Pragmatic clinical trials (PCTs) seek to show the effectiveness of treatments in routine, clinical practice (MacPherson 2004). However, a number of ethical challenges come to the fore when collater...

Volume 20, Issue 2, February 2020, Page 38-41.

Volume 19, Issue 7, July 2019, Page 53-55.

The introduction of Western healthcare, via colonialism, into Africa facilitated a confrontation of indigenous and exogenous “medical” knowledge as well as the attendant praxis. Although colonialism has been expunged from the shores of Africa, the epistemic and ideological frictions it introduced into the sphere of healthcare linger and raise different dilemmas. Against this background, this paper explores pragmatic and ethical approaches that may help engage these tensions in the context of drug development based on validated traditional phytomedicines.

Many drugs used in paediatric medicine are off-label. There is a rising call for the use of adaptive clinical trial designs in responding to the need for safe and effective drugs given their potential to offer efficiency and cost-effective benefits compared with traditional clinical trials. ADs have a strong appeal in paediatric clinical trials given the small number of available participants, limited understanding of age-related variability and the desire to limit exposure to futile or unsafe interventions. Although the ethical value (...) of adaptive trials has increasingly come under scrutiny, there is a paucity of literature on the ethical dilemmas that may be associated with paediatric adaptive designs. This paper highlights some of these ethical concerns around safety, scientific/social value and caregiver/guardian comprehension of the trial design. Against this background, the paper develops a non-static conceptual lens for understanding PADs. It shows that ADs are epistemically open and reduce some of the knowledge-associated uncertainties inherent in clinical trials as well as fast-track the time to draw conclusions about the value of evaluated drugs/treatments. On this note, the authors argue that PADs are ethically justifiable given they have multiple layers of safety, exposing enrolled children to lesser potential risks, create social/scientific value generally and for paediatric populations in particular, specifically foster the flourishing of paediatric populations and can significantly improve paediatric trial efficiency when properly designed and implemented. However, because PADs are relatively new and their regulatory, ethical and logistical characteristics are yet to be clarified in some jurisdictions, the cooperation of various public and private stakeholders is required to ensure that the interests of children, their caregivers and parents/guardians are best served while exposing paediatric research subjects to the most minimal of risks when they are enrolled in paediatric trials that use ADs. Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable. (shrink)

Funding broadly connotes the notion of an institution and/or institutions making money and other resources available to individual researchers and organizations to accomplish specific projects. Whi...

The power of the scientific enterprise presents multiple avenues for harnessing and increasingly controlling biological phenomena and instituting interventions in different areas of biomedicine (Af...

Contexts where the same clinician with an ongoing physician-patient relationship seeks to enroll his or her own patient(s) into a clinical research are ethically tricky due to the associated role c...

One of the central characteristics of public health disasters is the rapid overlapping of different needs and priorities that require making critical choices that inevitably elicit conflicti...

COVID‐19, caused by a novel coronavirus named SARS‐CoV‐2, was identified in December 2019, in Wuhan, China. It was first confirmed in sub‐Saharan Africa in Nigeria on 27 February 2020 and has since spread quickly to all sub‐Saharan African countries, causing more than 111,309 confirmed cases and 2,498 deaths as of 03 June 2020. The lessons learned during the recent Ebola virus disease (EVD) outbreaks in some sub‐Saharan African countries were expected to shape and influence the region’s responses to COVID‐19 pandemic. (...) However, some of the challenges associated with the management of the EVD outbreaks persist and create obstacles for the effective management of the COVID‐19 pandemic. This article describes the commonalities between the EVD epidemics and COVID‐19 pandemic, with a view to draw on lessons learned to effectively tackle the ongoing pandemic. Key successes, failures and lessons learned from previous EVD outbreaks are discussed. Recommendations on how these lessons can be translated to strengthen the COVID‐19 response in sub‐Saharan Africa are provided. (shrink)

I read with great bewilderment the unconvincing arguments of Peter F. Omonzejele in his article “Ethical Challenges Posed by the Ebola Virus Epidemic in West Africa” published in the 11 issue of the Journal of Bioethical Inquiry. While the author glaringly mixed up anthropological issues concerning the hygiene of hand-washing and safe burials in an article with a title clearly focused on ethical challenges, he failed to establish how the current Ebola epidemic ravaging some West Africa countries made these human (...) practices ethical challenges. Anecdotal examples cited in the article fit entirely into the realm of anthropological and sociological issues fuelling the spread of Ebola but are not in any way related to ethical challenges. The title was either misleading or the author deliberately discussed anthropological/sociological issues tangentially in an article supposedly written on ethical issues.The author also contradicted himself, having categorized as a compelling need t .. (shrink)

Community engagement in research, including public health related research, is acknowledged as an ethical imperative. While medical care and public health action take priority over research during infectious disease outbreaks, research is still required in order to learn from epidemic responses. The World Health Organisation developed a guide for community engagement during infectious disease epidemics called the Good Participatory Practice for Trials of Emerging (and Re‐emerging) Pathogens that are Likely to Cause Severe Outbreaks in the Near Future and for which (...) Few or No Medical Counter‐Measures Exist (GPP‐EP). This paper identified priorities for community engagement for research conducted during infectious disease outbreaks drawing on discussions held with a purposive sample of bioethicists, social scientists, researchers, policy makers and laypersons who work with ethics committees in West Africa. These perspectives were considered in the light of the GPP‐EP, which adds further depth and dimension to discussions on community engagement frameworks. It concludes that there is no presumptive justification for the exclusion of communities in the design, implementation and monitoring of clinical trials conducted during an infectious disease outbreak. Engagement that facilitates collaboration rather than partnership between researchers and the community during epidemics is acceptable. (shrink)

This book presents the first critical examination of the overlapping ethical, sociocultural, and policy-related issues surrounding disasters, global bioethics, and public health ethics. These issues are elucidated under the conceptual rubric: Public health disasters. The book defines PHDs as public health issues with devastating social consequences, the attendant public health impacts of natural or man-made disasters, and latent or low prevalence public health issues with the potential to rapidly acquire pandemic capacities. This notion is illustrated using Ebola and pandemic influenza (...) outbreaks, atypical drug-resistant tuberculosis, and the health emergencies of earthquakes as focal points. Drawing on an approach that reckons with microbial, existential, and anthropological realities; the book develops a relational-based global ethical framework that can help address the local, anthropological, ecological, and transnational dynamics of the ethical issues engendered by public health disasters. The book also charts some of the critical roles that relevant local and transnational stakeholders may play in translating the proposed global ethical framework from the sphere of concept to the arena of action. This title is of immense benefit to bioethics scholars, public and global health policy experts, as well as graduate students working in the area of global health, public health ethics, and disaster bioethics. (shrink)

While most business ethics texts focus exclusively on individual decision making--what should an individual do--this resource presents the whole business ethics story. Highly realistic, readable, and down-to-earth, it moves from the individual to the managerial to the organizational level, focusing on business ethics in an organizational context to promote an understanding of complex influences on behavior. The new Fifth Edition is the perfect text for students entering the workplace, those seeking to become professionals in training, communications, compliance, in addition to (...) chief ethics officers, corporate counsel, heads of human resources, and senior executives. (shrink)

Psychological assessment has long been reported as a key component of clinical psychology. This paper examined and shed light on the complexities surrounding the clinical significance of therapeutic approach to treatment Planning. To achieve this objective, the paper searched and used the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to analysed the underlying themes: 1) a strong basis for the usage of therapeutic approach to psychological assessment in treatment plans, 2) explained the conceptual meaning (...) of clinical significant change in therapeutic assessment, 3) used initial theory to explain the therapeutic mechanisms of change in clinical practice, 4) analysed the empirically documenting clinically significant change in therapeutic assessment. Finally, the study suggested that though therapeutic assessment is not sufficient for the systematic study of psychotherapy outcome and process, it is still consistent with both the lay-man and professional expectations regarding treatment outcome and also provides a precise method for classifying clients as “changed” or “unchanged” on the basis of clinical significance criteria. (shrink)

A large and important part of social relations is gender relations between men and women. Over time, the manifestation of such relations has often been one of violence, particularly violence against women. Different approaches have been deployed to deal with the experience of gender-based violence (GBV). One popular approach is the human rights framework that suggest that GBV can be addressed by granting certain rights to women. We argue that while a human rights framework holds some promise in resolving GBV, (...) it is limited in some ways because it does not take the cultural perceptions of gender relations that envision gender duties into account. As part of our argument, we show that social relations in African communities ought to be primarily based on the principle of duty to the other, rather than an emphasis on rights. We conclude that there is a need to complement the rights-based approach with a duty-based approach to effectively address GBV. (shrink)

In chapter 3 of Wild Animal Ethics Johannsen argues for a collective obligation based on beneficence to intervene in nature in order to reduce the suffering of wild animals. In the same chapter he claims that the non-identity problem is merely a “theoretical puzzle” which doesn’t affect our reasons for intervention. In this paper I argue that the non-identity problem affects both the strength and the nature of our reasons to intervene. By intervening in nature on a large scale we (...) change which animals come into existence. In doing so, we enable harmful animals to inflict harms on other animals, and we put other animals in harm’s way. The harms that these animals will inflict and endure are foreseeable. Furthermore, since non-human animals aren’t moral agents, harmful animals cannot be morally responsible for their harmful actions. I argue therefore that by causing animals to exist, knowing that they will inflict and suffer harms, we become morally responsible for those harms. By engaging in identity-affecting actions then we take on secondary moral duties towards the animals we have thereby caused to exist, and these secondary moral duties may be extremely demanding, even more so than the initial costs of intervention. Finally, these duties are duties of justice rather than duties of beneficence, and as such are more stringent than purely beneficence-based moral reasons. Furthermore, this conclusion flows naturally from several plausible principles which Johannsen explicitly endorses. (shrink)

National Book Award Finalist. How did humanity originate and why does a species like ours exist on this planet? Do we have a special place, even a destiny in the universe? Where are we going, and perhaps, the most difficult question of all, "Why?" In The Meaning of Human Existence, his most philosophical work to date, Pulitzer Prize–winning biologist Edward O. Wilson grapples with these and other existential questions, examining what makes human beings supremely different from all other species. Searching (...) for meaning in what Nietzsche once called "the rainbow colors" around the outer edges of knowledge and imagination, Wilson takes his readers on a journey, in the process bridging science and philosophy to create a twenty-first-century treatise on human existence—from our earliest inception to a provocative look at what the future of mankind portends. Continuing his groundbreaking examination of our "Anthropocene Epoch," which he began with The Social Conquest of Earth, described by the New York Times as "a sweeping account of the human rise to domination of the biosphere," here Wilson posits that we, as a species, now know enough about the universe and ourselves that we can begin to approach questions about our place in the cosmos and the meaning of intelligent life in a systematic, indeed, in a testable way. Once criticized for a purely mechanistic view of human life and an overreliance on genetic predetermination, Wilson presents in The Meaning of Human Existence his most expansive and advanced theories on the sovereignty of human life, recognizing that, even though the human and the spider evolved similarly, the poet's sonnet is wholly different from the spider's web. Whether attempting to explicate "The Riddle of the Human Species," "Free Will," or "Religion"; warning of "The Collapse of Biodiversity"; or even creating a plausible "Portrait of E.T.," Wilson does indeed believe that humanity holds a special position in the known universe. The human epoch that began in biological evolution and passed into pre-, then recorded, history is now more than ever before in our hands. Yet alarmed that we are about to abandon natural selection by redesigning biology and human nature as we wish them, Wilson soberly concludes that advances in science and technology bring us our greatest moral dilemma since God stayed the hand of Abraham. (shrink)

Esta dissertação encontra-se construída em torno de um núcleo central - a exposição, aná-lise e discussão do chamado 'Argumento da linguagem privada', de Wittengstein. A dinâmica própria da abordagem e discussão do tema leva necessariamente a percorrer o conjunto da obra de Wittengstein, o que motiva um notável aprofundamento do assunto e torna ainda mais aliciante este ensaio.

The most important clarification we bring in our reply to commentators concerns the problem of the “explanatory gap”: that is, the gulf that separates physical processes in the brain from the experienced quality of sensations. By adding two concepts (bodiliness and grabbiness) that were not stressed in the target article, we strengthen our claim and clarify why we think we have solved the explanatory gap problem, – not by dismissing qualia, but, on the contrary, by explaining why sensations have a (...) “feel” and why “feels” feel the way they do. We additionally clarify our views on: internal representations (we claim internal representations cannot explain why sensation has a feel), on behaviorism (we are not behaviorists), on perception and action (we believe there can be perception without action), and on the brain (we believe the brain does do something important in perception). (shrink)

This is the first modern, annotated and scholarly edition of Jean-Baptiste Du Bos’ _Critical Reflections on Poetry and Painting_, one of the seminal works of modern aesthetics in any language.

An article of mine in The Heythrop Journal a decade ago discussed Descartes’ “Olympica” dream-sequence, the original of which is lost, but the details of which are preserved in a French version in...

What sorts of things really exist, in the world or out of it? What can we know about them? How do your thoughts and words relate to reality? What are human beings? What do their freedom and consciousness amount to? How should people act? What would a just society be like? These are the perennial problems of philosophy, which have been examined and debated for thousands of years and are still confronted by philosophers today. In his superb general introduction to (...) contemporary philosophy and its concerns, Anthony O'Hear shows how differing answers to these questions lead to differing conceptions of ourselves and the world. (shrink)

The phenomenon of action in which the mind moves the body has puzzled philosophers over the centuries. In this new edition of a classic work of analytical philosophy, Brian O'Shaughnessy investigates bodily action and attempts to resolve some of the main problems. His expanded and updated discussion examines the scope of the will and the conditions in which it makes contact with the body, and investigates the epistemology of the body. He sheds light upon the strangely intimate relation of awareness (...) in which we stand to our own bodies, doing so partly through appeal to the concept of the body-image. The result is a new and strengthened emphasis on the vitally important function of the bodily will as a transparently intelligible bridge between mind and body, and the proposal of a dual aspect theory of the will. (shrink)

Providing a vibrant four-color design, market-leading BUSINESS ETHICS: ETHICAL DECISION MAKING AND CASES, Ninth Edition, thoroughly covers the complex environment in which managers confront ethical decision making. Using a proven managerial framework, this accessible, applied text addresses the overall concepts, processes, and best practices associated with successful business ethics programs--helping readers see how ethics can be integrated into key strategic business decisions. Thoroughly revised, the new ninth edition incorporates coverage of new legislation affecting business ethics, the most up-to-date examples, and (...) the best practices of high-profile organizations. It also includes 20 all-new or updated original case studies. (shrink)

Although vast and complex, the universe is orderly in many ways, and conditions at its beginning were right for the eventual evolution of life on this planet. But with life there is death, and with sentient life there is great pain and suffering, often with no apparent justification or purpose. Taking these things together, is it reasonable to conclude that the universe was brought about by God? Moreover, does the magnitude of seemingly pointless suffering square with the idea that God (...) exists, or is it good reason to think there is no God? These questions come up for many people, not just religious believers, and are examined in this engaging and thought-provoking book. Starting out with no pre-disposition to theism, atheism, or agnosticism, God, Evil, and Design takes up these questions in order to see where an impartial investigation leads. To achieve impartiality, the reader is invited to simulate ignorance insofar as his or her own religious preference is concerned. With this approach, God, Evil, and Design provides both a fresh look at important and controversial issues in philosophy and an excellent introduction to the contemporary debates surrounding them. Lively and non-technical, this book will be accessible to anyone with an interest in these topics. (shrink)

In this first systematic reconstruction of the concept of human flourishing, Eri Mountbatten-O'Malley addresses the central problems with the treatment of the concept in psychology, education, policy and science. He develops a sophisticated methodology of conceptual analysis and makes the case for paying closer attention to complex human contexts, purposes and uses. Re-humanizing current research on the concept that is technicalized and detached from ordinary uses, this volume takes the 'human' in conceptions of human flourishing seriously.

Two centuries after they were published, Kant's ethical writings are as much admired and imitated as they have ever been, yet serious and long-standing accusations of internal incoherence remain unresolved. Onora O'Neill traces the alleged incoherences to attempt to assimilate Kant's ethical writings to modern conceptions of rationality, action and rights. When the temptation to assimilate is resisted, a strikingly different and more cohesive account of reason and morality emerges. Kant offers a `constructivist' vindication of reason and a moral vision (...) in which obligations are prior to rights and in which justice and virtue are linked. O'Neill begins by reconsidering Kant's conceptions of philosophical method, reason, freedom, automony and action. She then moves on to the more familiar terrain of interpretation of the Categorical Imperative, while in the last section she emphasises differences between Kant's ethics and recent 'Kantian' ethics, including the work of John Rawls and other contemporary liberal political philosophers. This reassessment will add significantly to the understanding of Kantian practical philosophy. (shrink)