This qualitative cross-sectional survey, undertaken in the antenatal booking clinics of a hospital in central London, explores pregnant women’s responses to routine HIV testing, examines their reasons for declining or accepting the test, and assesses how far their responses fulfil standard criteria for informed consent. Of the 32 women interviewed, only 10 participants were prepared for HIV testing at their booking interview. None of the women viewed themselves as being particularly at risk for HIV infection. The minority of the participants (...) who declined testing differed from those who accepted, by interpreting test acceptance as risky behaviour, privileging the negative outcomes of HIV positivity and expressing an inability to cope with these, should they occur. Troublingly, only a minority of women had a broad understanding of the rationale for the test, and none fulfilled the standard criteria for informed consent. This study suggests that, although routine screening combined with professional recommendation may be successful in increasing uptake, this may be at the cost of eroding informed consent. Protecting third parties from a preventable disease may outweigh the moral duty of respecting autonomy, enshrined in Western bioethical tradition. Nevertheless, such a policy should be made transparent, debated in the public domain and negotiated with women seeking antenatal care. (shrink)

‘Doing good medical ethics’ involves attending to both the biomedical and existential aspects of illness. For this, we need to bring in a phenomenological perspective to the clinical encounter, adopt a virtue-based ethic and resolve to re-evaluate the goals of medicine, in particular the alleviation of suffering and the role of compassion in everyday ethics.

Seroprevalence monitoring of HIV in pregnant women by anonymised unlinked testing has been widely adopted in the UK and other countries. The scientific rationale is to eliminate participation and selection bias. The ethical justification is that the public good outweighs any harm to individuals. The assumption has been that individuals have had their autonomy respected by the offer of informed consent. In the light of new scientific evidence, it is doubtful that the public good is best served by the continuation (...) of anonymously testing women receiving antenatal care. It is submitted that it is no longer ethical for health professionals to refrain from informing pregnant women of the benefits of voluntary named testing, or to request their consent to anonymised testing. The legal and moral concept of duty of care is examined, and the abrogation of this duty through anonymisation is explained. (shrink)

The maternal‐fetal HIV transmission trials, conducted in developing countries in the 1990s, undoubtedly generated one of the most intense, high profile controversies in international research ethics. They sparked off a prolonged acrimonious and public debate and deeply divided the scientific community. They also provided an impetus for the revision of the Declaration of Helsinki – the most widely known guideline for international research. In this paper, I provide a brief summary of the context, outline the arguments for and against the (...) controversial use of placebo controls, and focus on particular areas that I believe merit further discussion or clarification. On balance, I argue that the researchers failed in their duties to protect the best interests of their research subjects, and to promote distributive justice. I discuss the difficulties of obtaining valid consent in this research context, and argue that it is unethical to inform women of their HIV status without at least offering them prophylactic treatment for their unborn children. A global view of justice, which endorses international equity, cannot be squared with international research guidelines that allow ‘local conditions’ to define the scope of duty to the control group. Finally, I suggest that the heated debate reflects a tension, if not an outright war, between two conflicting meta‐ethical systems, or incommensurable paradigms, that underpin scientific research involving human subjects. (shrink)

Philosophical and scientific understandings of compassion converge, both stressing its necessity for the moral life and human flourishing. I conceptualise a dynamic and frangible account of professional virtues, including compassion, and propose that mechanistic organisational systems of care and the biomedical paradigm create a strong risk of dehumanisation and the obliteration of compassion in healthcare. Additionally, the neoliberal market ideology, with its instrumental approach to individuals and commodification of healthcare creates a corrosive influence that alienates clinicians from their patients and (...) severely curtails the scope for compassionate practice. The tension between efficiency and patient orientated care – although they need not be mutually exclusive – has become more acute in the current economic climate, at a time when the boundaries of medicine have broadened and expectations for healthcare have risen. This has created an unsustainable dynamic within which alienated healthcare professionals struggle to fulfil their healing roles and patients experience abandonment and more anxiety. (shrink)

Philosophical and scientific understandings of compassion converge, both stressing its necessity for the moral life and human flourishing. I conceptualise a dynamic and frangible account of professional virtues, including compassion, and propose that mechanistic organisational systems of care and the biomedical paradigm create a strong risk of dehumanisation and the obliteration of compassion in healthcare. Additionally, the neoliberal market ideology, with its instrumental approach to individuals and commodification of healthcare creates a corrosive influence that alienates clinicians from their patients and (...) severely curtails the scope for compassionate practice. The tension between efficiency and patient orientated care – although they need not be mutually exclusive – has become more acute in the current economic climate, at a time when the boundaries of medicine have broadened and expectations for healthcare have risen. This has created an unsustainable dynamic within which alienated healthcare professionals struggle to fulfil their healing roles and patients experience abandonment and more anxiety. (shrink)

“Anonymised screening is a research tool to inform policy and practice and individual decision making, but is not a tool to identify those at risk that could directly benefit from intervention.”1The assumption that the information acquired will be used to prioritise health care resources may prove false. A government, after weighing up the costs and benefits, may choose not to adopt appropriate interventions. Or, even if a policy is proposed,, it may not be adhered to. Even as I write, antenatal (...) clinics that serve populations with the highest concentration of refugees from sub-Saharan Africa, and therefore of those at risk, still do not have a policy of universal screening.Anonymised screening is a form of non-therapeutic research, and should comply with the Helsinki Declaration on Non-therapeutic Research involving Human Subjects. I have already argued that physicians who undertake anonymised screening have abrogated their duty, as outlined in article one, “... to remain the protector of the life and health of that person on whom biomedical research is being carried out”.2In addition, article four states: “In research on man, the interest of science and society should never take precedence over considerations related to the wellbeing of the subject.”2The desire for an outcome—perfect epidemiological figures—should not override the ethics of the process whereby this is achieved. The …. (shrink)

Hoffmaster endeavours to enrich the dominant bioethical paradigm, based on abstract principles, with the lived experience of moral decision making. He proposes that bioethics involves not only the justifications for moral judgments, but also the understanding of the beliefs and values underpinning them. The “old” conventional bioethics, situated in “rationality and generality”, is to be replaced by a new “reoriented” bioethics, situated in the untidy world of “lived human experience”. In other words, context, in its widest sense, is to be (...) integrated into the bioethical framework. The relevance of social context in moral philosophy is not new, however. As MacIntyre tells us in After Virtue : “... it also follows that we have not yet fully understood the claims of any moral philosophy until we have spelled out what its social embodiment would be”. He reminds us that Plato and Aristotle, amongst others, undertook this project. MacIntyre, like Hoffmaster, laments the loss of social embodiment in the “narrow conception” of contemporary moral philosophy. I submit that we are now witnessing the rejection of Cartesian duality and the revival, or restoration, of an old paradigm—reintegrating the social milieu, narrative, and the emotions, in our conceptualisation of moral philosophy. Hoffmaster’s second goal is to raise the profile of social science research in the field of bioethics. He argues that the distinction between descriptive and normative ethics is artificial, and that the former is unfairly …. (shrink)

Pork producers in Western Europe moreand more encounter a variety of societalconcerns about pork and pork production. Sofar, however, producers predominantly focusedon low consumer prices, therewith addressingjust one concern. This resulted in an intensiveand large-scale production system, decreasinglyrelated to the area of farm land, andaccompanied with increasing concerns aboutsafety and healthiness of pork, animal welfare,environmental pollution, and others.An overview was given of possible concernsabout West-European pork production with theconsumers, citizens, and producers, and thoseconcerns are traced back to the pork productionsystem. (...) The various kinds and qualities ofinformation about the pork production system onwhich possible concerns are based have beenworked out extensively in this paper. Knowledgeabout the aspects of pork production that cangive rise to concerns can be used in two ways.First, the communication about those aspectstowards consumers and citizens can be adjustedor extended to give them better possibilitiesto make food choices or to develop their ownopinions about pork production. Second,producers could change the pork productionsystem such that it better satisfies consumersand citizens. Such adaptations are wellpossible, as three pork quality schemes, whichhave been evaluated, illustrate. However, mostof these adaptations can only be carried out atthe cost of the present low consumer prices andwill not occur spontaneously on a large scale.Therefore, accounting for the type andrelevance of the concerns, legislation isnecessary to address societal concerns in abalanced way such that pork production systemsbecome acceptable for the majority of oursociety. (shrink)

The study of reciprocal altruism, or the exchange of goods and services between individuals, requires attention to both evolutionary explanations and proximate mechanisms. Evolutionary explanations have been debated at length, but far less is known about the proximate mechanisms of reciprocity. Our own research has focused on the immediate causes and contingencies underlying services such as food sharing, grooming, and cooperation in brown capuchin monkeys and chimpanzees. Employing both observational and experimental techniques, we have come to distinguish three types of (...) reciprocity. Symmetry-based reciprocity is cognitively the least complex form, based on symmetries inherent in dyadic relationships (e.g., mutual association, kinship). Attitudinal reciprocity, which is more cognitively complex, is based on the mirroring of social attitudes between partners and is exhibited by both capuchin monkeys and chimpanzees. Finally, calculated reciprocity, the most cognitively advanced form, is based on mental scorekeeping and is found only in humans and possibly chimpanzees. (shrink)

The present paper explores, theoretically, and empirically, whether compliance with the International Code of marketing of breast-milk substitutes impacts on financial performance measured by stock markets. The empirical analysis, which considers a 20-year period, shows that stock markets are indifferent to the level of compliance by manufacturers with the International Code. Two important issues emerge from this result. Based on our finding that financial performance as measured by stock markets cannot explain the level of compliance, the first issue refers to (...) what alternative types of mechanisms drive manufacturers who comply the least with voluntary codes such as the International Code. Conversely, from our finding that stock markets do not reward the most compliant, the second issue raised is an inherent weakness of stock markets to fully incorporate social and environmental values. (shrink)

Advancing second-person neuroscience will need strong theories, as well as the new methods detailed by Schilbach et al. I assess computational theories, enactive theories, and cognitive/information processing theories, and argue that information processing approaches have an important role to play in second-person neuroscience. They provide the closest link to brain imaging and can give important insights into social behaviour.

The modern concept of ‘style’ – from which ‘stylistics’ is derived, a discipline that witnessed the quarrel between Linguistics and Literary studies in the 20th century – has inherited from Ancient Rhetoric its substance (figures and tropes) and was largely used as a direct translation from the Latin concept ‘elocutio’ (especially in Demetrius’ treatise De elocutione [Περὶ ἑρμηνείας]) and also as a translation for Greek concepts (usually indirectly), such as ἑρμηνεία, λέξις and φράσις. There are still some other concepts that (...) seem intimately connected to ‘style’, for instance ‘ornatum’ and ‘decorum’. Considering that classical references of ‘style’ present themselves essential to write the history of this modern concept, this paper seeks to present a catalog of ancient concepts that have found in ‘style’ (in English and French) their traditional translation, as well as attempting to build a short history of each of these translation paths. (shrink)

Desde o Problema XXX, atribuído a Aristóteles, uma longa tradição de filósofos, artistas e escritores vê a melancolia como afeto positivo ligado ao “homem de gênio” e à criação intelectual em geral. Do ponto de vista da teoria dos afetos de Espinosa, o problema da melancolia coloca um outro: como é possível que de uma tristeza profunda possa nascer a atividade intectual, artística, literária? Toda atividade é uma produção, uma alegria, aumento da potência de agir e pensar: como ela poderia (...) nascer da melancolia? Nossa hipótese é que o problema se explica pela “alegria eufórica”, a outra face da melancolia, que nasce como reação do desejo contra a própria tristeza. Por ser alegria, afasta a tristeza profunda; mas por ser eufórica, mantém o “melancólico” preso à sua própria doença. Assim, a reação não cura o “doente” de seu “mal”, o mantém num círculo interminável de euforia e estado melancólico. (shrink)

Grossmann's intriguing proposal can benefit from a more thorough integration of the primate literature, particularly on neophobia. Moreover, it directly leads to strong predictions in callitrichids, the only other cooperatively breeding primates beyond humans, which may indeed be met: Being more likely to signal distress than independently breeding monkeys, and responding to such signals with approach and affiliation.

In this paper, we aim to bring to discussion the concept of locus amoenus, a common denomination of locus communis (topos, for the greeks), that makes reference to the ideal landscape according to the norms of the ancient idyllic poetry. We will describe and analyze the locus amoenus from an 18th century Italian poetry perspective, more specifically from the fables of Luigi Fiacchi, a poet and Catholic priest of that century. The analysis will focus on the references, either direct or (...) not, that the author, known by the epithet ‘Il Casio’, does to the Classical Antiquity. (shrink)