Surgical devices are often marketed before there is good evidence of their safety and effectiveness. Our paper discusses the ethical issues associated with the early marketing and use of new surgical devices from the perspectives of the six groups most concerned. Health Canada, which is responsible for licensing new surgical devices, should amend their requirements to include rigorous clinical trials that provide data on effectiveness and safety for each new product before it is marketed. Industry should comply with all Health (...) Canada requirements to obtain licenses for new products. Until Health Canada requires effectiveness and safety data, industry should cooperate with physicians in appropriate studies before releasing new products and should make balanced presentations of all the available evidence. Surgeons should, before using a new surgical device, assess the evidence on its effectiveness and safety and ensure they are properly trained and competent in using the device. Surgeons should provide their patients with an evaluation of the available evidence and inform them about possible complications and the surgeon's level of experience with the new device. Patients, who should be given an honest evaluation of the available evidence, possible complications, and the surgeon's experience, should be encouraged to evaluate the evidence and information to their own satisfaction to ensure that fully informed consent is given. Health institutions, responsible for regulating practice within their walls, should review new devices for safety, effectiveness, and economic impacts, before allowing their use. They should also limit the use of new surgical devices to surgeons trained and competent in the new technology. Professional societies should provide guidance on the early adoption of new surgical devices and technologies. We urge all those involved in the development, licensing, and use of new surgical devices to aim for higher ethical standards to protect the health and safety of patients requiring surgery. The lowest acceptable ethical standard would require device manufacturers to provide surgeons with accurate and timely information on the efficacy and safety of their products, allowing surgeons and patients to evaluate the evidence (and the significance of information not yet available) before surgery. (shrink)

This series of responses was commissioned to accompany the article by Singer et al, which can be found at http://www.biomedcentral.com/1472-6939/2/1. If you would like to comment on the article by Singer et al or any of the responses, please email us on [email protected].

This paper argues first that claims that we are in the midst of a global obesity epidemic are vastly overblown and hardly new since we can find such calls to alarm for over a century at least. Second, we suggest that claims made about the possibility of losing weight are, for most people, simply false. Bluntly stated, there is lots of evidence to suggest that diets don’t work for the vast majority of people: even for those who lose weight, their (...) reprieve from fat tends to be short lived with 90% regaining their lost weight. Third, we maintain that claims made that obesity is either itself a disease or is causally and directly linked to harmful and sometimes lethal diseases are also misguided. Finally, we discuss the ways in which the construction of obesity as an epidemic disease has affected various parties, including fat people themselves. In particular, we discuss two approaches that have been made to the general anti-fat attitudes of contemporary western societies: the ‘fat and fit’ and ‘fat and proud’ movements. (shrink)

The aim of UK-REACH (“The United Kingdom Research study into Ethnicity And COVID-19 outcomes in Healthcare workers”) is to understand if, how, and why healthcare workers (HCWs) in the United Kingdom (UK) from ethnic minority groups are at increased risk of poor outcomes from COVID-19. In this article, we present findings from the ethical and legal stream of the study, which undertook qualitative research seeking to understand and address legal, ethical, and social acceptability issues around data protection, privacy, and information (...) governance associated with the linkage of HCWs’ registration data and healthcare data. We interviewed 22 key opinion leaders in healthcare and health research from across the UK in two-to-one semi-structured interviews. Transcripts were coded using qualitative thematic analysis. Participants told us that a significant aspect of Big Data research in public health is varying drivers of mistrust—of the research itself, research staff and funders, and broader concerns of mistrust within participant communities, particularly in the context of COVID-19 and those situated in more marginalised community settings. However, despite the challenges, participants also identified ways in which legally compliant and ethically informed approaches to research can be crafted to mitigate or overcome mistrust and establish greater confidence in Big Data public health research. Overall, our research indicates that a “Big Data Ethics by Design” approach to research in this area can help assure (1) that meaningful community and participant engagement is taking place and that extant challenges are addressed, and (2) that any new challenges or hitherto unknown unknowns can be rapidly and properly considered to ensure potential (but material) harms are identified and minimised where necessary. Our findings indicate such an approach, in turn, will help drive better scientific breakthroughs that translate into medical innovations and effective public health interventions, which benefit the publics studied, including those who are often marginalised in research. (shrink)

Book reviewed in this article: Mystical Bedlam: Madness, Anxiety, and Healing in Seventeenth Century England. By Michael MacDonald. Making It Crazy: An Ethnography of Psychiatric Clients in an American Community. By Sue E. Estroff. Mind, Mood, and Medicine: A Guide to the New Biopsychiatry. By Paul H. Wender, M.D. and Donald F. Klein, M.D.

Three acclaimed literary critics ask: Do women construct and write fiction differently from men? They explore theoretical aspects of the feminist agenda as well as analyze their own creative procedures. Sue Roe, Susan Sellers, Nicole Ward Jouve.

We submit this brief in support of the Nonhuman Rights Project’s efforts to secure habeas corpus relief for the elephant named Happy. The Supreme Court, Bronx County, declined to grant habeas corpus relief and order Happy’s transfer to an elephant sanctuary, relying, in part, on previous decisions that denied habeas relief for the NhRP’s chimpanzee clients, Kiko and Tommy. Those decisions use incompatible conceptions of ‘person’ which, when properly understood, are either philosophically inadequate or, in fact, compatible with Happy’s personhood.

In December 2013, the Nonhuman Rights Project (NhRP) filed a petition for a common law writ of habeas corpus in the New York State Supreme Court on behalf of Tommy, a chimpanzee living alone in a cage in a shed in rural New York (Barlow, 2017). Under animal welfare laws, Tommy’s owners, the Laverys, were doing nothing illegal by keeping him in those conditions. Nonetheless, the NhRP argued that given the cognitive, social, and emotional capacities of chimpanzees, Tommy’s confinement constituted (...) a profound wrong that demanded remedy by the courts. Soon thereafter, the NhRP filed habeas corpus petitions on behalf of Kiko, another chimpanzee housed alone in Niagara Falls, and Hercules and Leo, two chimpanzees held in research facilities at Stony Brook University. Thus began the legal struggle to move these chimpanzees from captivity to a sanctuary, an effort that has led the NhRP to argue in multiple courts before multiple judges. The central point of contention has been whether Tommy, Kiko, Hercules, and Leo have legal rights. To date, no judge has been willing to issue a writ of habeas corpus on their behalf. Such a ruling would mean that these chimpanzees have rights that confinement might violate. Instead, the judges have argued that chimpanzees cannot be bearers of legal rights because they are not, and cannot be persons. In this book we argue that chimpanzees are persons because they are autonomous. (shrink)

In this study, we developed and validated an instrument that researchers can use to measure the collective effort of principals and teachers who excise their own unique leadership to genera...

Moffat, Sue Review of: Celebrating with children: Volume 1 resources, volume 2 readings, by Robert Borg, Gerard Kelly, Brian Lucas,, pp.302 + 188, $29.95, $24.95.

In this brief, we argue that there is a diversity of ways in which humans (Homo sapiens) are ‘persons’ and there are no non-arbitrary conceptions of ‘personhood’ that can include all humans and exclude all nonhuman animals. To do so we describe and assess the four most prominent conceptions of ‘personhood’ that can be found in the rulings concerning Kiko and Tommy, with particular focus on the most recent decision, Nonhuman Rights Project, Inc v Lavery.

Defining relationships and limiting power: two leaders of Australian nursing, 1868–1904 This paper analyses aspects of the relationship between nursing and medicine during 1868–1904, in terms of power, gender and authority. A biographical approach is used with a focus on two leading nurses in Australia and their relationship with two leading medical practitioners. The first nurse is Lucy Osburn, the figurehead of the first generation of Nightingale nursing in Australia. The second nurse represents the second generation when Nightingale nursing had (...) largely won acceptance and was firmly established in Australian hospitals: she is Susan McGahey. Their main medical antagonists were Dr Alfred Roberts and Dr Anderson Stuart. A struggle over the control of nursing is evident in these relationships. The outcome transcended personalities, greatly influenced the structure of modern nursing, and marked the rising tide of medical domination in Australia. (shrink)

Whether, and to what degree, do patents granted on human genes cast a shadow of uncertainty over genomics and its applications? Will owners of patents on individual genes or clusters of genes sue those performing whole-genome analyses on human samples for patent infringement? These are related questions that have haunted molecular diagnostics companies and services, coloring scientific, clinical, and business decisions. Can the profusion of whole-genome analysis methods proceed without fear of patent infringement liability?Whole-genome sequencing is proceeding apace. Academic centers (...) have been performing whole-genome and -exome sequencing in research for at least five years, and academic clinical laboratories with national reach have been doing sequencing for clinical applications for almost as long. Companies have also been offering WGS and WES as a clinical service for a few years now. So far as we know, no one has been sued for infringement of “gene patents” for performing WGS. (shrink)

Pamela Sue Anderson’s project about vulnerability and the silencing of the female speaker began with her realization of the female philosopher’s position within academia. Exposing the disavowal of the female “knower,” Anderson lays bare the mechanisms of excluding women from intellectual, artistic and religious discourse. Moving beyond the negative configuration of vulnerability associated with an openness to violence, Anderson refigures it as an openness to affection. The denial of thus refigured vulnerability has led to the literal and discursive oppression of (...) women through the “wilful ignorance” of their intellectual, emotional and sexual needs. In this article Filipczak analyses manifestations of this oppression exposed by female writers who illustrate the predicament discussed by Anderson in their fiction. Starting with Anderson’s refiguring of Antigone as a figure of dissent and marginality in her early work, Filipczak discusses Maggie Tulliver from The Mill on the Floss by George Eliot, Morag Gunn from The Diviners by Margaret Laurence and Mary Magdalene from The Secret Gospel of Mary Magdalene by Michèle Roberts. What connects these characters is the fact that they are disavowed as knowers in intellectual, artistic or theological endeavours by male figures of authority who deny vulnerability as an openness to affection, and rely on social collusion with such denial. The analysis also refers to Anna Karenina by Leo Tolstoy and Aritha van Herk’s Places Far From Ellesmere. (shrink)

Life, on a day to day basis, is a sequence of emotional states: hope, disappointment, irritation, anger, affection, envy, pride, embarrassment, joy, sadness and many more. We know intuitively that these states express deep things about our character and our view of the world. But what are emotions and why are they so important to us? In one of the most extensive investigations of the emotions ever published, Robert Roberts develops a novel conception of what emotions are and then (...) applies it to a large range of types of emotion and related phenomena. In so doing he lays the foundations for a deeper understanding of our evaluative judgments, our actions, our personal relationships and our fundamental well-being. Aimed principally at philosophers and psychologists, this book will certainly be accessible to readers in other disciplines such as religion and anthropology. (shrink)

Robert C. Roberts first presented his vivid account of emotions as 'concern-based construals' in his book Emotions: An Essay in Aid of Moral Psychology. In this new book he extends that account to the moral life. He explores the ways in which emotions can be a basis for moral judgments, how they account for the deeper moral identity of actions we perform, how they are constitutive of morally toned personal relationships like friendship, enmity, collegiality and parenthood, and how pleasant (...) and unpleasant emotions interact with our personal wellbeing. He then sketches how, by means of their moral dimensions, emotions participate in our virtues and vices, and for better or worse, express our moral character. His rich study will interest a wide range of readers working on virtue ethics, moral psychology and emotion theory. (shrink)

Out of the ferment of recent debates about the intellectual virtues, Roberts and Wood have developed an approach they call 'regulative epistemology'. This is partly a return to classical and medieval traditions, partly in the spirit of Locke's and Descartes's concern for intellectual formation, partly an exploration of connections between epistemology and ethics, and partly an approach that has never been tried before. Standing on the shoulders of recent epistemologists - including William Alston, Alvin Plantinga, Ernest Sosa, and Linda (...) Zagzebski - Roberts and Wood pursue epistemological questions by looking closely and deeply at particular traits of intellectual character such as love of knowledge, intellectual autonomy, intellectual generosity, and intellectual humility. Central to their vision is an account of intellectual goods that includes not just knowledge as properly grounded belief, but understanding and personal acquaintance, acquired and shared through the many social practices of actual intellectual life. This approach to intellectual virtue infuses the discipline of epistemology with new life, and makes it interesting to people outside the circle of professional epistemologists. It is epistemology for the whole intellectual community, as Roberts and Wood carefully sketch the ways in which virtues that would have been categorized earlier as moral make for agents who can better acquire, refine, and communicate important kinds of knowledge. (shrink)

Cognitive psychologists have uncovered a number of natural tendencies to systematic errors in thinking. This paper proposes some ways that intellectual character virtues might help correct these sources of epistemic unreliability. We begin with an overview of some insights from recent work in dual-process cognitive psychology regarding ‘biases and heuristics’, and argue that the dozens of hazards the psychologists catalogue arise from combinations and specifications of a small handful of more basic patterns of thinking. We expound four of these, and (...) sketch how they conspire to produce the myriad biases, heuristics, and illusions. We then offer accounts of two character virtues—self-vigilance and intellectual vitality—and explain how these virtues could help correct our error-prone thinking. The self-vigilant person appreciates her vulnerability to natural epistemic defects, is on the watch for cues to the working of these possible error-makers, and intelligently acts to correct for them. The intellectually vital person is naturally or has learned to be energetic, active, alert, attentive, and inquisitive, contrary to the natural tendency to cognitive laziness. We suggest that these intellectual virtues, like the moral virtues, will cluster in the personality, and will tend to be mutually reinforcing and mutually recruiting, even as each has its own corrective function. (shrink)

What is the opposite of freedom? In _Freedom as Marronage_, Neil Roberts answers this question with definitive force: slavery, and from there he unveils powerful new insights on the human condition as it has been understood between these poles. Crucial to his investigation is the concept of marronage—a form of slave escape that was an important aspect of Caribbean and Latin American slave systems. Examining this overlooked phenomenon—one of action from slavery and toward freedom—he deepens our understanding of freedom (...) itself and the origin of our political ideals. Roberts examines the liminal and transitional space of slave escape in order to develop a theory of freedom as marronage, which contends that freedom is fundamentally located within this space—that it is a form of perpetual flight. He engages a stunning variety of writers, including Hannah Arendt, W. E. B. Du Bois, Angela Davis, Frederick Douglass, Samuel Taylor Coleridge, and the Rastafari, among others, to develop a compelling lens through which to interpret the quandaries of slavery, freedom, and politics that still confront us today. The result is a sophisticated, interdisciplinary work that unsettles the ways we think about freedom by always casting it in the light of its critical opposite. (shrink)