Book reviewed in this article: In That Case: Medical Ethics in Everyday Practice. By Alastair Campbell and Roger Higgs. Medical Genetics Casebook: A Clinical Introduction to Medical Ethics Systems Theory. By Colleen D. Clements. Cases in Bioethics from the Hastings Center Report. Edited by Carol Levine and Robert M. Veatch. Hastings‐on‐Hudson.

Discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, (...) and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature. (shrink)

The spread of new information and communications technologies during the past two decades has helped reshape civic associations, political communities, and global relations. In the midst of the information revolution, we find that the speed of this technology-driven change has outpaced our understanding of its social and ethical effects. The moral dimensions of this new technology and its effects on social bonds need to be questioned and scrutinized: Should the Internet be understood as a new form of public space and (...) a source of public good? What are we to make of hackers? Does the Internet strengthen or weaken community? In The Internet in Public Life, essayists confront these and other important questions. This timely and necessary volume makes clear the need for a broader conversation about the effects of the Internet, and the questions raised by these seven essays highlight some of the most pressing issues at hand. (shrink)

We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series, 25 per cent received lectures and case conferences, with an ethicist in attendance, and 50 per cent served as controls. A post-intervention questionnaire was administered. Knowledge scores did (...) not differ among the groups. Confidence regarding ethical issues was significantly greater in the aggregate intervention group compared to the control group. Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls. Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile. We conclude that ethics education can have an impact on house officers' confidence and their responses to a simulated case, and that the EI was more effective than the LI. Such results have implications regarding the implementation of ethics education during residency. (shrink)

In "The Imagination of Disaster," written at or close to the height of the Cold War, Sontag ruminates on what America's interest in, if not preoccupation with, science fiction films tell us about ourselves.1 Their popularity cannot be explained in terms of their entertainment value alone; or if it can, then why audiences found such films entertaining is something that itself needs explanation. Almost all films in the hero genre are also science fiction and are concerned with disasters of one (...) kind or another. What Sontag has to say about disaster in the 1950s can easily be applied to the seemingly insatiable desire for hero films today. Her account is useful in explaining both what our attractions... (shrink)

Over the last couple of decades, oocyte donation has become common, important, and sometimes lucrative. Women who donate eggs are often offered fees, though ostensibly only to offset their expenses and limited to no more than $10,000, following recommendations adopted by the fertility industry. Is the industry adhering to its recommendations? A study of advertisements published in college newspapers raises questions.

We use Homer and Sun Tzu as a background to better understand and reformulate confrontation, anger and violence in medicine, contrasting an unproductive ‘love of war’ with a productive ‘art of war’ or ‘art of strategy’. At first glance, it is a paradox that the healing art is not pacific, but riddled with militaristic language and practices. On closer inspection, we find good reasons for this cultural paradox yet regret its presence. Drawing on insights from Homer's The Iliad and The (...) Odyssey, we argue for better understanding of confrontation, anger, bullying, intimidation and violence in medicine in order to change the culture. For example, equating medicine with war is not a given condition of medicine but a convenient metaphor with historical origins and a historical trajectory. Other, non-martial metaphors, such as medicine as collaboration, may be more appropriate in an age of team-based care. Taking lessons from Homer, we suggest three key ways in which cold-hearted confrontation and anger in medicine can be transformed into productive, warm-hearted engagement: the transformation of angry impulse into reflection, moral courage and empathy. Thinking with Homer can offer an aesthetically and morally charged alternative to the current body of literature on topics, such as anger in doctors, and how this may be ‘managed’, without recourse to an instrumental economy where emotions are viewed as commodities, and emotional responses can be ‘trained’ through communication skills courses. (shrink)

Capitalizing on the hype surrounding stem cell research, numerous clinics around the world offer “stem cell therapies” for a variety of medical conditions. Despite questions about the safety and efficacy of these interventions, anecdotal evidence suggests a relatively large number of patients are traveling to receive these unproven treatments — a practice called “stem cell tourism.” Because these unproven treatments pose risks to individual patients and to legitimate translational stem cell research, stem cell tourism has generated substantial policy concern and (...) inspired attempts to reduce these risks through the development of guidelines for patients and medical practitioners. This paper examines the roles and responsibilities of physicians in patients' home countries with respect to patients' decisions to try unproven stem cell therapies abroad. Specifically, it examines professional guidance from two organizations — the American Medical Association and the International Society for Stem Cell Research — and assesses physicians' professional and legal obligations to patients considering unproven stem cell therapies. Then, drawing on qualitative interviews conducted with patients who traveled abroad for unproven stem cell treatments, it explores the roles that physicians actually play in patients' decisions and compares these actual roles with their professional and legal responsibilities. The paper concludes with a discussion of strategies to help improve the guidance physicians provide to patients considering unproven treatments. (shrink)

Stem cell science, using both embryonic and a variety of tissue-specific stem cells, is advancing rapidly and offers promise to improve medical care in the future. Yet, with the notable exception of hematopoietic stem cell transplantation, a long-established approach to treating certain cancers of the blood system, this promise is long term and most stem cell research focuses on basic scientific questions or the collection of pre-clinical data. Although some clinical trials are underway, most are focused on safety, and novel (...) effective therapy is likely a long way off. Despite the preliminary nature of most stem cell research, however, numerous clinics around the world offer stem cell “therapies” to patients today outside the context of a clinical trial. Although the number of patients who have received these stem cell-based interventions is unknown, anecdotal reports suggest a substantial population of patients is willing to try them, despite unresolved questions about their safety and efficacy. (shrink)

The recent publication by Wylie et al. is reviewed, demonstrating that the p53 protein regulates the movement of transposons. While this work presents genetic evidence for a piRNA‐mediated p53 interaction with transposons in Drosophila and zebrafish, it is herein placed in the context of a decade or so of additional work that demonstrated a role for p53 in regulating transposons and other repetitive elements. The line of thought in those studies began with the observation that transposons damage DNA and p53 (...) regulates DNA damage. The presence of transposon movement can increase the rate of evolution in the germ line and alter genes involved in signal transduction pathways. Transposition can also play an important role in cancers where the p53 gene function is often mutated. This is particularly interesting as recent work has shown that de‐repression of repetitive elements in cancer has important consequences for the immune system and tumor microenvironment. (shrink)

In vitro fertilization using donated oocytes is an important medical technique that provides the only option for some infertile patients to have children. The technique remains ethically contentious, however, and, as a result of this controversy, different oversight approaches have been developed in countries around the world. This paper examines the oversight and practice of oocyte donation in Canada, the United Kingdom and the United States to examine how policy choices have influenced the development and use of this medical technology. (...) Examining per capita utilization of oocyte donation in these three countries provides evidence that supply-side policies—specifically policies affecting the compensation of potential oocyte donors—have substantially influenced the use of this technology. These results should provide useful insight for policymakers developing or revising oocyte donation policies. (shrink)

We believe that the professional responsibility of bioscience and biotechnology professionals includes a social responsibility to contribute to the resolution of ethically fraught policy problems generated by their work. It follows that educators have a professional responsibility to prepare future professionals to discharge this responsibility. This essay discusses two pilot projects in ethics pedagogy focused on particularly challenging policy problems, which we call “fractious problems”. The projects aimed to advance future professionals’ acquisition of “fractious problem navigational” skills, a set of (...) skills designed to enable broad and deep understanding of fractious problems and the design of good policy resolutions for them. A secondary objective was to enhance future professionals’ motivation to apply these skills to help their communities resolve these problems. The projects employed “problem based learning” courses to advance these learning objectives. A new assessment instrument, “Skills for Science/Engineering Ethics Test”, was designed and administered to measure the success of the courses in doing so. This essay first discusses the rationale for the pilot projects, and then describes the design of the pilot courses and presents the results of our assessment using SkillSET in the first pilot project and the revised SkillSET 2.0 in the second pilot project. The essay concludes with discussion of observations and results. (shrink)

Past research has repeatedly documented the close relationship between visual attention and awareness. Most recently, research exploring change blindness, inattentional blindness, repetition blindness, and the attentional blink has converged on the conclusion that attention to one aspect of a scene or event may lead to a highly circumscribed awareness of only the specific information attended, while other information, even that which is spatially or temporally nearby can go completely unnoticed. In the present report, we extend these observations to the dynamic (...) allocation of attention during a well-structured meaningful event. In two experiments, subjects viewed brief videos of simple events and were told to pay close attention to them. During the events, an unexpected disruption consisting of a brief low spatial frequency motion field occurred. Despite intensive questioning and opportunities for recognition, the majority of subjects reported no awareness of 200, 400, or 600 ms disruptions. In a second experiment, blank-screen disruptions were added, and these resulted in no increase in detection. We conclude that visual attention may result in far more transitory awareness of visual information than previously appreciated. (shrink)

While some may argue that universities are in a state of crisis, others claim that we are living in a post-university era; a time after universities. If there was a battle for the survival of the institution, it is over and done with. The buildings still stand. Students enrol and may attend lectures, though let’s be clear—most do not. But virtually nothing real remains. What some mistakenly take to be a university is, in actuality, an ‘uncanny’ spectral presence; ‘the nagging (...) presence of an absence … a “spectralized amnesiac modernity with its delusional totalizing systems”’. It is the remains and remnants of the university.[1]Overstatement? Perhaps. We think many if not most administrators, at all levels, will likely dissent. So too will many if not most teachers and students. Trying to determine whether this is correct, or to what extent, by consulting polls and reading opinion pieces in various education journals and professional papers is likely to be of little help. In any case, it is the hypothesis, along with closely related ones, and concerns about what can be done in the circumstances, that have generated this special issue.This special issue highlights and illustrates that most of the contested issues regarding educational theory and practice central to how universities and schools should be, and how they should be run, are first and foremost questions of value rather than fact. They are questions regarding what we want, but more importantly what we should want, from our universities and schools; about what they should be and what students, teachers and administrators should be doing to facilitate this.[1] See Cox and Levine and Boaks, Cox and Levine. (shrink)

Until recently, the paradoxes of set theory were hardly used at all in the analysis of dialectical contradiction. "Violations of the Aristotelian law of contradiction have been found everywhere except where logic and mathematics saw them." Today a practice of study of paradoxes in set theory by the devices of materialist dialectics is taking shape in our literature.