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)

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)

There is increasing interest in the need to address the ethical dilemmas related to the engagement of adolescents in sexual and reproductive health research. Research projects, including those that address issues related to STIs and HIV, adverse pregnancy outcomes, violence, and mental health, must be designed and implemented to address the needs of adolescents. Decisions on when an individual has adequate capacity to give consent for research most commonly use age as a surrogate rather than directly assessing capacity to understand (...) the issues and make an informed decision on whether to participate in research or not. There is a perception that adolescents participating in research are more likely to be coerced and may therefore not fully comprehend the risk they may be taking when engaging in research. This paper examines the various ethical issues that may impact stakeholders' decision making when considering engaging adolescents in SRH research in Nigeria. It makes a case for lowering the age of consent for adolescents. While some experts believe it is possible to extrapolate relevant information from adult research, studies on ethical aspects of adolescents' participation in research are still needed, especially in the field of sexual and reproductive health where there are often differences in knowledge, attitudes and practices compared to adults. The particular challenges of applying the fundamental principles of research ethics to adolescent research, especially research about sex and sexuality, will only become clear if more studies are conducted. (shrink)

BackgroundThe global interest in developing therapies for Ebola infection management and its prevention is laudable. However the plan to conduct an emergency immunization program specifically for healthcare workers using experimental vaccines raises some ethical concerns. This paper shares perspectives on these concerns and suggests how some of them may best be addressed.DiscussionThe recruitment of healthcare workers for Ebola vaccine research has challenges. It could result in coercion of initially dissenting healthcare workers to assist in the management of EVD infected persons (...) due to mistaken beliefs that the vaccine offers protection. It could also affect equity and justice. For example, where people who are not skilled health care professionals but who provide care to patients infected with Ebola are not prioritized for vaccination. The possibility of study participants contracting Ebola infection despite the use of experimental vaccine, and the standard of care they would receive, needs to be addressed clearly, transparently and formalized as part of the ethics review process. Future access to study products in view of current status of the TRIPS agreement needs to be addressed. Finally, broad stakeholder engagement at local, regional and international levels needs to be promoted using available communication channels to engage local, regional and international support. These same concerns are applicable for current and future epidemics.SummarySuccessful Ebola vaccine development research requires concerted efforts at public dialogue to address misconceptions, equity and justice in participant selection, and honest discussions about risks, benefits and future access. Public dialogue about Ebola vaccine research plans is crucial and should be conducted by trusted locals and negotiated between communities, researchers and ethics committees in research study sites. (shrink)

This paper describes a three-year project designed to build the capacity of members of research ethics committes to perform their roles and responsibilities efficiently and effectively. The project participants were made up of a cross-section of the membership of 13 Research Ethics Committees (RECs) functioning in Nigeria. They received training to develop their capacity to evaluate research protocols, monitor trial implementation, provide constructive input to trial staff, and assess the trial's success in promoting community engagement in the research. Following the (...) training, technical assistance was provided to participants on an ongoing basis and the project's impacts were assessed quantitatively and qualitatively. Results indicate that sustained investment in capacity building efforts (including training, ongoing technical assistance, and the provision of multiple tools) improved the participants’ knowledge of both the ethical principles relevant to biomedical research and how effective REC should function. Such investment was also shown to have a positive impact on the knowledge levels of other RECs members (those who did not receive training) and the overall operations of the RECs to which the participants belonged. Building the capacity of REC members to fulfill their roles effectively requires sustained effort and investment and pays off by enabling RECs to fulfill their essential mission of ensuring that trials are conducted safely and ethically. (shrink)

HIV prevention is a critical health issue in Nigeria; a country that has one of the worst HIV epidemic profiles in the world. With 270,000 new infections in 2012, Nigeria is a prime site for HIV prevention research. One effect of the HIV epidemic has been to revolutionalise ethical norms for the conduct of research: it is now considered unethical to design and implement HIV related studies without community engagement. Unfortunately, there is very little commensurate effort in building the capacity (...) of local persons to engage actively with researchers, and there is no existing platform to facilitate dialogue between researchers and communities engaged in research in Nigeria. In an effort to address this gap, we undertook a series of three community dialogues and two community-researcher interface meetings in Nigeria. This paper aims to give an empirical account of the dialogue from these community engagement processes and provide a resulting critique of the implementation of research ethics practices in Nigeria. It is anticipated that the outputs will: support researchers in designing community-based research protocols; inform ethics committees of key considerations during research protocol reviews from a community perspective; and inform policy makers and research sponsors about issues of primary concern to communities with respect to HIV research. (shrink)

This paper describes a three‐year project designed to build the capacity of members of research ethics committes to perform their roles and responsibilities efficiently and effectively. The project participants were made up of a cross‐section of the membership of 13 Research Ethics Committees (RECs) functioning in Nigeria. They received training to develop their capacity to evaluate research protocols, monitor trial implementation, provide constructive input to trial staff, and assess the trial's success in promoting community engagement in the research.Following the training, (...) technical assistance was provided to participants on an ongoing basis and the project's impacts were assessed quantitatively and qualitatively. Results indicate that sustained investment in capacity building efforts (including training, ongoing technical assistance, and the provision of multiple tools) improved the participants’ knowledge of both the ethical principles relevant to biomedical research and how effective REC should function. Such investment was also shown to have a positive impact on the knowledge levels of other RECs members (those who did not receive training) and the overall operations of the RECs to which the participants belonged. Building the capacity of REC members to fulfill their roles effectively requires sustained effort and investment and pays off by enabling RECs to fulfill their essential mission of ensuring that trials are conducted safely and ethically. (shrink)

ABSTRACT The aim of this study is to determine how stakeholder engagement can be adapted for the conduct of COVID‐19‐related clinical trials in sub‐Saharan Africa. Nine essential stakeholder engagement practices were reviewed: formative research; stakeholder engagement plan; communications and issues management plan; protocol development; informed consent process; standard of prevention for vaccine research and standard of care for treatment research; policies on trial‐related physical, psychological, financial, and/or social harms; trial accrual, follow‐up, exit trial closure and results dissemination; and post‐trial access (...) to trial products or procedures. The norms, values, and practices of collectivist societies in Sub‐Saharan Africa and the low research literacy pose challenges to the conduct of clinical trials. Civil‐society organizations, members of community advisory boards and ethics committees, young persons, COVID‐19 survivors, researchers, government, and the private sector are assets for the implementation and translation of COVID‐19 related clinical trials. Adapting ethics guidelines to the socio‐cultural context of the region can facilitate achieving the aim of stakeholder engagement. (shrink)

Dental caries is the main oral health challenge for children in Nigeria. Concern about its negative impact makes screening for caries in children an attractive public health strategy. The ability to detect the preclinical phase of caries, the availability of screening tools with high accuracy, and the possibility of treatment before onset of clinical symptoms with significant cost and health benefits, makes it appropriate for screening. However in Nigeria, the poor availability of highly specific and sensitive screening tools, poor access (...) to oral health care and concerns with pre-screening consent, raise the question of the appropriateness of conducting screening programmes for children. We argue that a number of structural challenges associated with poor uptake of oral health care services need to be addressed before screening for caries can be considered ethically appropriate. These include facilitating access of children to quality oral health care and a systematic national approach to oral health impl... (shrink)

The successful demonstration that antiretroviral (ARV) drugs can be used in diverse ways to reduce HIV acquisition or transmission risks – either taken as pre-exposure prophylaxis (PrEP) by those who are uninfected or as early treatment for prevention (T4P) by those living with HIV – expands the armamentarium of existing HIV prevention tools. These findings have implications for the design of future HIV prevention research trials. With the advent of multiple effective HIV prevention tools, discussions about the ethics and the (...) feasibility of future HIV prevention trial designs have intensified. This article outlines arguments concerning the inclusion of newly established ARV-based HIV prevention interventions as standard of prevention in HIV prevention trials from multiple perspectives. Ultimately, there is a clear need to incorporate stakeholders in a robust discussion to determine the appropriate trial design for each study population. (shrink)

In their recent paper‘Undue inducement: a case study in CAPRISA 008’, Mngadi et al conclude that a participant in an HIV prevention study who deliberately concealed her pregnancy was not ‘unduly induced’ to participate by the offer of an experimental product. This paper argues that while the authors’ conclusion is sound, the framing of this case study is consistent with the preoccupation in research ethics with the concept of undue inducement, coupled with a highly risk-averse attitude to pregnancy. We suggest (...) that the critical research ethics question raised by Mngadi et al ’s case study is not ‘undue inducement’, but the exclusion of pregnant women from research studies where the risks are acceptable to the potential participant, and benefits likely. We also suggest that current regulatory paradigms regarding pregnancy are both overly paternalistic and value the fetus over the mother. In order to ensure timely provision of new HIV prevention agents, we argue that there is a need for expeditious testing of proven effective agents in pregnancy, with due consideration given to situations where preliminary efficacy data exist but fall short of licensure standards. This requires a paradigm shift from researchers, funders, regulators and ethical review bodies towards practices that critically examine the legitimacy of the exclusion of pregnant women on a study-by-study basis. (shrink)

BackgroundThe pursuit of a cure for HIV is a high priority for researchers, funding agencies, governments and people living with HIV (PLWH). To date, over 250 biomedical studies worldwide are or have been related to discovering a safe, effective, and scalable HIV cure, most of which are early translational research and experimental medicine. As HIV cure research increases, it is critical to identify and address the ethical challenges posed by this research.MethodsWe conducted a scoping review of the growing HIV cure (...) research ethics literature, focusing on articles published in English peer-reviewed journals from 2013 to 2021. We extracted and summarized key developments in the ethics of HIV cure research. Twelve community advocates actively engaged in HIV cure research provided input on this summary and suggested areas warranting further ethical inquiry and foresight via email exchange and video conferencing.DiscussionDespite substantial scholarship related to the ethics of HIV cure research, additional attention should focus on emerging issues in six categories of ethical issues: (1) social value (ongoing and emerging biomedical research and scalability considerations); (2) scientific validity (study design issues, such as the use of analytical treatment interruptions and placebos); (3) fair selection of participants (equity and justice considerations); (4) favorable benefit/risk balance (early phase research, benefit-risk balance, risk perception, psychological risks, and pediatric research); (5) informed consent (attention to language, decision-making, informed consent processes and scientific uncertainty); and (6) respect for enrolled participants and community (perspectives of people living with HIV and affected communities and representation).ConclusionHIV cure research ethics has an unfinished agenda. Scientific research and bioethics should work in tandem to advance ethical HIV cure research. Because the science of HIV cure research will continue to rapidly advance, ethical considerations of the major themes we identified will need to be revisited and refined over time. (shrink)

Discursive accounts of the body have been prominent recently. While acknowledging the usefulness of these, the author, drawing upon specific philosophers of the body and a wide range of other theorists, focuses attention on the experiencing body which she refers to as 'creatural existence’. Thinking in terms of the creatural, she argues, can better situate human beings in their environment, thus emphasizing a kind of 'ecological notion of subjectivity’, in which place-based existence is understood anew. The educational implications of focusing (...) on what bodies 'do' and not so much in terms of how they are socially inscribed, presents them as practico-sensory totalities which should perhaps be seen as systems rather than an as mere organisms or entities. Such an articulation of creatural existence emphasizes animality, and in so doing reminds us of the centrality of the senses in all knowing and doing, including crucially, in relation to those practices which we have understood as 'work'. Multi-sensorial education is a major sub-theme of the book and the author argues persuasively for this by means of a critical analysis of the ocularcentrism that is characteristic of contemporary culture. (shrink)

Moral theory has generally focused on resolving ethical dilemmas by identifying ethically sound options. Whether the focus is on consequences, duties, principles or virtues, ethical cases are often approached in ways that assume morally sound solutions can be found and followed. Such ‘ideal morality’ assumes that moral goodness is always possible, leaving people confident they have done the right thing. Such an approach becomes inadequate in disaster settings where any good solution is often difficult to see. This paper examines recent (...) work on nonideal moral theory as a useful model for disaster bioethics. This approach views moral dilemmas as situations where no choice is ideal and every option involves some element of unavoidable wrongdoing. Rather than straining for ideal answers, this approach acknowledges that sometimes the lesser of two evils is the best that can be done. Such situations inevitably lead to feelings of regret or guilt, commonly encountered in discussions of disaster bioethics. This paper explores the practical implications of nonideal approaches for disaster responders working in tragic situations. (shrink)

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 attempts 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, autonomy and action. She then moves on to the more familiar terrain of interpretation of the Categorical Imperative, while in the last section she emphasizes differences between Kant's ethics and recent "Kantian" ethics, including the work of John Rawls and other contemporary liberal political philosophers. (shrink)

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)

This article presents normative information for the Defining Issue Test Version 2 (DIT2) schema scores and most common summary scores based on secondary data from the last 10 years DIT2 database (N = 73740, Mage = 23.11, SD = 7.87, the age range in year = 12–95) maintained by the University of Alabama’s Center for the Study of Ethical Development from 2011 to 2020. More specifically, the study provides (1) norms by education; (2) norms by gender and education; and (3) (...) norms by gender and age for the DIT2. The norms indicate a general but not consistent trend that moral reasoning scores increase by education level. Additionally, the Personal Interest and Maintain Norms scores are higher for males than females for all education levels and age groups while Postconventional, N2, and Type indicator scores are higher for females than males for all education levels and age groups. (shrink)

A good deal of attention has been given in recent philosophy of religion to the question of whether we can sensibly attribute to God a form of knowledge which the 16th-century Jesuit theologian Luis de Molina termed "middle knowledge". Interest in the doctrine has been spurred by a recognition of its intimate connection to certain conceptions of providence, prophecy, and response to petitionary prayer. According to defenders of the doctrine, which I will call "Molinism", the objects of middle knowledge are (...) all the true counterfactuals of the form, 'If C were to occur, then S would freely do A', where C specifies a particular set of circumstances. (Such propositions are usually referred to as "counterfactuals of freedom" - hereafter "CFs".)' I will try to assess the current status of two distinct questions: (1) Are there true CFs? and (2) Could God know true CFs if there are any? Obviously, Molinism must answer both questions affirmatively. Most of the discussion has focused on the first question. I hope to show that this approach has been a dialectical mistake on the part of critics of Molinism, for the difficulties of giving an affirmative answer to question (2) are, I believe, far easier to state clearly and convincingly. (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)

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)

1 The Platonic and Christian Ulysses JEAN PEPIN i PHILOSOPHOS ODYSSEUS1 Several philosophical schools in antiquity made use of the figure of Ulysses. ...

The Language Dynamic identifies a number of mechanisms that enable the meaning potential of language from the phoneme through grammar and discourse and onto ideological systems. This book, which underpins functional theories of language with concepts from biological and cultural evolution, social semiotics and systems theory, is relevant to all who are interested in how and why we can mean and what it means for us as humans to be semiotic agents.

Medicine is about caring for people. It is a moral enterprise, not simply a technique or a pursuit. Though modern healthcare offers an amazing array of options, it has also become a complex and sometimes utterly de-humanizing system. Now, more than ever, we need guidance to navigate through the issues surrounding our medical care. Advances in medical technology have blessed many with longer and healthier lives, but they have also provided us with interventions and procedures that call for serious ethical (...) evaluation. The BioBasics series is committed to an uncompromising respect for human life that will serve as a compass through a maze of challenging questions. (shrink)

This volume is a collection of 16 essays, old and new, relating history and exegesis in the writings of Bede and Adomnán, and in the lives of Thomas Becket. The first part consists of seven studies of Bede's writings, notably his biblical commentaries and his Ecclesiastical History. Two of the essays are published here for the first time. The five studies in the second part, devoted to Adomnán, discuss his life of Saint Columba (the Vita Columbae) and his guide to (...) the Holy Places (De locis sanctis). One essay ('The Bible as Map'), published posthumously, compares his presentation of a major theme, the earthly and heavenly Jerusalem, with the approach adopted by Bede. The third section consists of two essays on the lives of Thomas Becket that were composed shortly after his death. They examine, in the context of patristic exegesis, the biblical images invoked in the texts in order to show how the saint's biographers understood the complex relationship between hagiography and history. With the exception of the Jarrow Lecture on Bede and the essays on Becket, the studies in both parts were published originally in edited books, some of them now hard to come by. (shrink)

Famous for their enigmatic ambiguity, the fragmentary texts of the Presocratic philosopher Heraclitus have puzzled and fascinated readers for over two millennia ...

The strongest version of the principle of the Identity of Indiscernibles states that of necessity, there are no distinct things with all their universals in common (where such putative haecceities as being Aristotle do not count as universals: I use 'universal' rather than 'property' here and in what follows for the simple reason that 'universal' is the term of art that most safely excludes haecceities from its instances). It is commonly supposed that Max Black's famous paper 'The identity of indiscernibles' (...) (2) refutes this thesis. (Armstong's [1], chapter 9 is representative here.) Black argues ([2], p. 156) that it is perfectly possible that there be a world consisting solely of two indiscernible spheres at some distance to each other and that this world constitutes a counterexample to the principle above. The strongest version of the bundle theory of substance claims that of necessity, the substances that make up the world are bundles of universals.1 It is commonly supposed that a consequence of Black's defeat of the principle of the Identity of Indiscernibles is that this bundle theory of substance is mistaken. (Again, Armstong's [1] is representative.) I shall argue that Black's thought experiment does not defeat the bundle theory and that, as a result, the bundle theory can be used to salvage the principle of the Identity of Indiscernibles. (shrink)

The twelve specially written essays in this volume investigate the neglected topic of mental action, and show its importance for the metaphysics, epistemology, and phenomenology of mind. The essays investigate what mental actions are, how we are aware of them, and what is the relationship between mental and physical action.

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)

Conventional wisdom suggests that the Platonist philosophers of Late Antiquity, from Plotinus (third century) to the sixth-century schools in Athens and Alexandria, neglected the political dimension of their Platonic heritage in their concentration on an otherworldly life. Dominic O'Meara presents a revelatory reappraisal of these thinkers, arguing that their otherworldliness involved rather than excluded political ideas, and he reconstructs for the first time a coherent political philosophy of Late Platonism.

Do you ever feel flawed, anxious, or afraid--like something might be wrong, but you're not sure what? The truth is, we all feel that way sometimes (or even most of the time!). We're trapped by a limited sense of self, held back by our own anxieties, fears, and compulsions. Mindfulness can offer intermittent relief from these contrived narratives, showing us how to be present, open, and available in the moment by observing our thoughts and feelings. This is all wonderful--until the (...) fears and doubts rush back in. How to Be a Spiritual Rebel offers more than simple mindfulness. Drawing on spiritual practices and recent findings in neuroscience, this groundbreaking guide will help you examine the psychological barriers that block your spiritual growth and keep you from embracing true liberation. You'll learn to cultivate courage, view your thoughts and feelings without letting them define you, and find guidance and support as you navigate the route to boundless freedom without fear or self-limiting attachments.If you're ready to take mindfulness--and spirituality--to the next level and experience true freedom and fulfillment, this candid, entertaining, and jargon-free guide will help point the way.--amazon.com. (shrink)

Contemporary African philosophy in indigenous African languages and English translation.

A globe-spanning investigation into the Transhumanist movement, considering the tech billionaires, scientific luminaries, and DIY body-hackers attempting to prolong, improve, and ultimately transcend the limits of human life.