For any reader interested in euthanasia, On Dying Well gives an accessible yet detailed account of the Church of England's view on the subject. First published in 1975, this short report is the product of the Church's Board for Social Responsibility, which brought together theologians, philosophers, lawyers, and medical professionals to form a working party with the remit of examining euthanasia. The second edition of On Dying Well leaves most of the original working party report findings unaltered, but adds a (...) new introduction by Professor Stuart Horner, chairman of the British Medical Association's ethics committee from 1989 to 1997. Other changes to the first edition are a redrafted chapter on the legal questions surrounding euthanasia in light of new cases pertinent to the debate and additional reflections on the report's medical content. Also included is an updated bibliography, listing publications produced after 1975 and, in appendix form, the 1993 Joint Submission to the House of Lords Select Committee on Medical Ethics made by the House of Bishops of the Church of England and the Roman Catholic Bishops' Conference of England and Wales. On …. (shrink)

This book explores major theoretical issues in the study of an individual life through its focus on Jean-Paul Sartre. Sartre's quest for an "existential psychoanalysis" led him to develop what he called "true novels" in the landmark studies of Flaubert and others. In clarifying Sartre's philosophical ideas in relation to the analysis of the self, Stuart L. Charme examines the attraction/repulsion of Freudian concepts and explores parallels to Erikson's ego psychology. Certain "mythic" qualities in religious biography and autobiography are (...) seen as central to Sartre, who presents lives--including his own--as normative models. The book concludes by making a provocative link between the modern preoccupation with self-analysis in biography and autobiography and a fundamental religious need that was once fulfilled by primitive myth. (shrink)

Since his death in 1980, there has been a resurgence of scholarly interest in the life and work of Jean-Paul Sartre, as interpreters have searched for the threads that link the diverse elements of his thought. In this book, Stuart Zane Charme uses the concept of vulgarity as a key to understanding the interaction of Sartre's social background and his analysis of existential authenticity.

Non‐homologous end‐joining (NHEJ) is the dominant means of repairing chromosomal DNA double strand breaks (DSBs), and is essential in human cells. Fifteen or more proteins can be involved in the detection, signalling, synapsis, end‐processing and ligation events required to repair a DSB, and must be assembled in the confined space around the DNA ends. We review here a number of interaction points between the core NHEJ components (Ku70, Ku80, DNA‐PKcs, XRCC4 and Ligase IV) and accessory factors such as kinases, phosphatases, (...) polymerases and structural proteins. Conserved protein‐protein interaction sites such as Ku‐binding motifs (KBMs), XLF‐like motifs (XLMs), FHA and BRCT domains illustrate that different proteins compete for the same binding sites on the core machinery, and must be spatially and temporally regulated. We discuss how post‐translational modifications such as phosphorylation, ADP‐ribosylation and ubiquitinylation may regulate sequential steps in the NHEJ pathway or control repair at different types of DNA breaks. (shrink)

SummaryThe Gainj of highland Papua New Guinea do not use contraception but have a total fertility rate of only 4·3 live births per woman, one of the lowest ever recorded in a natural fertility setting. From an analysis of cross-sectional demographic and endocrinological data, the causes of low reproductive output have been identified in women of this population as: late menarche and marriage, a long interval between marriage and first birth, a high probability of widowhood at later reproductive ages, low (...) effective fecundability and prolonged lactational amenorrhoea. These are combined with near-universal marriage, a low prevalence of primary sterility and a pattern of onset of secondary sterility similar to that found in other populations. Of all the factors limiting fertility, by far the most important are those involved in birth spacing, especially lactational amenorrhoea. (shrink)

SummaryThe effects of infant suckling patterns on the post-partum resumption of ovulation and on birth-spacing are investigated among the Gainj of highland New Guinea. Based on hormonal evidence, the median duration of lactational anovulation is 20·4 months, accounting for about 75% of the median interval between live birth and next successful conception. Throughout lactation, suckling episodes are short and frequent, the interval changing slowly over time, from 24 minutes in newborns to 80 minutes in 3-year olds. Maternal serum prolactin concentrations (...) decline in parallel with the changes in suckling patterns, approaching the level observed in non-nursing women by about 24 months post-partum. A path analysis indicates that the interval between suckling episodes is the principal determinant of maternal prolactin concentration, with time since parturition affecting prolactin secretion only in so far as it affects suckling frequency. The extremely prolonged contraceptive effect of breast-feeding in this population thus appears to be due to a slow decline in suckling frequency with time since parturition and absence of a decline over time in hypothalamic–pituitary responsiveness to the suckling stimulus. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

The gelsolin gene family encodes a number of higher eukaryotic actin-binding proteins that are thought to function in the cytoplasm by severing, capping, nucleating or bundling actin filaments. Recent evidence, however, suggests that several members of the gelsolin family may have adopted unexpected nuclear functions including a role in regulating transcription. In particular, flightless I, supervillin and gelsolin itself have roles as coactivators for nuclear receptors, despite the fact that their divergence appears to predate the evolutionary appearance of nuclear receptors. (...) Flightless I has been shown to bind both actin and the actin-related BAF53a protein, which are subunits of SWI/SNF-like chromatin remodelling complexes. The primary sequences of some actin-related proteins such as BAF53a exhibit conservation of residues that, in actin itself, are known to interact with gelsolin-related proteins. In summary, there is a growing body of evidence supporting a biological role in the nucleus for actin, Arps and actin-binding proteins and, in particular, the gelsolin family of actin-binding proteins. (c) 2005 Wiley Periodicals, Inc. (shrink)

The interactivist approach to development generates a framework of types of constraints on what can be constructed. The four constraint types are based on: (1) what the constructed systems are about; (2) the representational relationship itself; (3) the nature of the systems being constructed; and (4) the process of construction itself. We give illustrations of each constraint type. Any developmental theory needs to acknowledge all four types of constraint; however, some current theories conflate different types of constraint, or rely on (...) a single constraint type to explicate development. Such theories will be inherently unable to explain important aspects of development. (shrink)

We assume that acting ethically is a skill. We then use a phenomenological description of five stages of skill acquisition to argue that an ethics based on principles corresponds to a beginner’s reliance on rules and so is developmentally inferior to an ethics based on expert response that claims that, after long experience, the ethical expert learns to respond appropriately to each unique situation. The skills model thus supports an ethics of situated involvement such as that of Aristotle, John Dewey, (...) and Carol Gilligan against the detached, rationalist ethics of Kant, John Rawls, Lawrence Kohlberg, and Jürgen Habermas. (shrink)

Humanitarian health care practitioners working outside familiar settings, and without familiar supports, encounter ethical challenges both familiar and distinct. The ethical guidance they rely upon ought to reflect this. Using data from empirical studies, we explore the strengths and weaknesses of two ethical models that could serve as resources for understanding ethical challenges in humanitarian health care: clinical ethics and public health ethics. The qualitative interviews demonstrate the degree to which traditional teaching and values of clinical health ethics seem insufficient (...) for addressing all the realities of health care practice during humanitarian missions. They equally suggest that greater good orientations of public health ethics can thwart the best intentions of health care professionals wanting to attend to the interests of individual patients. Even though neither is complete on its own for helping guide health professionals on field missions, taken together these models have much to offer. At the same time, the narratives of the humanitarian health care workers illustrate how some of the crucial differences between public health ethics and clinical ethics generate tensions in humanitarian health practice. We offer an analysis of some of the complexities this creates for humanitarian health care ethics, and consider ways of adjudicating between the two models. (shrink)

Furthermore, adults with decision-making capacity, including pregnant women, can currently accept interventions with moderate net risks for themselves in other settings (e.g., open f...

Volume 19, Issue 10, October 2019, Page 43-46.

Taking Rom Harré's social constructionism as a focus we point to and discuss the issue of the a priori psychological subject in social constructionist theory. While Harré indicates that interacting, intending beings are necessary for conversation to occur, he assumes that the primary human reality is conversation and that psychological life emerges from this social domain. Nevertheless, we argue that a fundamental and agentive psychological subject is implicit to his constructionist works. Our critical analyses focus upon Harré's understandings of persons, (...) human development and human agency. Our intention is neither to suggest that this latent entity must be understood in a Cartesian sense nor is it to ask for an explicit accounting of an autonomous agent. Rather, our claim is simply that psychological subjectivity is reflexively entailed in Harré's human psychology. We suggest that this pertains more generally to social constructionist theory. (shrink)

Against the background assumptions that knowing what clinical ethics consultation represents to those with whom ethics consultants work most closely is a necessary component for being responsible in the practice of ethics consultation, and the complexities of soliciting and understanding colleague evaluations require another inherent responsibility for the methods by which ethics consultations are evaluated, in this article we report our experience soliciting, analyzing, and trying to understand retrospective evaluations of our Clinical Ethics Consultation Service. These evaluations were collected through (...) a quality assessment effort at our institution. Drawing from the qualitative elements of our survey instrument, we describe unexpected variations among the requests for ethics consultation and the retrospective reports from those colleagues making the requests. Focusing on just one aspect – the reason for request – raised several core questions about how we should evaluate those retrospective reports, what could be learned from the differences that we were now encountering, and what we could learn about the process of evaluating our practices. Working through these questions, we suggest several issues to consider in ongoing efforts to describe and evaluate clinical ethics consultation: the role of time and memory in evaluating retrospective evaluations, the importance of attending to the language of moral shift or disruption with which our colleagues describe their experiences, and how to understand the role of ethics consultation in creating ‘moral space’ for colleagues to process their moral experiences. (shrink)

Web scraping involves using computer programs for automated extraction and organization of data from the Web for the purpose of further data analysis and use. It is frequently used by commercial companies, but also has become a valuable tool in epidemiological research and public health planning. In this paper, we explore ethical issues in a project that “scrapes” public websites of U.S. county jails as part of an effort to develop a comprehensive database to enhance HIV surveillance and improve continuity (...) of care for incarcerated populations. We argue that the well-known framework of Emanuel et al. provides only partial ethical guidance for the activities we describe, which lie at a complex intersection of public health research and public health practice. We suggest some ethical considerations from the ethics of public health practice to help fill gaps in this relatively unexplored area. (shrink)