National electronic health record initiatives are in progress in many countries around the world but the debate about the ethical issues and how they are to be addressed remains overshadowed by other issues. The discourse to which all others are answerable is a technical discourse, even where matters of privacy and consent are concerned. Yet a focus on technical issues and a failure to think about ethics are cited as factors in the failure of the UK health record system. In (...) this paper, while the prime concern is the Australian Personally Controlled Electronic Health Record (PCEHR), the discussion is relevant to and informed by the international context. The authors draw attention to ethical and conceptual issues that have implications for the success or failure of electronic health records systems. Important ethical issues to consider as Australia moves towards a PCEHR system include: issues of equity that arise in the context of personal control, who benefits and who should pay, what are the legitimate uses of PCEHRs, and how we should implement privacy. The authors identify specific questions that need addressing. (shrink)

Social networking sites such as MySpace and virtual communities such as on-line support groups can be a rich source of data for researchers. These sites can be an effective way of reaching and researching young people in order to address their particular health needs. Internet-based research is also potentially risky and exploitative. There is some guidance for conducting research online, but there are no detailed or universally accepted ethics guidelines for research of webspaces such as MySpace or virtual communities in (...) which young people participate. One question that arises is — If MySpace is a public webspace, can research be done without consent? In this paper I investigate ethical issues surrounding young people’s consent in cyber research. I identify issues that help determine whether consent is needed, offer suggestions for dealing with consent in cyberspace and add my voice to the call for a resource of case studies — indispensible in the development of guidelines and the education of researchers and research ethics committees. (shrink)

By looking closely at the ideas of Rosseau, Kant, and Mill, Autonomy and Patients' Decisions traces the modern concept of autonomy from its historical roots, ...

The American Journal of Bioethics, Volume 12, Issue 1, Page 42-44, January 2012.

Bioethics, Volume 36, Issue 7, Page 765-773, September 2022.

Is Female Genital Cosmetic Surgery for an adolescent with Body Dysmorphic Disorder ever ethically justified? Cosmetic genital surgery for adolescent girls is one of the most ethically controversial forms of cosmetic surgery and Body Dysmorphic Disorder is typically seen as a contraindication for cosmetic surgery. Two key ethical concerns are that Body Dysmorphic Disorder undermines whatever capacity for autonomy the adolescent has; and even if there is valid parental consent, the presence of Body Dysmorphic Disorder means that cosmetic surgery will (...) fail in its aims. In this article, we challenge, in an evidence-based way, the standard view that Body Dysmorphic Disorder is a contraindication for genital cosmetic surgery in adolescents. Our argument gathers together and unifies a substantial amount of disparate research in the context of an ethical argument. We focus on empirical questions about benefit and harm, because these are ethically significant. Answers to these questions affect the answer to the ethical question. We question the claim that there would be no benefit from surgery in this situation, and we consider possible harms that might be done if treatment is refused. For an adolescent with Body Dysmorphic Disorder, the most important thing may be to avoid harm. We find ourselves arguing for the ethical justifiability of cosmetic labioplasty for an adolescent with Body Dysmorphic Disorder, even though we recognize that it is a counter intuitive position. We explain how we reached our conclusion. (shrink)

ABSTRACT I examine the impact of addiction on autonomy in terms of the standard literature on addiction – referred to also as ‘substance dependence.’1 Then in terms of the criteria for substance dependence, by developing a set of practical strategies to help people with addictions think more clearly, I test the idea whether addicts can be helped to become more autonomous. Given that unsuccessful attempts to quit constitute part of the criteria of substance dependence, I look at what goes wrong (...) when people try to quit using a substance. The subjective experience of addiction is an important aid in understanding addiction and first person accounts and literary characterisations of addiction provide insight into the addict's mind and assist us in deciding whether addicts can be helped to become more autonomous. (shrink)

Child co-research has become popular in social research involving children. This is attributed to the emphasis on children’s rights and is seen as a way to promote children’s agency and voice. It is a way of putting into practice the philosophy, common amongst childhood researchers, that children are experts on childhood. In this article, we discuss ethical complexities of involving children as co-researchers, beginning with an analysis of the literature, then drawing on data from interviews with researchers who conduct child (...) co-research. We identify six ethical complexities, some of which are new findings which have not been mentioned before in this context. In light of these possible ethical complexities, a key finding is for researchers to be reflexive – to reflect on how the research may affect child co-researchers and participants before the research starts. A separate overriding message that came out in responses from the researchers we interviewed was the need for support and training for child co-... (shrink)

Ethics education is recognized as an integral component of health professionals’ education and has been occurring in various guises in the curricula of health professional training in many countries since at least the 1970s. However, there are a number of different aims and approaches adopted by individual educators, programs, and, importantly, different health professions that may be characterized according to strands or trends in ethics education.

(2010). Ashley's Interests Were Not Violated Because She Does Not Have the Necessary Interests. The American Journal of Bioethics: Vol. 10, No. 1, pp. 52-54.

Labiaplasty is a form of genital surgery to reduce large or protruding labia minora. Internationally, the rates of this surgery among women and girls is increasing and is viewed as a worrying trend. Currently, the main clinical strategy is to reassure adolescents that they are normal by talking about the variation of labia size and appearance and showing pictures demonstrating the wide range of normal female genital appearance. For the most part, policy documents recommend against labiaplasty in adolescents, claiming that (...) it is medically non-essential surgery. In this paper, we contrast findings from our interviews with clinicians with the existing literature and policy documents and we point out areas needing more thought. This is qualitative research using semi-structured interviews. We set out to find out on what basis clinicians decide how to treat or manage adolescent patients seeking labiaplasty. We interviewed clinicians who are likely to be approached by under-eighteens requesting labiaplasty. We use interpretive content analysis and thematic analysis to analyse the data. Our findings support the emphasis on education and reassurance as the first step for all patients, but other issues that have not figured previously in the literature that would alter clinical strategies for managing patients emerge as well. Key findings are that reassurance does not always work and that the distinction between functional and appearance concerns is not a solid foundation in itself for deciding whether surgery is ethically appropriate. We conclude that the distinction between functional and appearance concerns is not ethically relevant. It is open to different interpretations and is not regarded by all clinicians as the definitive factor in relation to surgery. The focus of clinicians should be on relieving distress whatever the cause. Appearance reasons may sometimes justify surgery but, also, functional reasons may sometimes not be sufficient justification for surgery. (shrink)

Alderson critiques our recent book on the basis that it overlooks children’s own views about their medical treatment. In this response, we discuss the complexity of the paediatric clinical context and the value of diverse approaches to investigating paediatric ethics. Our book focuses on a specific problem: entrenched disagreements between doctors and parents about a child’s medical treatment in the context of a paediatric hospital. As clinical ethicists, our research question arose from clinicians’ concerns in practice: What should a clinician (...) do when he or she thinks that parents are choosing a treatment pathway that does not serve the child’s best interests? Alderson’s work, in contrast, focuses on the much broader issue of children’s role in decision-making about treatment and research. We argue that these different types of work are zooming in on different aspects of paediatric ethics, with its complex mix of agents, issues and relationships. Paediatric ethics overall needs a rich mix of approaches,... (shrink)

This article deals with the prospect of genetically enhancing intelligence. We identify and contrast social attitudes (disapproval) to the use of future genetic technology with social attitudes (approval) for environmental methods of enhancing intelligence. Using various forms of the argument that the means by which enhancement is achieved has moral significance, we look for differences that could justify the different attitudes. We find that the different attitudes cannot be ethically justified. We predict that the lack of ethical justification for distinguishing (...) between means of enhancement is likely to result in the eventual acceptance of genetic enhancement of intelligence. (shrink)

Excluding women from participating in clinical drug trials might seem like a good thing. It may seem like a good way to protect women from the risks of being a research subject and a way to prevent fetal harm. However, the exclusion or inadequate representation of women in clinical trials may actually cause harm. Excluding women from clinical trials does not rule out the possibility of damage to offspring. Nor does it guarantee researchers or institutions freedom from legal liability. The (...) issue of women’s exclusion has received substantial attention in the USA but very little in Australia. (shrink)

A notable feature of the COVID-19 pandemic is that children are less at risk of becoming infected or, if infected, less likely to become seriously unwell, so ethical discussions have consequently focused on the adult healthcare setting. However, despite a lower risk of children becoming acutely ill with COVID-19, there nevertheless may be significant and potentially sustained effects of COVID-19 on the physical, psychological, and emotional health and well-being of children. Focusing on the context of children’s cancer care, and specifically (...) bone marrow transplant, we describe some of these effects and then address one specific ethical challenge that arises. That is the question of what and how much to tell children whose cancer treatment has been changed because of COVID-19. Drawing on our previous work on the ethical reasons for telling the truth to younger children we link different ethical reasons to the different types of information that could be given to children in this context. We argue that children should be given an explanation of the changes that they will directly experience, including some changes to the process of their actual medical treatment; but not about increased risk associated with these changes, unless they specifically ask for this information. (shrink)

The Kennedy Krieger lead paint study is a landmark case in human experimentation and a classic case in research ethics. In this paper I use the lead paint study to assist in the analysis of the ethics of research on less expensive, less effective interventions. I critically evaluate an argument by Buchanan and Miller who defend both the Kennedy Krieger lead paint study and public health research on less expensive, less effective interventions. I conclude that Buchanan and Miller’s argument is (...) flawed but that does not mean that research designed to find less effective interventions cannot be justified in some situations. Based on my analysis, I suggest questions to ask when considering such research and I offer some principles to guide us. In the process, light is shed on the various debates and issues raised by the lead paint study; e.g. standards of care, researchers’ responsibilities to research subjects, the distinction between treatment and research and the question of what it is that legitimizes public health research. (shrink)

When the benefits of surgery do not outweigh the harms or where they do not clearly do so, surgical interventions become morally contested. Cutting to the Core examines a number of such surgeries, including infant male circumcision and cutting the genitals of female children, the separation of conjoined twins, surgical sex assignment of intersex children and the surgical re-assignment of transsexuals, limb and face transplantation, cosmetic surgery, and placebo surgery.

The advent of IVF and advances in reproductive technologies largely reflect the importance in our society of biological parenthood and genetic kinship. As illustrated in the controversy piece by Merle Spriggs,1 however, the same technology has confused our understanding of what makes a parent.An embryo mixup in Britain has resulted in a white couple giving birth to two black twins. Genetic tests have established that the wrong sperm was used to inseminate the ova of the white woman who (...) gave birth to the twins. The two couples involved are apparently both seeking custody. Who should have parental rights and responsibilities for the twins?While once it may have been obvious who a child’s parents were and who had obligations and claims with regard to children, the separation of genetic, gestational, and nurturing roles now makes it impossible to “discover” who is the real parent. As Ruth Macklin points out, the question: “Which role should entitle a woman to a greater claim on the baby in the case of a dispute?” is a moral question which cannot be answered by discovery, say through a blood test, but is a matter for decision.2 Which are the morally …. (shrink)

When Timothy Sprigge's The Vindication of Absolute Idealism appeared in 1983 it ran very much against the grain of the dominant linguistic and analytic traditions of philosophy in Britain. The very title of this work was a challenge to those who believed that Absolute Idealism fell with the critiques of Bertrand Russell and G. E. Moore at the beginning of the 20th century. Sprigge, however, saw himself as providing an underrepresented position in the philosophical spectrum rather than as advocating an (...) abandoned view. For him, idealism did not fall at any determinate point in the history of philosophy. The truth of any philosophical thesis cannot depend on what happens to be currently fashionable, but rather must stand on the soundness of philosophical argument. To this end, The Vindication of Absolute Idealism is a bold statement of his conclusions, a synthesis of panpsychism and absolute idealism, which he contends is the most satisfactory solution to the question of the nature of consciousness and the mind-body problem. Sprigge's view of consciousness remains a challenge to mainstream physicalism and a viable option that addresses pressing contemporary concerns not only in metaphysics and philosophy of mind but also in environmental ethics and animal rights. (shrink)

Graham Bird’s ‘A Comment on Timothy Sprigge’s Account of William James’, in the last issue of Bradley Studies might have better been called ‘A Comment on Timothy Sprigge’s Account of Graham Bird on William James’ True, that would identify its topic as a somewhat limited one as, if the index is correct, there are just nine sentences on this topic in my book James and Bradley: American Truth and British Reality. But it appears to be the matter which has mainly (...) fired Bird’s article. Bird believes that I have read his own book, William James, carelessly and misrepresent what he said, claiming to illustrate this with copious quotations from his own book. He dismisses ‘the unworthy thought that one who treats my [Bird’s] text so carelessly might not be a very reliable guide to James’s’. My own view is that ‘unworthy thoughts’ are better not expressed and I shall keep quiet about any of mine which might be deemed such. I don’t think that I read either Bird or James himself carelessly. If I was at all misleading, by failing to emphasise that Bird’s position was that James was attempting to unite the cognitive and the affective, I apologize; the offending remark was my response to his presupposing throughout his commentary the prima facie relevance of this distinction to the interpretation of James’s pragmatism. As for my not having read James carefully, his work has been my favourite philosophical reading for more than forty years, and I have puzzled endlessly over parts of it which I found problematic. I read Bird’s book thoroughly when I reviewed it, and my copy of it is covered in detailed pencil comments. (shrink)

The Kennedy Krieger lead paint study received a lot of attention after a US Court of Appeals ruled that a parent cannot consent to the participation of a child in non-therapeutic research. The ruling has raised fears that, if it goes unchallenged, valuable research might not proceed and ultimately all children would be harmed. The author discusses significant aspects of the study that have been neglected, and argues that the study was unethical because it involved injustice and its design meant (...) that the study lacked importance and value. Issues of benefit, risk, and consent are vital, but it is sometimes a mistake to consider these issues before settling questions about justice and the importance and value of a research project. The author concludes by offering a strategy for researchers and reviewers of research to appreciate, in a vivid way, the implications of research participation. (shrink)

Can moral judgements be true or false? Can rational methods be applied to ethics? In this landmark study, Sprigge gives an account of how philosophers have tackled these questions and puts forward his own theory on the matter.

A deaf lesbian couple who chose to have a deaf child receive a lot of criticismA deaf lesbian couple in the US deliberately tried to create a deaf child. Sharon Duchesneau and Candy McCullough hoped their child, conceived with the help of a sperm donor, would be deaf like the rest of the family. Their daughter, five year old Jehanne, is also deaf and was conceived with the same donor. News of the couple choosing to have a deaf child has (...) only been revealed with the birth of their son Gauvin.1–4To increase their chance of having a deaf baby the women sought a deaf sperm donor from a sperm bank but were told that congenital deafness is “precisely the sort of condition” that disqualifies would-be donors. Rather than dismiss the idea they found their own sperm donor by asking a deaf friend who comes from a family with five generations of deafness.1The women, both professionals in the mental health field, insist that they would still love …. (shrink)

Lawrence Johnson advocates a major change in our attitude toward the nonhuman world. He argues that nonhuman animals, and ecosystems themselves, are morally significant beings with interests and rights. The author considers recent work in environmental ethics in the introduction and then presents his case with the utmost precision and clarity. Written in an attractive, nontechnical style, the book will be of particular interest to philosophers, environmentalists and ecologists.

The new prominence given to science for economic growth and industry comes with an increased policy focus on the promotion of commodification and commercialization of academic science. This paper posits that this increased interest in commodification is a new steering mechanism for governing science. This is achieved by first outlining what is meant by the commodification of scientific knowledge through reviewing a selection of literatures on the concept of commodification. The paper concludes with a discussion of how commodification functions as (...) a means for governing science. (shrink)

Experimental research has shown that pairs of stimuli which are congruent and assumed to 'go together' are recalled more effectively than an item presented in isolation. Will this multisensory memory benefit occur when stimuli are richer and longer, in an ecological setting? In the present study, we focused on an everyday situation of audio-visual learning and manipulated the relationship between audio guide tracks and viewed portraits in the galleries of the Tate Britain. By varying the gender and narrative style of (...) the voice-over, we examined how the perceived congruency and assumed unity of the audio guide track with painted portraits affected subsequent recall. We show that tracks perceived as best matching the viewed portraits led to greater recall of both sensory and linguistic content. We provide the first evidence that manipulating crossmodal congruence and unity assumptions can effectively impact memory in a multisensory ecological setting, even in the absence of precise temporal alignment between sensory cues. (shrink)

À luz da secularização da sociedade, que marcou a época moderna e a contemporânea e, sobretudo, com a larga difusão do ateísmo, trata-se de discutir a questão do mal, mostrando, por um lado, que a crença em Deus poderia atribuir uma importância cada vez maior à questão do mal, mas, por outro, poder-se-ia esperar, à luz da influência do ateísmo, que o mal assumisse uma significação inédita, ou seja, o deslocamento da questão do mal, exclusivamente, à perspectiva moral. Neste artigo, (...) fala-se não de um mundo sem religião nem sem divino nem sem divindades. Fala-se de um mundo sem Deus, no singular, limitando-se o autor a tratar de uma só das religiões monoteístas e a filosofia que ela inspirou, a saber, o Cristianismo, ainda que sem fazer distinções entre suas diferentes confissões. Partindo, pois, do pressuposto de que o mal é a única coisa que Deus não criou, o autor mostra que os filósofos, inspirados no Cristianismo, consideraram que não seria possível ser virtuoso e dizer-se ateu ao mesmo tempo, a não ser pagando o preço de uma contradição. (shrink)

A n IVF mixup has resulted in a white couple giving birth to black twins. Prior to DNA testing, no one can be sure whether the white woman’s eggs were fertilised with the black man’s sperm, or the black couple’s embryo was mistakenly implanted in the white woman. It is believed that Mr and Mrs A, the white couple, want to keep the babies and there is conjecture about Mr and Mrs B, the black couple, wanting them too.1 Under the (...) Human Fertilisation and Embryology Act 1990, a woman who has a child born through IVF, even if it is not genetically hers, is the “legal mother”. Paternity, however, is “open to legal interpretation”.1–3News of the mixup has elicited a range of reactions. It is thought …. (shrink)

Graham Bird’s ‘A Comment on Timothy Sprigge’s Account of William James’, in the last issue of Bradley Studies might have better been called ‘A Comment on Timothy Sprigge’s Account of Graham Bird on William James’ True, that would identify its topic as a somewhat limited one as, if the index is correct, there are just nine sentences on this topic in my book James and Bradley: American Truth and British Reality. But it appears to be the matter which has mainly (...) fired Bird’s article. Bird believes that I have read his own book, William James, carelessly and misrepresent what he said, claiming to illustrate this with copious quotations from his own book. He dismisses ‘the unworthy thought that one who treats my [Bird’s] text so carelessly might not be a very reliable guide to James’s’. My own view is that ‘unworthy thoughts’ are better not expressed and I shall keep quiet about any of mine which might be deemed such. I don’t think that I read either Bird or James himself carelessly. If I was at all misleading, by failing to emphasise that Bird’s position was that James was attempting to unite the cognitive and the affective, I apologize; the offending remark was my response to his presupposing throughout his commentary the prima facie relevance of this distinction to the interpretation of James’s pragmatism. As for my not having read James carefully, his work has been my favourite philosophical reading for more than forty years, and I have puzzled endlessly over parts of it which I found problematic. I read Bird’s book thoroughly when I reviewed it, and my copy of it is covered in detailed pencil comments. (shrink)