of moral distress, resources used, intention to leave, and turnover of nurses using a new survey instrument. Research design (...) A mixed methods embedded design included a longitudinal, descriptive investigator-developed electronic survey with open-ended questions sent twice a week for 6 weeks. Analysis included descriptive and comparative statistics and content analysis of narrative data. Participants Registered nurses from four hospitals within one large healthcare system in Midwest United States. Ethical considerations IRB approval was obtained. Results 246 participants completed the baseline survey, 80 participants provided data longitudinally for a minimum of 3 data points. At baseline, moral-conflict distress occurred with the highest frequency, followed by moral-constraint distress and moral-tension distress. By intensity, the most distressing sub-category was moral-tension distress, followed by “other” distress and moral-constraint distress. Longitudinally, when ranked by frequency, nurses experienced moral-conflict distress, moral-constraint distress, and moral-tension distress; by intensity, scores were highest for moral-tension distress, moral-uncertainty distress, and moral-constraint distress. Of available resources, participants spoke with colleagues and senior colleagues more frequently than using consultative services such as ethics consultation. Conclusions Nurses experienced distress related to a number of moral issues extending beyond the traditional understanding of moral distress (as occurring due to a constraint) suggesting that our understanding and measurement of moral distress should be broadened. Nurses frequently used peer support as their primary resource but it was only moderately helpful. Effective peer support for moral distress could be impactful. Future research on moral distress sub-categories is needed. (shrink)

En los más disímiles contextos universitarios, se generan hoy programas para mejorar los desempeños de los docentes en el proceso formativo; pero, infortunadamente estos no siempre resultan en un mejoramiento de la práctica cotidiana de las universidades, sobre todo en la calidad de la formación de los profesionales. De este hecho, el propósito del presente artículo está dado en realizar una valoración de las principales influencias epistemológicas en lo relativo a la profesionalización del docente universitario y develar aquellos desempeños idóneos (...) esenciales que deben poseer en este nivel de educación como expresión de las competencias que deben desarrollar. Today, in most diverse university contexts, programs are developed to improve the performance of professors in the educational process; but unfortunately, they do not always result in improving the daily practice of universities, especially in the quality of professionals training. Of this fact, the purpose of the present article is to carry out a valuation of the main epistemological influences related to the professionalization of universities` professors; and to determine the main essential suitable performances these professionals should have as an expression of the competences they must develop. (shrink)

When classes of structures are not first-order definable, we might still try to find a nice description. There are two common ways for doing this. One is to expand the language, leading to notions of pseudo-elementary classes, and the other is to allow infinite conjuncts and disjuncts. In this paper we examine the intersection. Namely, we address the question: Which classes of structures are both pseudo-elementary and ${\mathcal {L}}_{\omega _1, \omega }$ -elementary? We find that these are exactly the classes (...) that can be defined by an infinitary formula that has no infinitary disjunctions. (shrink)

Moshe Tati, a sanitation worker in Jerusalem, was among the first of more than a thousand mortally sick Israelis who signed up for illicit and clandestine ‘transplant tour’ packages that included: travel to an undisclosed foreign and exotic setting; five-star hotel accommodation; surgery in a private hospital unit; a ‘fresh’ kidney purchased from a perfect stranger trafficked from a third country. Although Tati’s holiday turned into a nightmare and he had to be emergency air-lifted from a rented transplant unit in (...) a private hospital in Adana, Turkey back to Israel, Moshe became a poster-boy of transplant tourism for the next decade. João Cavalcanti was among the first of 38 residents of the slums of Recife recruited by retired military Captain Ivan da Silva and his sidekick Captain Gadddy Tauber to travel to Durban, South Africa to provide a spare kidney to an Israeli transplant tourist in Durban. This article examines the logics and practices through which kidney buyers and kidney sellers, organs brokers, surgeons and their accessories convince themselves that they are engaged in an illegal but still mutually beneficial ‘medical-recreational’ adventure, an ‘extreme medical sport’ of sorts. While life, health and survival motivate ‘transplant tourism’, a euphemism for human trafficking in spare body parts, the freedom to roam, mobility, is an essential feature of transplant tours for kidney buyers and kidney sellers. (shrink)

Public health ethics, like the field of public health it addresses, traditionally has focused more on practice and particular cases than on theory, with the result that some concepts, methods, and boundaries remain largely undefined. This paper attempts to provide a rough conceptual map of the terrain of public health ethics. We begin by briefly defining public health and identifying general features of the field that are particularly relevant for a discussion of public health ethics.Public health is primarily concerned with (...) the health of the entire population, rather than the health of individuals. Its features include an emphasis on the promotion of health and the prevention of disease and disability; the collection and use of epidemiological data, population surveillance, and other forms of empirical quantitative assessment; a recognition of the multidimensional nature of the determinants of health; and a focus on the complex interactions of many factors—biological, behavioral, social, and environmental—in developing effective interventions. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)