SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence-based implementation strategy (Grimshaw & Eccles (...) 1998). (shrink)

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)

Medical Humanities the journal started life in 2000 as a special edition of the JME. However, the intellectual taproots of the medical humanities as a field of enquiry can be traced to two developments: calls made in the 1920s for the development of multidisciplinary perspectives on the sciences that shed historical light on their assumptions, methods and practices; refusals to assimilate all medical phenomena to a biomedical worldview. Medical humanities the term stems from a desire to situate the significance of (...) medicine as a product of culture. But despite growing usage over half a century the term defies a unifying encapsulation and continues to conjure up a multitude of discourse communities, including scholars working at the interfaces of health and humanities, arts and health, and medical education and bioethics. The field is intellectually capacious and polymorphous, forming and reforming around critical new research questions and teaching tasks spanning disciplines. (shrink)

Bioethics case reports generally treat aspects of moral fathomability, characterised and addressed in different ways. This paper reads the case as a textual model of scenarios and draws attention to its structure, narrative shape, linguistic register, and the effects of tone and temporality on reader expectation and responsiveness. Such textual elements of case composition reflect authorial purpose and influence the interpretation, including moral and ethical interpretation, of bioethics cases.

In this paper, we reflect upon shame and humiliation as threats to personal and professional integrity and moral agency within contemporary health care. A personal narrative, written by a nurse about a particular shift in a British National Health Service Accident and Emergency Department, is provided as a case study. This is critically reflected and commented upon in dialogue with insights into the nature of shame and humiliation. It is suggested that Accident and Emergency is a locus that is latently (...) prone to dynamics of shame and humiliation, a potential exacerbated within a culture subject to externally‐determined time targets that are enforced by a top‐down system of surveillance and management. The result is that nurses may lose their sense of professional competence and responsibility, moral agency, and integrity, to their own personal detriment, as well as to the detriment of patients with whom they work. Insofar as examining a small part of a whole may suggest insights into the operation and ethos of a very large system, this very particular case study narrative/reflection has some important implications and lessons for the wider organization and provision of health care in Britain and beyond. (shrink)

Volume 20, Issue 7, July 2020, Page W17-W19.

The first part of the book, dedicated to 'Rhetorical and Epistemological Aspects of Science Writing', addresses how scientific pursuits and methods feed into multi-level texts that generate responses within science, society, and culture.

This collection arose out of a conference on intuitions at the University of Notre Dame in April 1996. The papers in it mainly address two related questions: (a) How much evidential weight should be assigned to intuitions? and (b) Are concepts governed by necessary and sufficient conditions, or are they governed by ‘family resemblance’ conditions, as Wittgenstein suggested? The book includes four papers by psychologists relating and analyzing some empirical findings concerning intuitions and eleven papers by philosophers endorsing various answers (...) to these questions. (shrink)

Traditionally, medical professionals have taken a paternalistic stance towards their patients and have relied on a traditional approach to medical ethics. In recent years, in Britain, however, a new ‘managerialism’ has developed in the National Health Service (the NHS). This stresses consumerism and greater patient choice and is changing the relationship between doctors and patients. This paper draws out the implications for patients. It describes the ethical characteristics of the two conflicting approaches and argues the need to stress again the (...) view of the patient as an individual person. (shrink)

A textbook on modal logic, intended for readers already acquainted with the elements of formal logic, containing nearly 500 exercises. Brian F. Chellas provides a systematic introduction to the principal ideas and results in contemporary treatments of modality, including theorems on completeness and decidability. Illustrative chapters focus on deontic logic and conditionality. Modality is a rapidly expanding branch of logic, and familiarity with the subject is now regarded as a necessary part of every philosopher's technical equipment. Chellas here offers (...) an up-to-date and reliable guide essential for the student. (shrink)

The coronavirus disease (COVID-19) crisis provoked an organizational ethics dilemma: how to develop ethical pandemic policy while upholding our organizational mission to deliver relationship- and patient-centered care. Tasked with producing a recommendation about whether healthcare workers and essential personnel should receive priority access to limited medical resources during the pandemic, the bioethics department and survey and interview methodologists at our institution implemented a deliberative approach that included the perspectives of healthcare professionals and patient stakeholders in the policy development process. Involving (...) the community more, not less, during a crisis required balancing the need to act quickly to garner stakeholder perspectives, uncertainty about the extent and duration of the pandemic, and disagreement among ethicists about the most ethically supportable way to allocate scarce resources. This article explains the process undertaken to garner stakeholder input as it relates to organizational ethics, recounts the stakeholder perspectives shared and how they informed the triage policy developed, and offers suggestions for how other organizations may integrate stakeholder involvement in ethical decision-making as well as directions for future research and public health work. (shrink)

Organ transplantation from living related donors in Bangladesh first began in October 1982, and became commonplace in 1988. Cornea transplantation from posthumous donors began in 1984 and living related liver and bone marrow donor transplantation began in 2010 and 2014 respectively. The Human Organ Transplantation Act officially came into effect in Bangladesh on 13th April 1999, allowing organ donation from both brain-dead and related living donors for transplantation. Before the legislation, religious leaders issued fatwa, or religious rulings, in favor of (...) organ transplantation. The Act was amended by the Parliament on 8th January, 2018 with the changes coming into effect shortly afterwards on 28th January. However, aside from a few posthumous corneal donations, transplantation of vital organs, such as the kidney, liver, heart, pancreas, and other body parts or organs from deceased donors, has remained absent in Bangladesh. The major question addressed in this article is why the transplantation of vital organs from deceased donors is absent in Bangladesh. In addition to the collection of secondary documents, interviews were conducted with senior transplant physicians, patients and their relatives, and the public, to learn about posthumous organ donation for transplantation. Interviews were also conducted with a medical student and two grief counselors to understand the process of counseling the families and obtaining consent to obtain posthumous cornea donations from brain-dead patients. An interview was conducted with a professional anatomist to understand the processes behind body donation for the purposes of medical study and research. Their narrative reveals that transplant physicians may be reticent to declare brain death as the stipulations of the 1999 act were unclear and vague. This study finds that Bangladeshis have strong family ties and experience anxiety around permitting separating body parts of dead relatives for organ donation for transplantation, or donating the dead body for medical study and research purposes. Posthumous organ donation for transplantation is commonly viewed as a wrong deed from a religious point of view. Religious scholars who have been consulted by the government have approved posthumous organ donation for transplantation on the grounds of necessity to save lives even though violating the human body is generally forbidden in Islam. An assessment of the dynamics of biomedicine, religion and culture leads to the conclusion that barriers to posthumous organ donation for transplantation that are perceived to be religious may actually stem from cultural attitudes. The interplay of faith, belief, religion, social norms, rituals and wider cultural attitudes with biomedicine and posthumous organ donation and transplantation is very complex. Although overcoming the barriers to organ donation for transplantation is challenging, initiation of transplantation of vital organs from deceased donors is necessary within Bangladesh. This will ensure improved healthcare outcomes, prevent poor people from being coerced into selling their organs to rich recipients, and protect the solidarity and progeny of Bangladeshi families. (shrink)

We live in a world of crowds and corporations, artworks and artifacts, legislatures and languages, money and markets. These are all social objects — they are made, at least in part, by people and by communities. But what exactly are these things? How are they made, and what is the role of people in making them? In The Ant Trap, Brian Epstein rewrites our understanding of the nature of the social world and the foundations of the social sciences. Epstein (...) explains and challenges the three prevailing traditions about how the social world is made. One tradition takes the social world to be built out of people, much as traffic is built out of cars. A second tradition also takes people to be the building blocks of the social world, but focuses on thoughts and attitudes we have toward one another. And a third tradition takes the social world to be a collective projection onto the physical world. Epstein shows that these share critical flaws. Most fundamentally, all three traditions overestimate the role of people in building the social world: they are overly anthropocentric. Epstein starts from scratch, bringing the resources of contemporary metaphysics to bear. In the place of traditional theories, he introduces a model based on a new distinction between the grounds and the anchors of social facts. Epstein illustrates the model with a study of the nature of law, and shows how to interpret the prevailing traditions about the social world. Then he turns to social groups, and to what it means for a group to take an action or have an intention. Contrary to the overwhelming consensus, these often depend on more than the actions and intentions of group members. (shrink)

Collecting data using an appropriate sampling technique is a challenging task for a researcher to do. The researchers will be unable to collect data from all possible situations, which will preclude them from answering the study’s research questions in their current form. In light of the enormous number and variety of sampling techniques/methods available, the researcher must be knowledgeable about the differences to select the most appropriate sampling technique/method for the specific study under consideration. In this context, this study also (...) looks into the basic concepts in probability sampling, kinds of probability sampling techniques with their advantages and disadvantages. Social science researchers will benefit from this study since it will assist them in choosing the most suitable probability sampling technique for completing their research smoothly and successfully. (shrink)

In the face of a perceived lack of widespread understanding of the theoretical issues underlying the development, dissemination and implementation of clinical guidelines, the Royal College of General Practitioners Guidelines Group developed a 2-day course aimed at teaching the theory in these areas. The course was targeted at potential opinion formers and ran on six occasions. Postal questionnaire assessment of the course revealed high levels of satisfaction with all aspects of the course and high levels of reported use of the (...) knowledge gained. Further developments of the course are discussed. (shrink)

Background Advocates for a regulated system to facilitate kidney donation between unrelated donor-recipient pairs argue that monetary compensation encourages people to donate vital organs that save the lives of patients with end-stage organ failure. Scholars support compensating donors as a form of reciprocity. This study aims to assess the compensation system for the unrelated kidney donation program in the Islamic Republic of Iran, with a particular focus on the implications of Islam on organ donation and organ sales. Methods This study (...) reviews secondary documents for philosophical argumentation and ethical analysis of human organ donation and sale for transplantation. Results and discussion According to Islamic law, organ donation is an act of _sadaqatul jariyah,_ and individuals are permitted to donate organs with the intention of saving lives. The commercialization of humans as organ sellers and buyers is contrary to the Islamic legal maxim _eethaar_, undermining donors of ‘selfless’ or ‘altruistic’ motivations. Such an act should be considered immoral, and the practice should not be introduced into other countries for the sake of protecting human dignity, integrity, solidarity, and respect. I, therefore, argue that Iran’s unrelated kidney donation program not only disregards the position of the Islamic religion with respect to the provision or receipt of monetary benefits for human kidneys for transplantation but that it also misinterprets the Islamic legal proscription of the sale of human organs. I also argue that the implementation of Iran’s unrelated kidney donor transplantation program is unethical and immoral in that potential donors and recipients engage in a bargaining process akin to that which sellers and buyers regularly face in regulated commodity exchange markets. Conversely, I suggest that a modest fixed monetary remuneration as a gift be provided to a donor as a reward for their altruistic organ donation, which is permissible by Islamic scholars. This may remove the need to bargain for increased or decreased values of payment in exchange for the organ, as well as the transactional nature of ‘buyer and seller’, ensuring the philosophy of ‘donor and recipient’ is maintained. Conclusions Offering a fixed modest monetary incentive to organ donors would serve to increase organ supply while protecting donors’ health and reducing human suffering without legalizing the human organ trade. (shrink)

There are very few medical ethics courses in British medical schools which are a formal part of the clinical curriculum. Such a programme is described in the following, along with the way in which the long-term curriculum committee of the University College and Middlesex Hospital Joint Medical School was persuaded to make it compulsory for first-year students. Pedagogical lessons which have been learned in its planning and implementation are outlined and teaching materials are included concerning student and course assessment which (...) should be useful for others engaged in similar work. Finally, some of the institutional obstacles facing such attempts are discussed, particularly problems concerning timetabling, different types of opposition and the consequent importance of building alliances among clinical teaching staff. (shrink)

This article examined the effect of culture and religiosity on perceptions of business ethics among students in a tertiary institution in Malaysia. A structured questionnaire was developed with scenarios on various aspects of business ethics, and self-administered to the students in the business studies program. The results from 767 respondents showed that there were significant differences among the Malays, Chinese, and Indian students on seven scenarios namely selling hazardous products, misleading instructions, selling defective products, padding expense account, taking sick to (...) take a day off, keeping quiet on defective products, and respond to supplier's take good care of clients attitude. There was also an association between culture and religiosity. The MANOVA results also showed that culture and religiosity have an effect on perceptions of business ethics. (shrink)

All major western countries today contain groups that differ in their religious beliefs, customary practices or ideas about the right way in which to live. How should public policy respond to this diversity? In this important new work, Brian Barry challenges the currently orthodox answer and develops a powerful restatement of an egalitarian liberalism for the twenty-first century. Until recently it was assumed without much question that cultural diversity could best be accommodated by leaving cultural minorities free to associate (...) in pursuit of their distinctive ends within the limits imposed by a common framework of laws. This solution is rejected by an influential school of political theorists, among whom some of the best known are William Galston, Will Kymlicka, Bhikhu Parekh, Charles Taylor and Iris Marion Young. According to them, this 'difference-blind' conception of liberal equality fails to deliver either liberty or equal treatment. In its place, they propose that the state should 'recognize' group identities, by granting groups exemptions from certain laws, publicly 'affirming' their value, and by providing them with special privileges or subsidies. In Culture and Equality, Barry offers an incisive critique of these arguments and suggests that theorists of multiculturism tend to misdiagnose the problems of minority groups. Often, these are not rooted in culture, and multiculturalist policies may actually stand in the way of universalistic measures that would be genuinely beneficial. (shrink)

Almost every country today contains adherents of different religions and different secular conceptions of the good life. Is there any alternative to a power struggle among them, leading most probably to either civil war or repression? The argument of this book is that justice as impartiality offers a solution. According to the theory of justice as impartiality, principles of justice are those principles that provide a reasonable basis for the unforced assent of those subject to them. The object of this (...) book is to set the theory out, explain its rationale, and respond to a variety of criticism that have been made of it. As the second volume of his work-in-progress, A Treatise on Social Justice, this work lies at the heart of a thriving academic debate which the author has played a key role in shaping. (shrink)

This paper defends a non-reductive realist view of the sensible qualities—roughly, the view that the sensible qualities are really instantiated by the external objects of perception, and not reducible to response-independent physical properties or response-dependent relational properties. I begin by clarifying and motivating the non-reductive realist view. I then consider some familiar difficulties for the view. Addressing these difficulties leads to the development and defence of a general theory, inspired by Russellian Monist theories of consciousness, of how the sensible qualities (...) relate to physical reality. I conclude by showing how this theory, which I call ‘Secondary Quality Russellian Monism’, resolves the most significant difficulties for the non-reductive realist view of the sensible qualities. (shrink)

The Infectious Diseases Act entered into force officially on 14 November 2018 in Bangladesh. The Act is designed to raise awareness of, prevent, control, and eradicate infectious or communicable diseases to address public health emergencies and reduce health risks. A novel coronavirus disease was first identified in Bangladesh on 8 March 2020, and the Ministry of Health and Family Welfare issued a gazette on 23 March, listing COVID-19 as an infectious disease and addressing COVID-19 as a public health emergency. The (...) gazette empowers the government to monitor the spread of infection. Despite there being an infrastructure of research ethics committees in almost all hospitals in Bangladesh, a lack of such committees in the clinical setting often forces healthcare professionals to allocate scarce healthcare resources to the task. These personnel are often either influenced by materialistic matters or guided by the emergency policies, without reaching a consensus on how to allocate scarce resources in times of need, especially in the time of the COVID-19 pandemic. Ethical dilemmas often arise when a number of patients with COVID-19, especially in poor and middle-class areas, are denied care while elites are prioritized to receive such scarce resources. Resource allocation in healthcare during the COVID-19 pandemic in Bangladesh appears to be unethical and in direct conflict with the biomedical principles of non-maleficence and procedural justice. The findings of this study suggest that the Act needs substantive changes in the stipulation of policy directing hospitals in the provision of resource allocation framework. Furthermore, parliament should produce guidance outlining how to successfully implement the law with the aim of protecting public health in times of emergency, especially the COVID-19 pandemic. (shrink)