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)

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

Cells can change their function by rapidly modulating the levels of certain proteins at the plasma membrane. This rapid modulation is achieved by using a specialised trafficking process called constitutive cycling. The constitutive cycling of a variety of transmembrane proteins such as receptors, channels and transporters has recently been directly demonstrated in a wide range of cell types. This regulation is thought to underlie important biological phenomena such as learning and memory, gastric acid secretion and water and blood glucose homeostasis. (...) This review discusses the molecular mechanisms of constitutive cycling, its regulation by extracellular agents such as hormones and its misregulation in disease states. BioEssays 25:39–46, 2003. © 2002 Wiley Periodicals, Inc. (shrink)

Too much contemporary bioethical discourse is weak on science, lazily citing and adopting science fiction scenarios rather than science facts in the framing of analyses and policies. We challenge bioethicists to take more seriously the role of providing informed insight into and oversight over contemporary science and its implications and applications. Bioethicists must work harder to understand the fast-changing truths and limits of basic science, and they must incorporate only appropriate and authentic science into their discourse, just as they did (...) in the past when addressing the quandaries of clinical medicine. The field of bioethics is not so old and entrenched that its future is assured. Bioethicists must make themselves useful to society in order to deserve and retain the public's trust. They can best do this by ensuring that decision making and public policy are grounded in facts, not fictions and fantasies. (shrink)

Executive Summary There is a general perception that biomedical research has not given the same attention to the health problems of women that it has given ...

BackgroundHuntington’s disease has a poor prognosis. For HD patients in the Netherlands, one way of dealing with their poor prognosis is by drawing up an advance euthanasia directive. Little is known about the perspectives of HD patients on their AED.AimTo gain insight into patients’ views on and attitudes towards their AED, and changes over time.MethodsA longitudinal qualitative interview study using 1 to 6 semi-structured interviews over a period of maximum three years. Nine HD patients who either had an AED or (...) were thinking about drawing it up participated in this study.ResultsWe identified two themes that characterize patients’ perspectives on their AEDs: general character of the AED; uncertainty around their AED. Ad The conditions that the participants described in their AED were generally not very specific for the person. Mostly they were general notions of unbearable suffering. Familiarity with HD in the family could play a role in drawing up an AED. Ad Participants generally were aware of the tentative character of their AED and could have doubts concerning their own willingness or the willingness of others in the future. Sometimes these doubts were so great, that it prevented them from drawing up an AED. However, patients did not alter their AED during the follow-up period or changed in their view or attitude on their AED.ConclusionHD patients that draw up an AED usually describe general conditions for euthanasia and recognize that these conditions may change as the disease progresses. An AED or the wish to draw one up may be a good conversation starter for conversations about goals and preferences for future care. (shrink)

While stigmatisation is universal, stigma research in low- and middle-income countries (LMIC) is limited. LMIC stigma research predominantly concerns health-related stigma, primarily regarding HIV/AIDS or mental illness from an adult perspective. While there are commonalities in stigmatisation, there are also contextual differences. The aim of this study in DR Congo (DRC), as a formative part in the development of a common stigma reduction intervention, was to gain insight into the commonalities and differences of stigma drivers (triggers of stigmatisation), facilitators (factors (...) positively or negatively influencing stigmatisation), and manifestations (practices and experiences of stigmatisation) with regard to three populations: unmarried mothers, children formerly associated with armed forces and groups (CAAFAG), and an indigenous population. Group exercises, in which participants reacted to statements and substantiated their reactions, were held with the ‘general population’ (15 exercises, n = 70) and ‘populations experiencing stigma’ (10 exercises, n = 48). Data was transcribed and translated, and coded in Nvivo12. We conducted framework analysis. There were two drivers mentioned across the three populations: perceived danger was the most prominent driver, followed by perceived low value of the population experiencing stigma. There were five shared facilitators, with livelihood and personal benefit the most comparable across the populations. Connection to family or leaders received mixed reactions. If unmarried mothers and CAAFAG were perceived to have taken advice from the general population and changed their stereotyped behaviour this also featured as a facilitator. Stigma manifested itself for the three populations at family, community, leaders and services level, with participation restrictions, differential treatment, anticipated stigma and feelings of scapegoating. Stereotyping was common, with different stereotypes regarding the three populations. Although stigmatisation was persistent, positive interactions between the general population and populations experiencing stigma were shared as well. This study demonstrated utility of a health-related stigma and discrimination framework and a participatory exercise for understanding non-health related stigmatisation. Results are consistent with other studies regarding these populations in other contexts. This study identified commonalities between drivers, facilitators and manifestations—albeit with population-specific factors. Contextual information seems helpful in proposing strategy components for stigma reduction. (shrink)

Faculty members in science, technology, engineering, and mathematics disciplines are typically expected to pursue grant funding and publish to support their research or teaching agendas. Providing effective professional development programs on grant preparation and management and on research publications is crucial. This study shares the design and implementation of such a program for Native STEM faculty from two tribal colleges and one public, non-tribal, Ph.D. granting institution during a 3-year period. The overall development and implementation of the program is centered (...) on the six R’s Indigenous framework – Respect, Relationship, Representation, Relevance, Responsibility, and Reciprocity. The role of NAF-STEM and their interactions with the program, as members of the community formed by their participation, impacted the program. Their practices and the program co-emerged over time, each providing structure and meaning for the other. Through such reciprocity, NAF-STEM and the program research team continually refined the program through their mutual engagement. They took on the shared responsibility of the program while they participated in and shaped its practices. The process and results of formative and summative assessment and the impact of COVID-19 on the program are reported. Results of the program offer lessons on the implementation of six R’s framework in professional development at institutions of higher education. (shrink)

Three experiments are reported which show that in certain contexts subjects reject instances of the valid modus ponens and modus tollens inference form in conditional arguments. For example, when a conditional premise, such as: If she meets her friend then she will go to a play, is accompanied by a conditional containing an additional requirement: If she has enough money then she will go to a play, subjects reject the inference from the categorical premise: She meets her friend, to the (...) conclusion: She will go to a play. Other contexts suppress the conditional fallacies. The first experiment demonstrates the effects of context on conditional reasoning. The second experiment shows that the inference suppression disappears when the categorical premise refers to both of the antecedents, such as: She meets her friend and she has enough money. In this case, subjects make both the valid inferences and the fallacies, regardless of the contextual information. The third experiment establishes that when subjects are given general information about the duration of a situation in which a conditional inducement was uttered, such as: If you shout then I will shoot you, they reject both the valid inferences and the fallacies. The results suggest that the interpretation of premises plays an even more central role in reasoning than has previously been admitted. Trois expériences montrent que dans certains contextes les sujets rejettent des instances valides de modus ponens et de modus tollens dans des énoncés conditionnels. Par exemple, quand une prémisse conditionnelle comme: Si elle rencontre son ami, alors elle ira jouer, est accompagnée par une phrase contenant une condition supplémentaire: Si elle a assez d'argent, alors elle ira jouer, les sujets rejettent l'inférence liant la prémisse catégorielle: Elle rencontre son ami, à la conclusion: Elle ira jouer. D'autres contextes éliminent également les inférences conditionnelles fallacieuses. La premiére expérience démontre l'effet du contexte sur la raisonnement conditionnel. La deuxiéme expérience montre que la suppression de l'inférence disparait quand la prémisse catégorielle fait référence aux deux antécédants, comme: Elle rencontre son ami et elle a assez d'argent. Dans ce cas, les sujets font aussi bien les inférences valides et fallacieuses, quelle que soit l'information contextuelle. La troisiéme expérience établit que quand l'on donne aux sujets des informations générales à propos de la durée d'une situation dans laquelle une conditionnelle a été prononcée, comme Si tu cries, alors je te tire dessus, ils rejettent autant les inférences valides que les inférences fallacieuses. Ces résultats suggèrent que l'interprétation des prémisses joue un rŏle encore plus central dans le raisonnement que l'on admettait auparavant. (shrink)

Ruth M Jonathan; Two Concepts of Education? A reply to D. J. O’Connor, Journal of Philosophy of Education, Volume 16, Issue 2, 30 May 2006, Pages 147–154, https.

The bioethical principle of autonomy is problematic regarding the future of the embryo who lacks the ability to self-advocate but will develop this defining human capacity in time. Recent experiments explore the use of clustered regularly interspaced short palindromic repeats /Cas9 for germline engineering in the embryo, which alters future generations. The embryo’s inability to express an autonomous decision is an obvious bioethical challenge of germline engineering. The philosopher Joel Feinberg acknowledged that autonomy is developing in children. He advocated that (...) to reserve this future autonomy, parents should be guided to make ethical decisions that provide children with open futures. Here, Feinberg’s 1980 open future theory is extended to the human embryo in the context of CRISPR germline engineering. Although the embryo does not possess the autonomous decision-making capacity at the time of germline engineering, the parental decision to permanently change the unique genetic fabric of the embryo and subsequent generations disregards future autonomy. Therefore, germline engineering in many instances is objectionable considering Feinberg’s open future theory. (shrink)

Background: The classical symptom specificity hypothesis (Blatt, 1974) links obsessional symptoms to autonomous interpersonal behavior. Inconsistent findings from cross-sectional group studies on symptom specificity have previously been associated with several conceptual and methodological limitations intrinsic to nomothetic research. Previous empirical case research reported ambivalences between autonomous and dependent interpersonal behavior in obsessional pathology. Aim and Method: The present ‘theory-building’ case study specifically aims at further refinement of the classical symptom specificity hypothesis by testing specific operationalizations within an empirical single case (...) design. Consensual Qualitative Research for Case studies is used to quantitatively and qualitatively describe the longitudinal, clinical interplay between obsessional symptoms and interpersonal dynamics throughout the process of a psychodynamic therapy. Interpersonal functioning is assessed by means of the Core Conflictual Relationship Theme method. The classical symptom specificity hypothesis is contrasted to an alternative hypothesis of interpersonal ambivalences as determinants of obsessional symptoms. Results: Close associations between obsessions and interpersonal dynamics are observed. Findings predominantly affirm the ambivalence hypothesis rather than the classical symptom specificity hypothesis. Psychodynamic interventions focusing on interpersonal conflicts are related to symptomatic changes. Conceptual and methodological considerations, limitations and future research indications are discussed. (shrink)

Martin Heidegger is, perhaps, the most controversial philosopher of the twentieth-century. Little has been written on him or about his work and its significance for educational thought. This unique collection by a group of international scholars reexamines Heidegger's work and its legacy for educational thought.

Urban and agricultural communities are interdependent but often differ on approaches for improving water quality impaired by nutrient runoff waterbodies worldwide. Current water quality governance involves an overlapping array of policy tools implemented by governments, civil society organizations, and corporate supply chains. The choice of regulatory and voluntary tools is likely to influence many dimensions of the relationship between urban and agricultural actors. These relationships then influence future conditions for collective decision-making since many actors participate for multiple years in water (...) quality improvement. In this policy analysis, we draw on our professional experiences and research, as well as academic and practitioner literatures, to investigate how different types of water quality interventions influence urban-agricultural relationships, specifically examining policy tools on a regulatory to voluntary spectrum. Interactions between farmers and other rural agricultural interests on one hand, and urban residents and their stormwater managers and wastewater treatment plants on the other, influence dynamics relevant for water quality improvement. We suggest that the selection of policy tools within complex governance contexts influence urban–agricultural relationships through financial exchange, political coalitions, knowledge exchange, interpersonal relationships, and shared sense of place. Policy tools that provide a means to build relationships and engage with people’s emotions and identities have potential to influence personal and community change and adaptive capacity, while processes such as lawsuits can catalyze structural change. Engaging these relationships is particularly critical given the need to move out of polarized positions to solve collective problems. (shrink)

The number of students with disabilities has increased by more than 900% in Québec universities Such an increase generates undue pressures on both the academic services available to that clientele and the personnel responsible for internships placement and supervision. In the past decade, a number of studies have attempted to make up for the lack of scientific knowledge on in-class support (measures to support the trainees.), and only a small number of studies worldwide, have focused specifically on accommodation in the (...) context of internships. This situation prompted the current researchers to conduct an exploratory research in partnership with university supervisors, field supervisors and internship coordinators. The research concentrated on three professional programs in order to highlight the specific challenges and issues supervisors must confront while providing support to students with disabilities. The study will eventually focus on testing the identified measures so as to assess their impact and help in developing required modifications. (shrink)

The number of children with chronic critical illness (CCI) is a growing population in the United States. A defining characteristic of this population is a prolonged hospital stay. Our study assessed the proportion of pediatric patients with chronic critical illness in U.S. hospitals at a specific point in time, and identified a subset of children whose hospital stay lasted for months to years. The potential harms of a prolonged hospitalization for children with CCI, which include over treatment, infection, disruption of (...) family life, and the intensive utilization of resources—combined with the moral distress experienced by the clinicians who care for the children, suggest the need for ethical analysis of this growing issue to identify actions that could be taken at the clinical and health systems levels to reduce the harms associated with prolonged hospital stay.In this article we present three real cases from our study that involved a very long hospital stay. We applied a framework developed by Mackenzie, Rogers, and Dodds to analyze inherent, situational, and pathogenic vulnerabilities to examine the ways that interventions intended to remedy one source of harm for the children in our cohort inadvertently created other harms. We examined the complex ways that children with protracted hospitalization are vulnerable to the choices made by their family and clinicians, as well as by healthcare systems and communities. Finally, we used this analysis to summarize actions and ethical responses to this growing patient population. Such an understanding is essential to making clinical and ethical decisions that arise for children who are at risk for a very long stay in the hospital. (shrink)

Is the societal-level of analysis sufficient today to understand the values of those in the global workforce? Or are individual-level analyses more appropriate for assessing the influence of values on ethical behaviors across country workforces? Using multi-level analyses for a 48-society sample, we test the utility of both the societal-level and individual-level dimensions of collectivism and individualism values for predicting ethical behaviors of business professionals. Our values-based behavioral analysis indicates that values at the individual-level make a more significant contribution to (...) explaining variance in ethical behaviors than do values at the societal-level. Implicitly, our findings question the soundness of using societal-level values measures. Implications for international business research are discussed. (shrink)

Four questions are raised about the semantics of Quantified Modal Logic. Does QML admit possible objects, i.e. possibilia? Is it plausible to admit them? Can sense be made of such objects? Is QML committed to the existence of possibilia? The conclusions are that QML, generalized as in Kripke, would seem to accommodate possibilia, but they are rejected on philosophical and semantical grounds. Things must be encounterable, directly nameable and a part of the actual order before they may plausibly enter into (...) the identity relation. QML is not committed to possibilia in that the range of variables may be restricted to actual objects. Support of the conclusions requires some discussion of substitution puzzles; also, the semantical distinction between proper names which are directly referring, and descriptions even where the latter are "rigid designators". Views of W.V. Quine, B. Russell, K. Donnellan, D. Kaplan as well as S. Kripke are invoked or evaluated in conjunction with these issues. (shrink)