Population-based research is enhanced by biological measures, but biological sampling raises complex ethical issues. The third British National Survey of Sexual Attitudes and Lifestyles (Natsal-3) will estimate the population prevalence of five sexually transmitted infections (STIs) (Chlamydia trachomatis, Neisseria gonorrhoeae, human papillomavirus (HPV), HIV and Mycoplasma genitalium) in a probability sample aged 16–44 years. The present work describes the development of an ethical approach to urine testing for STIs, including the process of reaching consensus on whether to return results. The (...) following issues were considered: (1) testing for some STIs that are treatable and for which appropriate settings to obtain free testing and advice are widely available (Natsal-3 provides all respondents with STI and healthcare access information), (2) limits on test accuracy and timeliness imposed by survey conditions and sample type, (3) testing for some STIs with unknown clinical and public health implications, (4) how a uniform approach is easier to explain and understand, (5) practical difficulties in returning results and cost efficiency, such as enabling wider STI testing by not returning results. The agreed approach, to perform voluntary anonymous testing with specific consent for five STIs without returning results, was approved by stakeholders and a research ethics committee. Overall, this was acceptable to respondents in developmental piloting; 61% (68 of 111) of respondents agreed to provide a sample. The experiences reported here may inform the ethical decision making of researchers, research ethics committees and funders considering population-based biological sampling. (shrink)

Plato famously characterized philosophy as practice for dying and death; contemporary philosophers in bioethics have produced a vast literature on the quest for a good death. Yet there is a relativ...

Issues surrounding the inclusion of transgender and intersex athletes in the women’s category in sport have spurred vigorous, and sometimes vicious, debate. The loudest voices on one edge of the de...

The 2024 Paris Olympic Games generated spirited, often misguided and ill-informed, discussion regarding regulations governing the eligibility of athletes with differences of sex development (DSD)....

Because health care professions exist to provide a good for society, ethical questions are inherently part of them. Such professions and their members can be assessed based on how effective they are in developing knowledge and enacting practices that further the health and well‐being of individuals and society. The complexity of contemporary health care environments makes it important to prepare clinicians who can anticipate, recognize, and address problems that arise in practice or that prevent a profession from fulfilling its service (...) goals and obligations. Different health care professions have evolved distinct perspectives about appropriate goals for, and the purposes of, their clinicians, even when the goal of improving health and well‐being for society is shared across professions. While medicine and nursing goals are shared in principle, they differ in the particulars. Given the centrality to nursing of ethical questions, the profession has a collective responsibility to help clinicians at all levels of practice become ethically savvy and to reinforce their moral agency as needed. Both knowledge of nursing ethics and knowledge of the interdisciplinary field of bioethics are critical to nursing work. (shrink)

The insights provided by a multi-disciplinary mix of health professionals from an acute medical ward of a regional Australian hospital indicate the value in extending the role of Hospital Ethics Committees to incorporating both ethics consultation and ethics education. It is the hope and expectation that the findings will assist other HECs in a similar stage of development.

This article describes an artwork in progress; a digital video of synchronized visual patterns based in part on rhythmic practices that are said to reliably lead to a shifted state of consciousness. The artwork is being developed to further understand the correlation of rhythm and consciousness. The investigation is based on a comparative study of the following practices: ‘The Art of Memory’ and Raymon Llull’s thirteenth-century diagrammatic mnemonics, the Lucid Dreaming exercises developed at Stanford University and the African Yoruba rhythms (...) of ritualized possession. Throughout history, states of extreme lucidity, whether described as ‘ah-ha’ moments or life-transforming epiphanies, have been described with striking consistently and with such frequency that, rather than extraordinary, they seem to be fundamental to the human condition. The paradoxical state of lucid dreaming has been scientifically identified at Stanford University as a state of wakeful awareness that occurs during REM sleep, while dreaming. We might anticipate in the near future, the identification of a wakeful state of lucidity, a state as distinct from normal wakeful awareness as the state of dreaming. Those who have experienced altered states of consciousness can lend unique perspective and insight into the nature of consciousness. Analysis of practices that lead to such states add further insight. From running, to rhythmic breathing, to the circular movement of pilgrims at Mecca, to circular mosh pits, rhythmic activity is prevalent among practices that are said to lead to a shifted state of consciousness. The research suggests that in addition to rhythm itself, the relationship between rhythms is a significant factor corresponding to shifted states of consciousness. The digital video artwork discussed in this article might be thought of as a visualization of such rhythmic sequencing, and its development a creative method of inquiry. (shrink)

In recent years there has been an increasing critique of the philosophically based reasoning in bioethics which is known as principlism. This article seeks to make a postmodern contribution to this emerging debate by using notions of power and discourse to highlight the limits and superficiality of this , rationalistic mode of reflection. The focus of the discussion will be on the principle of autonomy. Recent doctoral research on a hospice organization (Karuna Hospice Service) will be used to contextualize the (...) debate to end-of life ethical dilemmas. The conclusion will be reached that the discursive richness of this organization's notion of autonomy or choice, which incorporates a holistic respect for the individual and the active creation of alternatives, can provide important insights to our understanding of autonomy in bioethics. The concern is raised that if autonomy is reified as a principle outside of the context of discourse, it may only complement the hegemonic power of biomedicine. (shrink)

Advances in life-sustaining medical technology as applied to neonatal cases frequently present ethical concerns with a strong emotional component. Neonates delivered in the gestation period of approximately 23held hostagemoral distress” regarding aggressive courses of treatment for some patients. Some of this distress results from a feeling of powerlessness regarding treatment decisions, coupled with a high intensity of hands-on contact with the patients and family. Lack of authority coupled with high responsibility may itself be a recipe for a different kind of (...) futility. (shrink)

This paper explores the bioethical issues associated with the diagnosis and treatment of vulvar cancer for Indigenous women in East Arnhem Land, Northern Territory, Australia. Based on a qualitative study of a vulvar cancer cluster of Indigenous women, the article highlights four main topics of bioethical concern drawn from the findings: informed consent, removal of body parts, pain management, and issues at the interface of Indigenous and Western health care. The article seeks to make a contribution towards Indigenous health and (...) bioethics and bring to light areas of further research. (shrink)

It is now common in health care for a diverse range of professions and disciplines to work together in regular and close contact. Thus, there are now calls in the literature for research that documents insights on the ethical dimension of multidisciplinary relationships. Recent Australian research has responded to this call by examining how a multidisciplinary team of health professionals define and operationalize the notion of ethics in an acute ward hospital setting. This article provides findings from the research study (...) that indicate that, although there is a shared conceptualization of ethics as "patient-centered care", there can be times of conflict and tension in determining what is best for the patient. The discussion begins to build an understanding of how a multidisciplinary mix of health professionals responds to ethical conflict and tension. The authors' hope and expectation is that, by keeping the research focus on what health professionals in a multidisciplinary team (MDT) actually do, rather than exclusively on how they philosophically think about ethical dilemmas, the insights can be translated into practical strategies that can be utilized to strengthen the process of ethical decision making within the health care system. (shrink)

A brief review and classification of technology in general begins the paper, followed by an application of the classification to two specific marathon case studies: the 2018 Boston marathon and the 2017 Nike Breaking2 Project marathon. Then concepts from an array of sport philosophers are discussed to suggest an explanation for why each of the case studies strikes us as problematic. The conclusion provides a reasonable explanation for our misgivings, as well as an indication of how we might evaluate sporting (...) endeavors in the face of increasing technological innovation. (shrink)

For qualitative researchers seeking the perspectives of people with unusual characteristics or circumstances, compliance with expectations about participant anonymity can be difficult, if not impossible. In the age of internet communications and emerging research methodologies, traditional strategies require ongoing re-examination to ensure cohesion between a project’s ethical framework and its research practice. This paper reflects on the approach to informed consent used in a study with parent carers whose children had high-level support needs. A two-step process of written consent was (...) developed in response to concerns about the possible re-identification of these parents as a result of their highly individual circumstances. This approach acknowledged the potential for identification, and maximised participants’ agency in choosing the level of risk that they were comfortable to accommodate. The paper discusses the researcher’s and participants’ responses to the adapted consent process and recommends that researchers and ethics review committees remain open to the development of collaborative and innovative approaches that are also culturally and contextually relevant, to enable people to contribute perspectives that might otherwise be silenced by the very ethical frameworks that purport to protect their interests. (shrink)

This article presents the findings of qualitative research which explored, from the mothers’ perspective, the process of decision-making about mode of delivery for a subsequent birth after a previous Caesarean Section. In contradiction to the clinical literature, the majority of mothers in this study were strongly of the opinion that a vaginal birth after caesarean (VBAC) posed a higher risk than an elective caesarean (EC). From the mothers’ perspective, risk discussions were primarily valuable for gaining support for their pre-determined choice, (...) rather than obtaining information. The findings posit ethical concerns with regards to informed consent and professional obstetric practice at a time when there is a documented and worrying trend towards an increase in births by caesarean section (CS). (shrink)

Medical ethics has traditionally been governed by two guiding, but sometimes conflicting, principlesthe Substituted Judgment Standard shows our concern for autonomy, whereas the Best Interest Standard shows our commitment to benevolence. Both standards are vulnerable to criticisms. Further, the principles can seem to offer conflicting prescriptions for action. The criticisms and conflict figure prominently in discussion of advance directive decisionmaking and Alzheimer's disease. After laying out each of the current standards and its problems, with Alzheimer's issues as my central concern, (...) I offer a new standard that avoids the problems while honoring our concerns for both autonomy and benevolence. (shrink)

There is a growing trend in Australia to require lawyers to certify reasonable prospects of success for the cases they bring and defend. New South Wales has led the way with the Legal Profession Act 2004 (NSW) Pt 3.2 Division 10 requiring legal practitioners to certify reasonable prospects of success in all claims for damages. The requirement places a significant onus on lawyers to make a judgment about the merits of a case before it is begun, yet the common law (...) has long provided mechanisms to ensure that cases without prospects of success do not go to trial. This article considers Australian legislative provisions requiring lawyers to certify reasonable prospects of success of cases. It examines the application of the NSW legislation by the courts highlighting the difficulties of interpretation of what constitute 'reasonable prospects of success' and the application of the legislation in the context of the dynamic litigation process. It is argued that these legislated obligations on lawyers will have a detrimental effect on access to justice by denying parties, in particular plaintiffs, the opportunity to have their cases properly and fully determined in the courts. This article examines common law mechanisms for dissuading cases without prospects and argues that the general law is an effective system for ensuring that cases without prospects of success are not maintained. The Australian experience is instructive for consideration of optimal reform packages for the administration of justice and to evaluate the role of any litigation lawyer within the judicial and court process. (shrink)

Roller derby, once known for scripted theatricality that made it more like a stage play than a sport, has reinvented itself as a legitimate athletic endeavour. Since its rebirth as the Women's Flat Track Derby Association in the early 2000s, it has experienced exponential growth, from 30 flat track derby leagues in 2005 to more than 450 leagues in 2010. This translates to more than 15,000 skaters worldwide. Roller derby provides a unique case of a women's sport that is not (...) derived from, or a diminutive version of, a men's sport, proudly stating as its philosophy a commitment to be?by the skaters, for the skaters?. This do-it-yourself aspect opens the way for examination of what a sport wholly created by women looks like and how that differs from sports created by men. The WFTDA claims that roller derby is empowering and revolutionary, yet some critics have claimed that the skaters reinforce rather than dismantle gender stereotypes. Using tools from previous gender critiques, I analyse several aspects of roller derby for their emancipatory potential and conclude that, while not completely unproblematic, the sport can function as a force for reshaping ideas about women, femininity, and sport. (shrink)

In a qualitative empirical research project on youth worship, we discovered that 'being together' is primary quality of youth worship. This primary quality consists of at least four aspects. Firstly, community is celebrated through physical presence. More specifically, the physical presence of siblings plays an important part in the participation of youth in worship. Secondly, an empathetic and emotional aspect is essential for adolescents. 'Being together' in youth worship means being together in unity and trust and in equality, as kindred (...) spirits. Thirdly, 'being together' in youth worship yields possibilities to cross social and ecclesiological boundaries. Fourthly, there is a theological aspect in 'being together' that could be described as 'sharing faith and being in God's presence'. (shrink)

In this paper, we examine the case of Ronda Rousey, a high profile female Mixed Martial Arts fighter in the Ultimate Fighting Championship. We argue that Rousey represents a female athlete who can be considered a gender transgressor yet simultaneously a Glamazon. The case of Rousey will be applied to gender transgressor theories to demonstrate that Rousey counters traditional discourse which holds that exhibiting stereotypically masculine traits implies not being an authentic woman. Female fighters face criticisms for being “unfeminine” or (...) “manly” because they participate in such an aggressive sport. Despite her gender divergent behaviour, as much as she transgresses, Rousey is also pinned by sporting and societal sexist culture that reinforces sex binaries and exposes pressures to adhere to hyperfemininity and heterosexual ideals. Finally, using the notions of self and power found in Michel Foucault’s later work as a springboard, we examine whether Rousey’s embrace of the Glamazon identity is an act of autonomy or evidence of false consciousness. (shrink)

As an artist I am interested in creative states of consciousness and the direct expression of altered states of consciousness in forms such as musical improvisation and the automatic writings and drawings of the Surrealist Artists. I have been investigating a particular spectrum of altered states characterized by an enhanced experience where out-of-the-ordinary information is accessed or an enhanced ability is realized beyond what would ordinarily be possible. Within this realm we would find the ‘peak performance’ state of athletes and (...) musicians, as well as a state of intellectual inspiration where a complex problem is solved and also the phenomenon of premonition. It is related to the ‘flow state’ as described in Flow, The Psychology of Optimal Experience (Mihályi Csíkszentmihályi, 1990) and the experience of the American clairvoyant Edgar Cayce who resolved complex medical ailments when in a self-induced hypnotic trance. Additional examples include Haitian Vodou ritualized possession and all experiences where healing and foretelling of the future takes place through a communion with spirits. It is a broad spectrum that has been described in various ways throughout history and within all cultures. But though the descriptions vary, this spectrum of consciousness shares the common characteristic of accessing extraordinary information or demonstrating extraordinary skill or ability. This article is an attempt to help clarify and define this particular spectrum of consciousness. (shrink)