All living human beings have the moral right not to be denied reasonable help in life threatening situations. Disasters take on many forms, but their consequences for individuals may be prolonged and stretch into the next generation. We have a moral obligation to create a better life for people by speaking out and trying to prevent man-made disasters and their consequences. To do this the commitment to life and its value must be reinforced. A number of suggestions are made, particularly (...) in relation to the role of nurses. Toutes les personnes ont le droit moral de recevoir l'aide raisonable dans des situations menaceant à la vie. Des désastres se présentent sous multiples formes, mais leur conséquences peuvent être prolongées pour des individus jusqu'à la prochaine génération. Nous avons une obligation morale de créér une meilleure vie pour tous les peuples en parlant en faveur de la prévention de désastres et leur conséquences. Un engagement à la vie et ses valeurs doit donc être renforcé. Quelques suggestions concernant le rôle des infirmiers/eres sont faites ici. Alle lebenden Menschen haben das morlaische Recht, in lebensdrohenden Situationen angemessene Hilfe zu erhalten. Katastrophen sind vielseitig, aber ihre Konsequenzen können sich für einzelne Menschen verlängern bis in die nächste Generation. Wir haben eine moralische Verpflichtung, ein besseres Leben zu erarbeiten für alle Menschen, in dem wir eintreten um künstliche Katastrophen und deren Konsequenzen zu verhüten. Eine Verpflichtung zum Leben und seinen Werten muss deshalb verstärkt werden. Eine Anzahl von Vorschlagen, besonders was die Rolle des Krankenpflegepersonals anbetricht, sind hier gemacht. (shrink)

Commentators on the ethics of translational research find it morally problematic. Types of translational research are said to involve questionable benefits, special risks, additional barriers to informed consent, and severe conflicts of interest. Translational research conducted on the global poor is thought to exploit them and increase international disparities. Some commentators support especially stringent ethical review. However, such concerns are grounded only in pre-approval translational research (now called T1 ). Whether or not T1 has these features, translational research beyond approval (...) ( T2 : phase IV, health services, and implementation research) is unlikely to and, when conducted on the global poor, may support development. Therefore, insofar as T1 is morally problematic, and no independent objections to T2 exist, the ethics of translational research is diverse: while some translational research is problematic, some is not. Funding and oversight should reflect this diversity, and T2 should be encouraged, particularly when conducted among the global poor. (shrink)

Systematic reviews, which were developed to improve policy-making and clinical decision-making, answer an empirical question based on a minimally biased appraisal of all the relevant empirical studies. A model is presented here for writing systematic reviews of argument-based literature: literature that uses arguments to address conceptual questions, such as whether abortion is morally permissible or whether research participants should be legally entitled to compensation for sustaining research-related injury. Such reviews aim to improve ethically relevant decisions in healthcare, research or policy. (...) They are better tools than informal reviews or samples of literature with respect to the identification of the reasons relevant to a conceptual question, and they enable the setting of agendas for conceptual and empirical research necessary for sound policy-making. This model comprises prescriptions for writing the systematic review's review question and eligibility criteria, the identification of the relevant literature, the type of data to extract on reasons and publications, and the derivation and presentation of results. This paper explains how to adapt the model to the review question, literature reviewed and intended readers, who may be decision-makers or academics. Obstacles to the model's application are described and addressed, and limitations of the model are identified. (shrink)

Background : researchers and sponsors increasingly confront the issue of whether participants in a clinical trial should have post-trial access (PTA) to the trial drug. Legislation and guidelines are inconsistent, ambiguous or silent about many aspects of PTA. Recent research highlights the potential importance of systematic reviews (SRs) of reason-based literatures in informing decision-making in medicine, medical research and health policy. Purpose: to systematically review reasons why drug trial participants should, or need not be ensured PTA to the trial drug (...) and the uses of such reasons. Data sources: databases in science/medicine, law and ethics, thesis databases, bibliographies, research ethics books and included publications’ notes/bibliographies. Publication selection: a publication was included if it included a reason as above. See article for detailed inclusion conditions. Data extraction and analysis: two reviewers extracted and analyzed data on publications and reasons. Results: of 2060 publications identified, 75 were included. These mentioned reasons based on morality, legality, interests/incentives, or practicality, comprising 36 broad (235 narrow) types of reason. None of the included publications, which included informal reviews and reports by official bodies, mentioned more than 22 broad (59 narrow) types. For many reasons, publications differed about the reason’s interpretation, implications and/or persuasiveness. Publications differed also regarding costs, feasibility and legality of PTA. Limitations: reason types could be applied differently. The quality of reasons was not measured. Conclusion: this review captured a greater variety of reasons and of their uses than any included publication. Decisions based on informal reviews or sub-sets of literature are likely to be biased. Research is needed on PTA ethics, costs, feasibility and legality and on assessing the quality of reason-based literature. (shrink)

There are many ethical decisions in the practice of health research and care, and in the creation of policy and guidelines. We argue that those charged with making such decisions need a new genre of review. The new genre is an application of the systematic review, which was developed over decades to inform medical decision-makers about what the totality of studies that investigate links between smoking and cancer, for example, implies about whether smoking causes cancer. We argue that there is (...) a need for similarly inclusive and rigorous reviews of reason-based bioethics, which uses reasoning to address ethical questions. After presenting a brief history of the systematic review, we reject the only existing model for writing a systematic review of reason-based bioethics, which holds that such a review should address an ethical question. We argue that such a systematic review may mislead decision-makers when a literature is incomplete, or when there are mutually incompatible but individually reasonable answers to the ethical question. Furthermore, such a review can be written without identifying all the reasons given when the ethical questions are discussed, their alleged implications for the ethical question, and the attitudes taken to the reasons. The reviews we propose address instead the empirical question of which reasons have been given when addressing a specified ethical question, and present such detailed information on the reasons. We argue that this information is likely to improve decision-making, both directly and indirectly, and also the academic literature. We explain the limitations of our alternative model for systematic reviews. (shrink)

Objectives: To report the attitudes and opinions of subjects in US clinical trials about whether or not, and why, they should receive post-trial access (PTA) to the trial drug, care and information. Design: Focus groups, short self-administered questionnaires. Setting: Boston, Dallas, Detroit, Oklahoma City. Participants: Current and recent subjects in clinical trials, primarily for chronic diseases. Results: 93 individuals participated in 10 focus groups. Many thought researchers, sponsors, health insurers and others share obligations to facilitate PTA to the trial drug, (...) if it benefited the subject, or to a therapeutic equivalent. Some thought PTA obligations include providing transition care (referrals to non-trial physicians or other trials, limited follow-up, short-term drug supply) or care for long-term adverse events. Others held, in contrast, that there are no PTA obligations regarding drugs or care. However, there was agreement that former subjects should receive information (drug name, dosage received, market approval date, long-term adverse effects, trial results). Participants frequently appealed to health need, cost, relationships, reciprocity, free choice and sponsor self-interest to support their views. Many of their reasons overlapped with those commonly discussed by bioethicists. Conclusion: Many participants in US trials for chronic conditions thought there are obligations to facilitate PTA to the trial drug at a “fair” price; these views were less demanding than those of non-US subjects in other studies. However, our participants’ views about informational obligations were broader than those of other subjects and many bioethicists. Our results suggest that the PTA debate should expand beyond the trial drug and aggregate results. (shrink)

When research concludes, post-trial access to the trial intervention or standard healthcare can be crucial for participants who are ill such as those in resource-poor countries with inadequate healthcare, British participants testing ‘last-chance drugs’ unavailable on the National Health Service and underinsured US participants. Yet, many researchers are unclear about their obligations regarding the post-trial period, and many research ethics committees do not know what to require of researchers. Consequences include participants who reasonably expect but lack PTA to the trial (...) intervention, unplanned financial liabilities for NHS Trusts forced to fund this, negative press and potential to undermine public trust.1–3,iOne reason for the lack of clarity is controversy over whether and when participants should have access, after the study, to the study intervention. At one extreme is the view that continued access should be ensured when the intervention has benefited the participant or when it has proven safe and effective for the participant population, irrespective of the cost and burden of ensuring continued access. At the other extreme is the view that continued access need never be provided so long as non-availability of the study intervention post-trial was adequately disclosed when participants were invited to participate.6 There is also disagreement about when poststudy access to the study intervention should be considered beneficial for participants. The spectrum ranges from the view that the intervention should be regarded as beneficial for a proposed use only after the …. (shrink)

Surveys were conducted at two metta meditation retreats in order to examine the psychological effects of metta meditation. Participants were invited to complete the survey at the beginning of the retreat, at the end of the retreat, and two weeks after the end of the retreat. Participants completed the same scales at each time phase, which included measures of happiness, compassionate love, revenge and avoidance motivation, gratitude, and a depression, anxiety and stress scale. Significant increases were found in happiness and (...) compassionate love, reductions in avoidance and revenge, and reductions on the depression, anxiety and stress subscales. (shrink)

A common reason for giving research participants post-trial access to the trial intervention appeals to reciprocity, the principle, stated most generally, that if one person benefits a second, the second should reciprocate: benefit the first in return. Many authors consider it obvious that reciprocity supports PTA. Yet their reciprocity principles differ, with many authors apparently unaware of alternative versions. This article is the first to gather the range of reciprocity principles. It finds that: most are false. The most plausible principle, (...) which is also problematic, applies only when participants experience significant net risks or burdens. Seldom does reciprocity support PTA for participants or give researchers stronger reason to benefit participants than equally needy non-participants. Reciprocity fails to explain the common view that it is bad when participants in a successful trial have benefited from the trial intervention but lack PTA to it. (shrink)

Care after research is for participants after they have finished the study. Often it is NHS-provided healthcare for the medical condition that the study addresses. Sometimes it includes the study intervention, whether funded and supplied by the study sponsor, NHS or other party. The NHS has the primary responsibility for care after research. However, researchers are responsible at least for explaining and justifying what will happen to participants once they have finished. RECs are responsible for considering the arrangements. There are (...) ethical and practical issues, in particular when participants may wish to continue on the study intervention after the study. There are also various guidelines and legislation. This document presents a framework of questions to help NHS RECs and their applicants. Information on this document’s development is here. (shrink)

"Kant and the Capacity to Judge" will prove to be an important and influential event in Kant studies and in philosophy.

In the theoretical framework developed by Y. Lenoir and his colleagues, Bourdieu’s concept of habitus is fundamental to explaining the tacit aspect of teaching practices. This article takes a critical look at the connection the framework makes between the concept of habitus and that of embedded skills, which is derived from French ergonomic psychology. Our primary objective is to examine the relevance and the limitations of this connection, with specific focus on its methodological implications. Our results indicate that a cognitive (...) interpretation of the concept of habitus may contribute significantly to understanding the implicit aspect of professional practices. Dans le cadre théorique élaboré par Y. Lenoir et ses collègues, le concept bourdieusien d’habitus joue un rôle central pour expliquer la dimension tacite des pratiques enseignantes. Cet article propose de porter un regard critique sur le rapprochement proposé dans ce cadre entre le concept d’habitus et celui de compétence incorporée issu de psychologie ergonomique francophone. Notre objectif principal est d’examiner la pertinence et les limites de ce rapprochement, en portant une attention particulière à ses implications méthodologiques. Nos résultats indiquent la pertinence d’une interprétation cognitive du concept d’habitus, contribuant de façon significative à la compréhension de la dimension implicite des pratiques professionnelles. (shrink)

Resumen Ésta es la primera traducción al español de las guías “Atención después de la investigación: un marco para los comités de ética de investigación del National Health Service (NHS) (borrador versión 8.0)”. El documento afirma que existe una fuerte obligación moral de garantizar que los participantes enfermos de un estudio clínico hagan una transición después del estudio hacia una atención de la salud apropiada. Con “atención de la salud apropiada” se hace referencia al acceso para los participantes a la (...) atención de la salud, proporcionada principalmente por el National Health Service (en adelante NHS), el sistema de salud del Reino Unido, y/o a la intervención en estudio, también llamada producto o tratamiento en investigación. Las guías “Atención después de la investigación” están dirigidas principalmente a los miembros de los 79 comités de ética de investigación del NHS y a quienes presentan sus estudios de investigación ante estos comités. Se trata de un documento borrador muy avanzado, trabajado en numerosas reuniones, durante más de 3 años, que ha sido discutido por participantes de estudios y miembros de la comunidad, miembros y presidentes de comités de ética de investigación del Reino Unido, especialistas internacionales en ética de la investigación, representantes de la industria y otras partes interesadas. La redacción de las guías es producto de la colaboración de Neema Sofaer y Penney Lewis, ambas investigadoras del King’s College London, en el Centre of Medical Law and Ethics del Dickson Poon School of Law, y Hugh Davies, Asesor en Ética de la Investigación de la Health Research Authority (HRA) del NHS. El traductor del presente documento, Ignacio Mastroleo, participó del workshop en la Fundación Brocher (Ginebra, Suiza, diciembre de 2011) donde se revisó el borrador versión 7.0 y contribuyó en la revisión del borrador de la versión 8.0 durante el 2012. -/- Abstract This is the first Spanish translation of the guidelines “Care after research: a framework for NHS RECs (8th draft)”. The document states that there is a strong moral obligation to ensure that participants in a clinical study who are ill transition after the study to appropriate healthcare. The terms "appropriate healthcare" refer to participants’ access to health care, mainly provided by the National Health Service (NHS), the health system in the UK, and/or to the intervention study also named investigational treatment or product. The guides "Care after research" are mainly directed to members of the 79 NHS committees of research ethics (RECs) and to those who submit their research to these committees. This is a very advanced draft document, worked in several meetings, for more than three years, that has been discussed with study participants and community members, members and chairs of RECs in the UK, international specialists in research ethics, industry representatives and other stakeholders. The drafting of the guidelines is the result of the collaboration of Neema Sofaer and Penney Lewis, both researchers at King's College London, at the Centre of Medical Law and Ethics of Dickson Poon School of Law, and Hugh Davies, Research Ethics Advisor of the Health Research Authority (HRA) of the NHS. The translator of this document, Ignacio Mastroleo, attended the workshop at the Brocher Foundation (Geneva, Switzerland, December 2011) where draft version 7.0 was revised and contributed in the revision of draft version 8.0 during 2012. (shrink)

An outstanding feature of the study of nursing ethics is that it raises questions concerning moral virtue, conscience, consistency and character. A considerable section of the literature is devoted to ideas of how best to teach ethics to health professionals. It has been shown that when faced with ethical dilemmas nurses tended to rely on intuition and instinct to resolve them, with little systematic analysis to help the process. Nurses who have been in practice for a number of years may (...) experience particular difficulties in resolving ethical dilemmas, for although they may be able easily to identify ethical problems they may feel powerless to behave appropriately through lack of theoretical background and/or confidence in participating in informed debate. An educational programme was designed to meet the needs of mature registered nurses who were undertaking a post-qualification part-time honours degree in nursing studies. A variety of teaching methods were employed in teaching the nurses. These included discussion, student-led seminars, structured debate and role play. A session which dealt with sudden death and organ donation is described in some detail. Because the topic involved communication between professionals and patients and/or relatives and was linked with ethics, role play was used to explore the dynamics in these areas. The participants were invited to act out the situation as they felt it might occur. Role play highlighted the stress and shock attached to such an experience. Before working through the dynamics of a situation the nurses were conscious of being part of decision-making 'in the cold' and 'in isolation'. As a result of the experiential learning they felt more able to reflect analytically and to participate in discussions in an informed and articulate way. (shrink)

Of the many ethical corporate marketing practices, many firms use corporate social responsibility (CSR) communication to enhance their corporate image. Yet, consumers, overwhelmed by these more or less well-founded CSR claims, often have trouble identifying truly responsible firms. This confusion encourages ‘greenwashing’ and may make CSR initiatives less effective. On the basis of attribution theory, this study investigates the role of independent sustainability ratings on consumers’ responses to companies’ CSR communication. Experimental results indicate the negative effect of a poor sustainability (...) rating for corporate brand evaluations in the case of CSR communication, because consumers infer less intrinsic motives by the brand. Sustainability ratings thus could act to deter ‘greenwashing’ and encourage virtuous firms to persevere in their CSR practices. (shrink)

Medical science is advancing all the time. Researchers are constantly trying to find new ways to help people to have long and healthy lives. Thanks to their work, doctors today can cure diseases, lessen pain, replace unhealthy limbs or organs, and help infertile couples have children. Doctors can even keep seriously ill people alive against all odds. But not everyone is enamored with advances in medicine. They question whether it is appropriate to prolong life in all cases, or believe that (...) certain treatments have been developed unethically. This book looks at how the ways that doctors treat the sick are developed, and examines some of the questions that are raised by advances in medical science. (shrink)

I focus on two main points in Ian Proops’s reading of Kant’s Paralogisms of Pure Reason: the structure of the paralogisms in the A edition of the Critique of Pure Reason, and the changes in Kant’s exposition of the paralogisms from A to B. I agree with Proops that there are defects in the A exposition and that Kant attempted to correct those defects in B. But I argue that Proops fails to give its due to what remains fundamental in (...) both editions: Kant’s criticism of the rational psychologist’s confusion between the subjective (albeit universally subjective) standpoint thinkers have on themselves just in virtue of thinking, and the objective, metaphysical standpoint on a thinking thing. In short, Proops fails to give sufficient attention to Kant’s opening statement in the Paralogisms of Pure Reason: ‘“I think” is the sole text of rational psychology’. (shrink)

The systematic review of reasons is a new way to obtain comprehensive information about specific ethical topics. One such review was carried out for the question of why post-trial access to trial drugs should or need not be provided. The objective of this study was to empirically validate this review using an author check method. The article also reports on methodological challenges faced by our study.

Vertrauenswürdigkeit von öffentlichen Personen und Institutionen ist für jeden Einzelnen ein wichtiges Kriterium und größtes Problem bei der Meinungsbildung. Eine Diskussion aus der Sicht der Psychologie, der Publizistik, der Politik, der Wirtschaft, der Philosophie, des Rechts und der Kunst kann helfen, aus wechselseitigen Perspektiven neue und übergreifende Einsichten in die Funktion von Vertrauen für die Beziehungen zwischen Personen und Institutionen zu gewinnen.

This dissertation proposes a new reading and appraisal of an important theory of distributive justice, Ronald Dworkin's "Equality of Resources" . ER is traditional in holding that choices made by rational, ignorant and purely self-interested beings are relevant to distributive justice. ER is novel both in its use of such choices and in incorporating the idea that one's success is largely one's own responsibility into liberal egalitarianism. ;I argue that the tax-and-redistribution scheme Dworkin proposes to make actual distributions just is (...) flawed because he misconceives the role of choice. He errs in thinking that the conditions for person X to receive compensation depend on the choices of such beings, although he is right, I argue, insofar as the relevant choices include X's hypothetical choices. Dworkin errs in that ER implies that whether X meets these conditions can depend on X's irrational choices, although he is right that whether X meets these conditions can depend on some of X's actual choices. ER becomes flawed, I argue, when Dworkin derives a tax-and-redistribution scheme designed to achieve distributive justice in reality from the auction he proposes for making hypothetical distributions just. ;I then consider whether ER withstands stock objections and how plausible it is relative to rival Theories. Dworkin argues that ER, but not Rawls' Theory, meets the following condition for a Theory to be plausible: the distributions a Theory deems just must be sensitive to choices. I argue that Dworkin's argument is no longer plausible once we realize to which choice sensitivity principle he is himself committed. However, I argue, Seana Shiffrin's objection to ER fails because she misunderstands the role of choice in ER, although she is right insofar as there is a related, though superficial, objection. I also argue that ER is inconsistent and show how to resolve this inconsistency without leaving ER vulnerable to attack by G. A. Cohen's rival Theory. I trace ER's inconsistency and the failure of Dworkin's argument against Rawls' Theory to Dworkin's method of justification. (shrink)

Commentators on the ethics of translational research find it morally problematic. Types of translational research are said to involve questionable benefits, special risks, additional barriers to informed consent, and severe conflicts of interest. Translational research conducted on the global poor is thought to exploit them and increase international disparities. Some commentators support especially stringent ethical review. However, such concerns are grounded only in pre-approval translational research. Whether or not T1 has these features, translational research beyond approval is unlikely to and, (...) when conducted on the global poor, may support development. Therefore, insofar as T1 is morally problematic, and no independent objections to T2 exist, the ethics of translational research is diverse: while some translational research is problematic, some is not. Funding and oversight should reflect this diversity, and T2 should be encouraged, particularly when conducted among the global poor. (shrink)

The article explores postmodern contributions to normativity of legal rules. Since Kant jurisprudence attributes binding force to legal norms which can formally be universalized. Giorgio Agamben's works, which are qualified here as postmodern, demonstrate that the far criticized - most prominently by Hegel - deficiency of substance of Kantian law might mean total submission to this insubstantiality and that generalisations always result in exclusion. Coincidently, as Agamben shows on the basis of a re-interpretation of Aristotle's concept of dýnamis and enérgeia, (...) there is a widely neglected chance in the potentiality of law without given content. Amplifying Agamben's considerations the article shows that legitimate law might require reflexivity with regard to its structural exclusion as well as its reduction to minimize marginalization. Binding law might further necessitate enactment recognising its fundamental potentiality which can only be guaranteed by - hence normative - plurality and which inevitably leads to variability of the grounds for its acceptance. (shrink)