Employing the National Institute of Mental Health-funded Prevention of Suicide in Primary Care Elderly Collaborative Trial as a case study, we discuss 2 sets of ethical issues: obtaining informed consent for a clinic-based intervention study and using treatment as usual (TAU) as the control condition. We then address these ethical issues in the context of the debate about the quality improvement efforts of health care organizations. Our analysis reveals the tension between ethics and scientific integrity involved with using TAU as (...) a control condition and the difficulty in designing high-quality research in a community-based setting. (shrink)

Over the last 300 years science has been quite successful at revealing the nature of physical reality. In so doing it has provided an epistemological basis for scientific discovery and technological innovation. But science has been decidedly less successful at guiding political debate. How do we conceive of the science-society relation in the 21st century? How does scientific research hook onto the world in a multi-faceted, pluralistic, and global age? This essay seeks to reframe our thinking about the broader impacts (...) of science by awakening an appreciation of the inescapably political and dimension of all knowledge, scientific or otherwise. (shrink)

IntroductionDeep brain stimulation (DBS) is increasingly used to treat the symptoms of various neurologic and psychiatric conditions. People can undergo the procedure during reproductive years but the safety of DBS in pregnancy remains relatively unknown given the paucity of published cases. We thus conducted a review of the literature to determine the state of current knowledge about DBS in pregnancy and to determine how eligibility criteria are approached in clinical trials with respect to pregnancy and the potential for pregnancy.MethodsA literature (...) review was conducted in EMBASE to identify articles involving DBS and pregnancy. Two reviewers independently analyzed the articles to confirm inclusion. Data extracted for analysis included conditions treated, complications at all stages of pregnancy, neonatal/pediatric outcomes, and DBS target. A second search was then conducted using www.clinicaltrials.gov. The same two reviewers then assessed whether each trial excluded pregnant individuals, lactating individuals, or persons of childbearing age planning to conceive. Also assessed was whether contraception had to be deemed adequate prior to enrollment.ResultsThe literature search returned 681 articles. Following independent analysis and agreement of two reviewers, 8 pregnancy related DBS articles were included for analysis. These articles described 27 subjects, 29 pregnancies (2 with subsequent pregnancies), and 31 infants (2 twin pregnancies). There was 1 preterm birth at 35 weeks, and 3 patients who experienced discomfort from the DBS battery (i.e., impulse generator) placement site. All 27 patients had a DBS device implanted before they became pregnant, which remained in use throughout their pregnancy. There was exclusion of pregnant individuals from 68% of 135 interventional trials involving DBS. Approximately 44% of these trials excluded persons of childbearing age not on “adequate contraception” or wishing to conceive in the coming years. Finally, 22% excluded breastfeeding persons.ConclusionThe data from 29 pregnancies receiving DBS treatment during pregnancy was not associated with unexpected pregnancy or post-partum complication patterns. Many clinical trials have excluded pregnant individuals. Documentation of outcomes in larger numbers of pregnancies will help clarify the safety profile and will help guide study designs that will safely include pregnant patients. (shrink)

Biomedical research is an increasingly multidisciplinary activity bringing together a range of different academic fields and forms of expertise to investigate diseases that are increasingly understood to be complex and multifactorial. Recently the discipline of ethics has been starting to find a place in large-scale biomedical collaborations. In this article we draw from our experience of working with the Malaria Genomic Epidemiology Network and other research projects to reflect upon the integration of ethics into biomedical research. We examine the way (...) in which ethics input may be valuable to research, the forms it tends to take, and also the problems and limitations of such collaborations. (shrink)

BackgroundObtaining consent has become a standard way of respecting the patient’s rights and autonomy in clinical research. Ethical guidelines recommend that the child’s parent/s or authorised legal guardian provides informed consent for their child’s participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child’s illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research literacy will (...) assist in developing appropriate consent guidelines.MethodsWe conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants’ views about informed consent processes. Data analysis was facilitated by NVIVO 11 software.ResultsAll participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting.ConclusionThe health care context, culture and research process influenced participants’ understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent.Trial registration Not applicable. (shrink)

BackgroundThe concept of benefit sharing to enhance the social value of global health research in resource poor settings is now a key strategy for addressing moral issues of relevance to individuals, communities and host countries in resource poor settings when they participate in international collaborative health research.The influence of benefit sharing framework on the conduct of collaborative health research is for instance evidenced by the number of publications and research ethics guidelines that require prior engagement between stakeholders to determine the (...) social value of research to the host communities. While such efforts as the production of international guidance on how to promote the social value of research through such strategies as benefit sharing have been made, the extent to which these ideas and guidelines have been absorbed by those engaged in global health research especially in resource poor settings remains unclear. We examine this awareness among stakeholders involved in health related research in Kenya.MethodsWe conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups.ResultsOur study suggests that although people have a sense of justice and the moral aspects of research, this was not articulated in terms used in the literature and the guidelines on the ethics of global health research.ConclusionThis study demonstrates that while in theory several efforts can be made to address the moral issues of concern to research participants and their communities in resource poor settings, quick fixes such as benefit sharing are not going to be straightforward. We suggest a need to pay closer attention to the processes through which ethical principles are enacted in practice and distil lessons on how best to involve individuals and communities in promoting ethical conduct of global health research in resource poor settings. (shrink)

Implementation of guidelines regarding breaches of electronic health information requires an anticipatory stance and physician and patient education regarding security and monitoring measures and methods of redress. Adopting a preventive ethics, rather than a crisis management, model may also increase physician awareness of how the information they choose to include and privilege within the health record may expose patients to added harms if not done mindfully.

Theory of Thought and Knowledge is an unchanged, high-quality reprint of the original edition of 1897. Hansebooks is editor of the literature on different topic areas such as research and science, travel and expeditions, cooking and nutrition, medicine, and other genres. As a publisher we focus on the preservation of historical literature. Many works of historical writers and scientists are available today as antiques only. Hansebooks newly publishes these books and contributes to the preservation of literature which has become rare (...) and historical knowledge for the future. (shrink)

This casebook offers a window into important aspects of the ethical landscapes that researchers, communities, health professionals, policy makers – and ethicists – had to navigate during the first 15 months of the COVID-19 pandemic. The cases presented in this casebook are inevitably a selection informed by and constrained by the processes through which they were sought, and by the pandemic itself. Additional cases could valuably complement all the thematic chapters in this casebook. In addition, this casebook calls for a (...) broader approach to research ethics, both in terms of the issues to be considered, and the range of stakeholders having ethical responsibilities relating to the conduct of research. However a broad range of stakeholders have differing values, remits, authorities and capacities to exercise power in pandemic contexts, and in many situations, exercises of power, and their impact on research, are not direct and explicit. As such they are less amenable to clear representation in real-world cases, highlighting the importance of complementing discussions of the cases in this casebook with conceptual literature. Reflection on the research that has not been conducted is also critical. The COVID-19 pandemic has reemphasized that global health emergencies are never only about health. The wide-ranging impacts of the pandemic on economies, employment, education and a range of socially and culturally important activities, accentuates the importance of an equally comprehensive research agenda, which goes beyond a narrow conception of ‘health’, and addresses a broad range of pandemic impacts on populations. A further way in which we believe debate on pandemic research ethics both could and should be broadened is in relation to aspects of pandemic science beyond those relating to ‘response’. Inevitably, in the context of an emerging and continuing pandemic, scientific research attention has tended to focus on interventions that can enable more effective responses. However pandemic science can be thought of as divisible into four interdependent and overlapping domains: prevention, preparedness, response, and recovery. Research is essential to the development, evaluation, and deployment of interventions in each of these domains and effective, valuable, trustworthy and trusted research will require ethical questions to be identified and addressed. This chapter concludes by inviting the connection of additional cases and conceptual resources to this casebook, to enhance and expand the themes and topics covered. (shrink)

Ethical discussions about Artificial Intelligence (AI) often overlook its potentially large impact on nonhuman animals. In a recent commentary on our paper about AI’s possible harms, Leonie Bossert argues for a focus not just on the possible negative impacts but also the possible beneficial outcomes of AI for animals. We welcome this call to increase awareness of AI that helps animals: developing and using AI to improve animal wellbeing and promote positive dimensions in animal lives should be a vital ethical (...) goal. Nonetheless, we argue that there is some value in focusing on technology-based harms in the context of AI ethics and policy discourses. A harms framework for AI can inform some of our strongest duties to animals and inform regulation and risk assessment impacts designed to prevent serious harms to humans, the environment, and animals. (shrink)

Error is a neglected epistemological category in the history of science. This neglect has been driven by the commonsense idea that its elimination is a general good, which often renders it invisible or at least not worth noticing. At the end of the sixteenth century across Europe, medicine increasingly focused on “popular errors,” a genre where learned doctors addressed potential patients to disperse false belief about treatments. By the mid-seventeenth century, investigations into popular error informed the working methodology of natural (...) philosophers, rather than just physicians. In 1646, Thomas Browne published Pseudodoxia Epidemica, a large volume on popular error. Despite Browne’s formal training as a physician, this work examined only a few medical errors and instead aspired to be an encyclopedia of error. Pseudodoxia Epidemica was highly popular, running to six editions, and was known by the Fellows of the Royal Society. Influenced by Browne, alongside Bacon’s theory of the idols, natural philosophic practice in the late sixteenth and seventeenth century developed a focus on error that revised traditional attention to the discovery of knowledge. Fellows such as Robert Boyle and Robert Hooke proposed new ways to secure truth under the far-reaching influence of Bacon’s refutations of “natural human reason” distorted by false idols, of syllogistic logic, and of “theories,” his label for traditional philosophical systems that bias thought toward falsity. In three parts, this article traces the progression in early modern scientific approaches to handling error, and especially medical error – from physicians’ efforts to identify and eradicate it through collaborative effort, to the striking tension in Browne’s work between seeking to eliminate error while also showing a marked tolerance for it, to the Royal Society’s Baconian objective of instrumentalizing error to find truth. Error emerges as its own epistemic category that serves as a driving force toward knowledge production. (shrink)

Critical care of neonatesThe recently published report of the Nuffield Council on Bioethics, Critical care decisions in fetal and neonatal medicine, is a valuable contribution to the discussion of decision making in the critical care of neonates. Drawing upon medical evidence, the working party highlights the many practical difficulties arising in neonatal care and by setting out clearly the nature of the ethical and other issues arising in this area of medicine, and their relationship with neonatal development, the resulting report (...) has the potential to lead both to improved practice and to better informed communication between doctors and families when they face difficult decisions about how best to treat very premature babies. Based on medical evidence, the working party sets out guidelines on decision-making about the resuscitation of babies born before the gestational age of 25 weeks and 6 days, dividing this period into four chronological periods: before 21 weeks and 6 days when resuscitation should normally only take place within the context of a research project; between 22 weeks and 23 weeks when resuscitation should not normally be carried out unless the parents request it; at 23 or 24 weeks when parental views should take precedence; and, after 24 weeks when resuscitation should be the norm unless not in the child’s best interests.There are several practical ethical difficulties with this aspect of the advice. To what extent, for example, does the paediatric assessment of the child, intended to play a role in decision-making about the appropriateness of resuscitation, itself depend on the initiation of resuscitation? To what extent is it reasonable and humane to expect parents to take full responsibility for making decisions about resuscitation between 23 and 24 weeks? On what grounds is it acceptable to attempt to resuscitate a baby <21 weeks and 6 …. (shrink)

This paper traces the unspoken, implicit white racial logic of the brain disease model of addiction, which is based on seemingly universal, disembodied brains devoid of social or environmental influences. In the United States, this implicit white logic led to “context-free” neuroscience that made the social hierarchies of addiction and its consequences invisible to, and thus exacerbated by, national policies on opioids. The brain disease model of addiction was selectively deployed among the white middle-class population that had long accessed narcotics (...) and pharmaceutical treatments for narcotics disorders from biomedical clinics, as opposed to from illegal sources subject to law enforcement. In turn, new treatments for opioid addiction were racially marketed to the same white clientele to which newly patented opioid analgesics were marketed, tapping into a circumscribed but highly lucrative consumer base that has long benefited from a legally protected, racially segregated safe space for white narcotics consumption. The connecting thread for the contemporary white opioid “crisis,” therefore, is white race as a ghost variable in addiction neuroscience and in its pharmaceutical and biotechnological translation. (shrink)

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Alternative proteins, including plant-based and cell-based meat and dairy analogues, are discursively positioned as a new form of meat and dairy and as a solution to the myriad of issues associated with conventional animal agriculture. Animal agricultural industries across various nations have resisted this positioning in regulatory spaces by advocating for laws that restrict the use of meat and dairy terms on the labels of alternative proteins products. Underlying this contestation are differing understandings of, and vested interests in, desirable futures (...) for animal agriculture. In Australia, this broader contestation led to a national-level inquiry by a Senate parliamentary committee entitled _Definitions of meat and other animal products_ (the Inquiry). This paper reports findings from a study of the problematizations developed through the Inquiry using a framework for policy discourse analysis referred to as Bacchi’s ‘What’s the Problem Represented to be’ methodology. It shows how the dominant discourse throughout the Inquiry moved away from the initial problematization of alternative proteins as a threat to animal agriculture. Instead, both industries were ultimately positioned as not in competition and only labelling laws were problematized with the solution being amendments to ensure ‘consumer clarity’. This outcome ignored a range of alternative problematizations related to the ethical, environmental, health, social and economic issues raised by animal agriculture and by alternative proteins. This lack of scrutiny benefits both industries, by closing off the policy discourse to consideration of a range of alternative interests, voices, and potential solutions, such as stricter health and welfare regulation. (shrink)

Lloyd (2009) contends that climate models are confirmed by various instances of fit between their output and observational data. The present paper argues that what these instances of fit might confirm are not climate models themselves, but rather hypotheses about the adequacy of climate models for particular purposes. This required shift in thinking—from confirming climate models to confirming their adequacy-for-purpose—may sound trivial, but it is shown to complicate the evaluation of climate models considerably, both in principle and in practice.

Although downloading music through unapproved channels is illegal, statistics indicate that it is widespread. The following study examines the attitudes and perceptions of college students that are potentially engaged in music downloading. The methodology includes a content analysis of the recommendations written to answer an ethical vignette. The vignette presented the case of a subject who faces the dilemma of whether or not to download music illegally. Analyses of the final reports indicate that there is a vast and inconsistent array (...) of actions and underlying feelings toward digital music downloading. The findings reveal inconsistencies between participants’ recommendations (what the subject should do) and their attitudes and opinions on the matter (what they would do in a similar situation). These inconsistencies support the notion that as technology evolves, it creates discrepancies between the way things are and the way the law expects them to be, leaving society in a muddle, trying to reconcile the two. What remains to be seen is whether the discrepancy in the case of music downloading becomes extreme enough that the law changes to accommodate an increasingly prevalent behavior, or whether new business models will emerge to bridge the gap between legality and reality. (shrink)

Descartes's approach to practical judgments about what is beneficial or harmful, or what to pursue or avoid, is almost exactly the opposite of his approach to theoretical judgments about the true nature of things. Instead of the cautious skepticism for which Descartes is known, throughout his ethical writings he recommends developing the habit of making firm judgments and resolutely carrying them out, no matter how doubtful and uncertain they may be. Descartes, strikingly, takes irresolution to be the source of remorse (...) and repentance, of vice, and of a weak soul. In order to explain its dangerousness, this essay offers an analysis of irresolution as a failure of the will to determine itself to follow a judgment in the face of ignorance or uncertainty. This analysis connects irresolution to weakness of will and explains why Descartes regards resolution as an essential component of virtue. (shrink)

A dazzling blend of business vision, history, social psychology, and economics, The Support Economy starts with a compelling premise: People have changed more than the corporations upon which their well-being depends. In the chasm that now separates the new individuals from the old organizations is the opportunity to forge a capitalism suited to our times and so unleash a vast new potential for wealth creation. In recent years, many books have offered fixes for this crisis, but they have dealt only (...) with its symptoms. The Support Economy is the first book to critically examine its cause: Managerial capitalism has outlived the society it was once designed to serve. It successfully achieved the efficient production of goods and services, but today's individuals want more. They want to take their lives into their own hands and are ready to pay for the support and advocacy necessary to fulfill that yearning. The next leap forward in wealth creation depends upon developing a new capitalism that speaks to the needs of people today. The Support Economy will be the next "must read" big think book. It speaks to every business and technology leader, as well as every reader interested in the future of the economy and society. (shrink)

Ayn Rand's career as a writer of fiction, accordingly, was preceded and accompanied by her work on the system of philosophic thought she ultimately called Objectivism. This chapter introduces her writing by showing how the chosen actions of a life consciously devoted to a conscious purpose were integrated with the texts she crafted, in both fiction and non‐fiction. Ayn Rand's major project was The Fountainhead. The money from the movie rights to The Fountainhead bought Ayn Rand time to begin her (...) next novel, Atlas Shrugged. Whereas the theme of The Fountainhead was individualism versus collectivism, not in politics but in man's soul, The Strike (as Atlas Shrugged was initially called) was designed to dramatize the conflict between individualism and collectivism within the political/economic realm. Rand was active in the American Writers Association and the Motion Picture Alliance for the Preservation of American Ideals. (shrink)

We force a property of cardinals first proved relatively consistent by Sargsyan, that of being supercompact but not equation image-supercompact, starting from a model of set theory which does not satisfy equation image and that contains supercompact cardinals.

Julian Savulescu argues for two principles of reproductive ethics: reproductive autonomy and procreative beneficence, where the principle of procreative beneficence is conceptualised in terms of a duty to have the child, of the possible children that could be had, who will have the best opportunity of the best life. Were it to be accepted, this principle would have significant implications for the ethics of reproductive choice and, in particular, for the use of prenatal testing and other reproductive technologies for the (...) avoidance of disability, and for enhancement. In this paper, it is argued that this principle should be rejected, and it is concluded that while potential parents do have important obligations in relation to the foreseeable lives of their future children, these obligations are not best captured in terms of a duty to have the child with the best opportunity of the best life. (shrink)

Commentators commonly assume that Descartes regards it as a function of the passions to inform us or teach us which things are beneficial and which are harmful. As a result, they tend to infer that Descartes regards the passions as an appropriate guide to what is beneficial or harmful. In this paper I argue that this conception of the role of the passions in Descartes is mistaken. First, in spite of a number of texts appearing to show the contrary, I (...) argue that Descartes does not regard it as the role of the passions to inform us about what is beneficial or harmful. Second, although Descartes calls the passions good and useful, I argue that Descartes does not think we should allow ourselves to be guided by them. When we recognize that the function of the passions is largely motivational and not informative, we can more easily understand Descartes's practical advice in The Passions of the Soul that happiness requires us to guide our passions instead of letting our passions guide us. (shrink)

This paper aims to investigate some important elements of the thought of George Bernard Shaw, more commonly known as one of the most famous playwrights of the twentieth century. Shaw’s philosophy dwells on the relationship between man and nature and especially the concept of freedom. Among all his works, it was decided here to analyse Saint Joan. In re-imagining the historical Joan as a heroine in a play of ideas, Shaw made use of the known facts about Joan of Arc (...) and Joan’s statements at her trial. Nonetheless, he made changes to emphasize her personal dignity and independence by contrast with the tyranny of institutions. Although he departed from the historical background, whitewashed her adversaries, and condensed episodes in Joan’s biography, he sought to be true to her confidence, courage, integrity, and common sense. His theatrical presentation is, in some respects, at odds with the Preface that accompanies the published play. (shrink)

The article deals with the concept or the image of God in the Hebrew Bible and the various understandings and interpretations of it by Jewish thinkers through generations. The biblical text, full of contradictions and anthropomorphic assertions about God, was a source of discomfort for Jewish philosophers and theologians. Therefore, the sublimation and distillation of the text was necessary, and it was done by use of different hermeneutical methods. The article deals with various attributes of the biblical God, and presents (...) different theological and philosophical interpretations of that issue by major Jewish thinkers. (shrink)