Current regulations and guidelines identify specific subject populations as vulnerable. Regulations and guidelines generally stipulate protections with regard to the process of informed consent. Recent clinical trials suggest that satisfying the legal requirements for additional safeguards may not protect subjects to the extent we may desire. We present proposed guidelines for the protection of decisionally impaired subjects throughout the course of the trial.

In July 2019, Stella Creasy MP and her team succeeded in attaching an amendment to a largely administrative bill which would require the UK government to liberalise abortion laws in Northern Ireland by 21 October 2019, provided the Northern Ireland government does not resume before that date.1 The amendment succeeded in the Commons, 332 votes to 99 and later, with some adjustments, in the Lords, 182 votes to 37. The Bill received Royal Assent on 24 July 2019. In Northern Ireland, (...) abortion remains a criminal offence punishable by up to life imprisonment in all except exceptional circumstances, that is, where it is ‘necessary to preserve the life of the woman’ or where there is a ‘risk of serious adverse effect which is either long term or permanent’.2 The law makes no provision for women who are pregnant as a result of rape, incest or in the case of fatal fetal abnormality. Because there is a lack of clarity around which circumstances or conditions would have a sufficiently ‘serious and long-term adverse effect’, it has been argued that the law has had a ‘chilling effect’ on service provision.3 As a result, only 13 abortions were performed in Northern Ireland in 2018/2019.4 Instead, more than 1000 women travelled from Northern Ireland to England to access legal abortion services.5 A recent review of the law in Northern Ireland concluded that this situation disadvantages women who cannot afford to or are unable to travel.3 Women are also reportedly purchasing abortifacients unlawfully online, exposing them to the risk of prosecution as well as to risks where the pills are unsafe or lead to complications. Creasey’s amendment requires the Secretary of State for …. (shrink)

The British Medical Association and Royal College of Physicians have published new guidance, endorsed by the General Medical Council, on decision-making about clinically assisted nutrition and hydration and adults who lack capacity to consent. The development of the guidance follows a series of legal cases which has created confusion about the precise circumstances in which an application to the court is required before CANH is withdrawn which has culminated with the decision of the Supreme Court in National Health Service Trust (...) versus Y. 1 This confirmed that there is no requirement to go to court, providing there is agreement as to the patient’s best interests, the provisions of the Mental Capacity Act 2005 have been observed, and the relevant professional guidance has been followed. The new guidance covers all decisions to start, restart, continue, or stop providing CANH in patients who are not imminently dying, in circumstances where CANH is the primary life-sustaining treatment being provided. It goes beyond the category of patients in permanent vegetative state or minimally conscious state who have previously been the subject of court applications, and also covers decisions for patients with neurodegenerative conditions and patients who have suffered a sudden onset brain injury in addition to having multiple comorbidities or general frailty which is likely to impact on life expectancy. It provides a clear statement of doctors’ legal responsibilities, covers the importance of robust best interests’ assessments and sets out the process to be followed for sufficient independent scrutiny of decisions. In light of some of the identified problems with decisions about CANH, a particular focus of the guidance is on the importance of regular best interests’ assessments, and it provides detailed practical guidance about how to approach these. The development of …. (shrink)

During a pandemic, where there is widespread human infection, various and varying measures are taken that are targeted at public health objectives. During the early stages of a pandemic, these objectives may focus on containing the disease and minimizing its spread, but they may switch to mitigation as the emergent infectious disease takes hold in a population. There has been considerable debate and elucidation of the ethical principles and framework for the various responses including the need to fast track research (...) and vaccine development. However, the measures imposed during a pandemic would have unintended and untoward effect on ongoing clinical research. For example, precautionary measures, such as social distancing, may hamper ongoing clinical research, because recruitment and participation of patients and healthy volunteers is a potential source of virus spread. In this paper, we argue that a framework is needed to ensure the continuity of such research. Such a framework that considers the pertinent issues would need the ‘buy in’ of the key stakeholders (policy makers, funding agencies, institutional authorities, researchers and subjects) to ensure that the issues that are ethically relevant to pandemic planning would not be neglected or overlooked. (shrink)

Placebo-controlled surgical trials can provide important information about the efficacy of surgical interventions. However, they are ethically contentious as placebo surgery entails the risk of harms to recipients, such as pain, scarring or anaesthetic misadventure. This has led to claims that placebo-controlled surgical trials are inherently unethical. On the other hand, without placebo-controlled surgical trials, it may be impossible to know whether an apparent benefit from surgery is due to the intervention itself or to the placebo effect.

Has biopolitics actually become thanatopolitics, a field of study obsessed with death? Is there something about the nature of biopolitical thought today that makes it impossibile to deploy affirmatively? If this is true, what can life-minded thinkers put forward as the merits of biopolitical reflection? These questions drive Improper Life.Campbell argues that a "crypto-thanatopolitics" can be teased out of Heidegger's critique of technology and that some of the leading scholars of biopolitics---including Michel Foucault, Giorgio Agamben, and Peter Sloterdijk---have been (...) substansively influenced by Heidegger's thought, particularly his reading of proper and improper writing. In fact, Campbell shows how all of these philosophers have pointed toward a tragic, thanatopolitical destination as somehow an inevitable result of technology. But in Improper Life he articulates a corrective biopolitics that can begin with rereadings of Foucault, Freud, and Gilles Deleuze. Throughout Improper Life, Campbell insists that biopolitics can become more positive and productively asserts an affirmation techne not thought through thanatos but rather through bios. (shrink)

"In techne of giving, Timothy Campbell elaborates a notion of generosity as way of responding to contemporary biopower. Reading films from Visconti, Rossellini, and Antonioni, he both updates their political lexicon while adopting them as models able to push back against neoliberal forms of gift-giving"--.

This article explores the accounts of Canadian-trained health professionals working in humanitarian and development organizations who considered not treating a patient or group of patients because of resource limitations. In the narratives, not treating the patient(s) was sometimes understood as the right thing to do, and sometimes as wrong. In analyzing participants’ narratives we draw attention to how medications and equipment are represented. In one type of narrative, medications and equipment are represented primarily as scarce resources; in another, they are (...) represented as patient care. In the contexts respondents were working, medications and equipment were often both patient care interventions and scarce resources. The analytic point is that health professionals tend to emphasize one conceptualization over the other in coming to assert that not treating is right, or wrong. Rendering tacit ethical frameworks more explicit makes them available for reflection and debate. (shrink)

First published in 2002. Routledge is an imprint of Taylor & Francis, an informa company.

Examines intelligent design as a science, a philosophy and a movement for educational reform. Central to all three aspects of ID is its claim that, if science education is to be other than state-sponsored propaganda, a distinction must be drawn between empirical science and materialist philosophy.

Although the overwhelming majority of terminally ill patients in Oregon who seek a physician's aid in dying are enrolled in hospice programs, hospices do not take a major role in this practice. An examination of fifty‐five Oregon hospices reveals that both legal and moral questions prevent hospices from collaborating fully with physician‐assisted death.

Middle childhood, the period from 6 to 12 years of age, is defined socially by increasing autonomy and emotional regulation, somatically by the development of anatomical structures for subsistence, and endocrinologically by adrenarche, the adrenal production of dehydroepiandrosterone (DHEA). Here I suggest that DHEA plays a key role in the coordinated development of the brain and body beginning with middle childhood, via energetic allocation. I argue that with adrenarche, increasing levels of circulating DHEA act to down-regulate the release of glucose (...) into circulation and hence limit the supply of glucose which is needed by the brain for synaptogenesis. Furthermore, I suggest the antioxidant properties of DHEA may be important in maintaining synaptic plasticity throughout middle childhood within slow-developing areas of the cortex, including the insula, thamalus, and anterior cingulate cortex. In addition, DHEA may play a role in the development of body odor as a reliable social signal of behavioral changes associated with middle childhood. (shrink)

The Ozark Highlands’ karst topography of caves and hollows has provided refuge and escape for myriad peoples seeking to evade mainstream society throughout history, ranging from displaced Native Americans to counter-cultural back-to-the-landers. This ethnographic and ethnohistorical research moves beyond the popular misconception that the back-to-the-land movement merely represented an offshoot of the countercultural revolution of the 1960s and 1970s, and situates it within a deeper historical context. In this paper, I present the Arcadian evocations in various Ozark-related media and how (...) they relate to homesteading in the region, and demonstrate the shared agrarian values among diverse waves of agrarian Ozark homesteaders, recent and historical. (shrink)

The problem of suffering is essentially a problem in philosophical theology. For many philosophical systems the phenomena of suffering set no special problem at all. The most influential philosophies of the present age, for example, have almost nothing to say on the subject—and there is no reason why, on their metaphysical; principles, they should say anything. The problem is a relevant one only for those philosophies which claim to be in at least general accord with the “religious interpretation of the (...) universe.” But for them it is crucial. Given a Weltanschauung like that of Absolute Idealism, for which the ultimate principle from which all things derive their being is an Infinite and Perfect Spirit, and it becomes at once a clear obligation to offer some explanation of how we are to reconcile the Goodness of God with the existence in the world of so much suffering which is prima facie just bad. As we all know, the problem is an extraordinarily hard one to solve. But, inasmuch as the religious interpretation of the universe demands its solution as a condition of its own possibility, its importance is proportionate to its difficulty. (shrink)

This case describes an adolescent in a crisis of a chronic medical condition whose situation is complicated by substance abuse and mental illness. D. Micah Hester provides an analytic approach, teasing apart the multiple layers of medical, developmental, and moral issues at hand and describing possible responses and outcomes. Amy T. Campbell examines existing legal guidelines for adolescent decision making, arguing that greater space exists for clinical discretion in these matters than commonly thought. Cheryl D. Lew discusses the development (...) of agency in adolescent patients, the ideal of autonomous decision making in the context of impairment and chronic illness, and the obligation of healthcare teams to examine an adolescent patient’s decisions in relation to her identity. (shrink)

In February 2020, the British Medical Association will be surveying members for their views on what the BMA’s position on physician-assisted dying should be. The BMA is currently opposed to physician-assisted dying in all its forms, a position that was agreed in 2006 at the annual representative meeting, the Association’s policy-making conference.1 As previously reported in Ethics briefing,2 the decision to survey members follows a motion passed at last year’s ARM which called on the BMA to “carry out a poll (...) of members to ascertain their views on whether the BMA should adopt a neutral position with respect to a change in the law on assisted dying”. The results from the survey will not determine BMA policy. Rather, the results be published ahead of this year’s ARM and provided to those attending to inform a debate and discussion on the BMA’s policy position. More information about the survey, including a briefing pack of useful information, and information for BMA members on how to participate can be found online at www.bma.org.uk/PAD. ### High Court rejects Judicial reviews on assisted suicide The High Court has refused permission for two separate challenges to the law on assisted suicide in the UK to proceed to a full hearing. In the first case, Phil Newby, who has motor neuron disease, applied for judicial review of the law on assisted suicide and asked for the court to carry out a detailed examination of what he termed “legislative facts” – that is, an examination of the existing evidence on the “costs, risks and benefits” of regulating assisted suicide – including a cross-examination of relevant expert witnesses.1 Handing down the judgement, Lord Justice Irwin and Mrs Justice May, held that assisted dying …. (shrink)

This anthology collects the texts that defined the concept of biopolitics, which has become so significant throughout the humanities and social sciences today. The far-reaching influence of the biopolitical—the relation of politics to life, or the state to the body—is not surprising given its centrality to matters such as healthcare, abortion, immigration, and the global distribution of essential medicines and medical technologies. Michel Foucault gave new and unprecedented meaning to the term "biopolitics" in his 1976 essay "Right of Death and (...) Power over Life." In this anthology, that touchstone piece is followed by essays in which biopolitics is implicitly anticipated as a problem by Hannah Arendt and later altered, critiqued, deconstructed, and refined by major political and social theorists who explicitly engaged with Foucault's ideas. By focusing on the concept of biopolitics, rather than applying it to specific events and phenomena, this Reader provides an enduring framework for assessing the central problematics of modern political thought. _Contributors_. Giorgio Agamben, Hannah Arendt, Alain Badiou, Timothy Campbell, Gilles Deleuze, Roberto Esposito, Michel Foucault, Donna Haraway, Michael Hardt, Achille Mbembe, Warren Montag, Antonio Negri, Jacques Rancière, Adam Sitze, Peter Sloterdijk, Paolo Virno, Slavoj Žižek. (shrink)

Over the past several decades, geneticists have succeeded in identifying the genetic mutations associated with disease. New strategies for treatment, including gene transfer and gene therapy, are under development. Although genetic science has been welcomed for its potential to predict and treat disease, interventions may become ethically objectionable if they threaten to alter characteristics that are distinctively human. Before we can determine whether or not a genetic technique carries this risk, we must clarify what it means to be “human”. This (...) paper inquires how “humanness” has been defined within various academic fields. The views of several legal theoreists, scientists, bioethicists, psychologists, philosophers and anthropologists whose works seem to best reflect how “humanness” is understood in their respective fields of study are considered. Our survey attempts to chart a path for a more detailed study on the meaning of “humanness” in the future. (shrink)

I have chosen my topic for this evening with an eye to something rather more than its intrinsic philosophical interest. Modern man, as we are all painfully aware, is facing a crisis of peculiar gravity. Perhaps the odds are not so very heavy against a third world war followed by world collapse into anarchy and barbarism. At such a time the philosopher is bound to ask himself whether there is no contribution which his science can make towards the succour of (...) civilization. (shrink)

This essay argues that the antitrafficking movement's dominant rhetorical and conceptual framework of human trafficking as "sold sex" has significant limitations that deserve greater critical moral reflection. This framework overlooks key issues of social and economic injustice, and eclipses the experiences of marginalized people and communities, including immigrants and gay, lesbian, bisexual, transgender, intersex, and queer people, whose welfare and empowerment have been key concerns for progressive people of faith. By asking what insights progressive Christian social ethics might contribute to (...) shaping alternative perspectives on antitrafficking analysis and activism, we explore progressive Christian critiques of neoliberalism and feminist critiques of the heteronormative family as resources for crafting analyses of and responses to human trafficking that foreground queer, feminist, and antiracist commitments. (shrink)