A Charter on Medical Professionalism (CMA) has just recently been developed internationally, and the Canadian Medical Association is calling for public dialogue on medical professionalism now that reforms in the Canadian system of health care are imminent. We posit that good practices are at issue; we outline the essence of these in general and also specifically in the knowing, teaching and intervening components of practice. We also see challenges not to, but in, medical professionalism – first and foremost in the (...) profession's definition of good practices and the payer's confinement of insurance coverage to these. (shrink)

In his recent book The Foundation of Bioethics , H. Tristam Engelhardt Jr. advances the idea of a peaceable pluralist moral society based on principles of autonomy, beneficience, and ownership. This paper tries to show that unless there is one and only one rationally sustainable definition of "a person", then the peaceable society cannot remain peaceable, but will be stirred up by groups with different and equally rational definitions. The paper further tries to show that Engelhardt's own definition of "a (...) persons in the strict sense" is an unsatisfactory solution to the problem, and the same is true for any of the possible compromises. Keywords: medical ethics, persons, autonomy CiteULike Connotea Del.icio.us What's this? (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Theoretical Remarks on Combined Creative and Scholarly PhD Degrees in the Visual ArtsJames Elkins (bio)The PhD in visual arts is inescapable: it is on the horizon. In just a few years, there will be a number of such programs in the United States, and if the trend mirrors the expansion of MFAs after the mid-1960s, then in a few decades the PhD will be the consensus "terminal" degree for (...) artists. Given that, it is pressing to consider how the degree might be theorized. In Australia and the United Kingdom, where the degrees already exist, their growth has been dictated in large measure by the existing educational structures and by the inevitable quest for funding. (In the United Kingdom, university departments get a disproportionate increase in their funding if they offer doctorate programs, and the same pattern occurs in state schools in America.) As a result, existing programs simply grow by exonomic necessity or opportunity, and so far they have not been well theorized apart from models already in use elsewhere in the university. Private universities and art schools in the United States are therefore well positioned to rethink the conceptual foundations of combined studio and scholarly PhDs, because they are largely freed of the temptation of increased funding and the obligation to fit the new programs into existing structures. In this essay, I propose eight configurations that such degrees might take. I close with three general observations about the future of such programs.Three pieces of background are necessary as introduction. First, the School of the Art Institute, Chicago, where I teach, is currently running an four-year undergraduate major in visual studies. Soon we will be expanding it into an MA and, in a few years, a PhD. At the BA level our program already has a large studio component. For that reason we have been looking at programs that offer comparable combinations of creative and scholarly work at the PhD level. Our own program, we hope, will be a place [End Page 22] where the possibilities of other programs can be kept open and continuously questioned.Second, this essay was originally a reader's report for a creative-arts PhD thesis called "Beyond the Surface: The Contemporary Experience of the Italian Renaissance," written by Jo-Anne Duggan for the University of Technology, Sydney. In fall 2003 Duggan was a candidate for the "DCA," Doctorate of Creative Arts." She is a photographer, and her special interest is photographing inside museums; her thesis explores the history and theory of that practice. The report I wrote for her was the basis of this essay, because I found that her thesis is a mixture of what I think are the eight principal possibilities for combining PhD-level scholarship and creative work.Third, this essay is the outgrowth of several colloquia that have been held at the College Art Association and at the Association of Independent Colleges of Art and Design/National Association of Schools of Art and Design (AICAD/NASAD) conferences (organizations of art school administrators). These ad hoc forums have been, so far, the only places where the new programs have been debated. I hope this essay can contribute to a more detailed discussion.Here are the eight configurations. The first five are (or will be) common, and the last two are rare but preferable.1. The thesis is art history, intended to inform the art practice. The most obvious relation between scholarship and creative work is that the former informs the latter. The artist positions her scholarship so that it supports her art practice. Within this possibility, perhaps the most common option would be to write an art historical thesis, covering the history of practices that lead up to the writer's own practice. Among the advantages would be that, in theory, the candidate would be able to go on to teach in a department of art history. In terms of her practice, the idea would be that historical knowledge strengthens art practice: a debatable point, if only because so many artists have done so well by ignoring or distorting the relevant history. In Canberra in summer 2003, I met a recent PhD whose thesis was on... (shrink)

The current study aimed to explore effective strategies for preventing cheating in online examinations by surveying students to determine their cheating strategies. A total of 406 Iranian students at BA, MA, and PhD levels in four programs, including English language teaching, English literature, Linguistics, and English language translation, participated in this study using a convenient sampling technique. The sample was drawn from 83 universities across all 31 provinces of Iran. The researchers developed a 30-item questionnaire and a 4-item interview to (...) collect data. The results revealed that searching in PDFs and using social media groups were the most commonly used cheating strategies. To prevent this form of academic dishonesty, teachers used various strategies, the most effective being the use of conceptual questions and one-by-one oral exams with turned-on webcams. The main reason for students to cheat was their desire to perform better. The implications of this study are relevant for educational stakeholders, particularly teachers, and students, in promoting academic integrity. (shrink)

This chapter contains sections titled: History Specific Features of Medical Ethics Recent Developments References and Further Reading.

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of molnupiravir through the large-scale Platform Adaptive trial of Novel antiviRals for eArly treatMent of COVID-19 In the Community randomised control trial. By analysing the ways in which the authorisation and clinical use of molnupiravir complicate standard approaches to clinical equipoise, standard of care and participant consent in the PANORAMIC randomised control trial, we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

This article considers the claim that gender diverse minors and their families should not be able to consent to hormonal treatment for gender dysphoria. The claim refers particularly to hormonal treatment with so-called ‘blockers’, analogues that suspend temporarily pubertal development. We discuss particularly four reasons why consent may be deemed invalid in these cases: the decision is too complex; the decision-makers are too emotionally involved; the decision-makers are on a ‘conveyor belt’; the possibility of detransitioning. We examine each of these (...) reasons and we show that none of these stand up to scrutiny, and that some are based on a misunderstanding of the nature and purposes of this stage of treatment and of the circumstances in which it is usually prescribed. Moreover, accepting these claims at face value could have serious negative implications, not just for gender diverse youth, but for many other minors and families and in a much broader range of healthcare settings. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of Molnupiravir through the large-scale PANORAMIC randomised control trial. By analysing the ways in which the authorisation and clinical use of Molnupiravir complicate standard approaches to clinical equipoise, standard of care, and participant consent in the PANORAMIC randomised control trial we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

Clinical information about patients is increasingly being stored in electronic form and has therefore become more easily shareable. Data are collected as part of clinical care but have multiple other potential uses in relation to health system planning, audit and research. The use of clinical information for these secondary uses is controversial, and the ability to safeguard personal and sensitive data under current practices is contested.In this study, we investigate the attitudes of a representative sample of the Danish population towards (...) transfer of clinical data from their general practice for secondary use. We specifically study: patients’ trust in different types of healthcare professionals, their interest in being asked about secondary use of data and their willingness to dispense from a requirement of informed consent based on their trust in healthcare professionals.We find that adult Danes are positive towards research that use patient data, and they generally trust general practitioners, hospitals and researchers to treat their data confidentially.Nevertheless, they feel that they have a right to control the use of their data, only 7.3% disagreeing, and that the data belong to them, only 14.0% disagreeing. Answers to further questions about the relation between trust, information and consent show that although trust modifies the wish for information and consent, there is still a strong view that the patient should control the use of data. We find no differences between those who have frequent contact with the healthcare system and those who do not. (shrink)

The prelims comprise: Introduction The Doctrine of Informed Consent I will make you an offer you cannot refuse! Consenting to an Unknown Future Consenting for Future Generations Research without Consent? Conclusion.

The health care systems are fairly similar in theScandinavian countries. The exact details vary, but inall three countries the system is almost exclusivelypublicly funded through taxation, and most (or all)hospitals are also publicly owned and managed. Thecountries also have a fairly strong primary caresector (even though it varies between the countries),with family physicians to various degrees acting asgatekeepers to specialist services. In Denmark most ofthe GP services are free. For the patient in Norwayand Sweden there are out-of-pocket co-payments for GPconsultations, (...) with upper limits, but consultations forchildren are free. Hospital treatment is free inDenmark while the other countries use a system without-of-pocket co-payment. There is a very strongpublic commitment to access to high quality healthcare for all. Solidarity and equality form theideological basis for the Scandinavian welfare state.Means testing, for instance, has been widely rejectedin the Scandinavian countries on the grounds thatpublic services should not stigmatise any particulargroup. Solidarity also means devoting specialconsideration to the needs of those who have lesschance than others of making their voices heard orexercising their rights. Issues of limited access arenow, however, challenging the thinking about a healthcare system based on solidarity. (shrink)

It has been argued that organs should be treated as individual tradable property like other material possessions and assets, on the basis that this would promote individual freedom and increase efficiency in addressing the shortage of organs for transplantation. If organs are to be treated as property, should they be inheritable? This paper seeks to contribute to the idea of organs as inheritable property by providing a defence of a default of the family of a dead person as inheritors of (...) transplantable organs. In the course of discussion, various succession rules for organs and their justifications will be suggested. We then consider two objections to organs as inheritable property. Our intention here is to provoke further thought on whether ownership of one's body parts should be assimilated to property ownership. (shrink)

This article introduces the notion of ‘routinisation’ into discussions of informed consent. It is argued that the routinisation of informed consent poses a threat to the protection of the personal autonomy of a patient through the negotiation of informed consent. On the basis of a large survey, we provide evidence of the routinisation of informed consent in various types of interaction on the internet; among these, the routinisation of consent to the exchange of health related information. We also provide evidence (...) that the extent of the routinisation of informed consent is dependent on the character of the information exchanged, and we uncover a range of causes of routinisation. Finally, the article discusses possible ways of countering the problem of routinisation of informed consent. (shrink)

In a recent article in theJournal of Medical Ethics,Neil Manson sets out to show that the meta-consent model of informed consent is not the solution to perennial debate on the ethics of biobank participation. In this response, we shall argue that (i) Manson’s considerations on the costs of a meta-consent model are incomplete and therefore misleading; (ii) his view that a model of broad consent passes a threshold of moral acceptability rests on an analogy that misconstrues how biobank research is (...) actually conducted and (iii) a model of meta-consent is more in tune with the nature of biobank research and enables autonomous choice. (shrink)

Smajdor argues that “recognition” is the solution to the “reifying attitude” that results from “the urge to protect ‘vulnerable’ people through exclusion from research”. Drawing on theories of reification, we argue that it is the concepts of autonomy and vulnerability themselves that have been reified, resulting in the impoverishment of approaches to autonomy at law and in research ethics. Overcoming such reification demands a deeper consideration of the grounds on which vulnerable individuals are owed recognition and thereby the forms such (...) recognition should take. Smajdor argues for a recognition that appeals to autonomy and that manifests in providing vulnerable individuals with the opportunity to assent. The problem is that this kind of recognition is dependent on a more fundamental kind. It is this second form of recognition that would need to do the heavy lifting for assent-based frameworks to avoid the same problems we find with consent. (shrink)