It has often been argued that if a clinician cannot decide which of two treatments to offer, a trial may be ethical, but it is unethical if she/he has a preference. Since individual clinicians usually have a preference, most trials could be judged unethical according to this line of argument. A recent important article in the New England Journal of Medicine argued that individual preferences are not as important as the collective uncertainty of informed clinicians. If clinicians are equally divided, (...) there is a state of collective equipoise and a trial is ethical. However, clinicians will seldom be exactly equally divided. We conducted an ethometric study to find out how much collective equipoise can be disturbed before the potential subjects in a trial think that it is unethical. Half of our subjects perceived a trial as unethical when equipoise was disturbed beyond 70:30. In other words, when 70 per cent of experts favour one treatment, 50 per cent of subjects would prefer that treatment to be administered rather than subjected to critical assessment. When equipoise is disturbed beyond 80:20, less than 3 per cent of subjects would consider human trials morally justifiable. (shrink)
Robert Grosseteste was one of the most independent and vigorous Englishmen of the Middle Ages--a medieval Dr. Johnson in his powers of mind and personality. Of humble birth, he lived for many years in obscurity and emerged only late in life as a national figure, deeply conservative and profoundly critical of the contemporary world. As a scientist, theologian, and pastoral leader, he was rooted in an English tradition going back beyond the Norman Conquest. This comprehensive study of one of (...) England's great intellects by the late Sir Richard W. Southern of Oxford University is an important contribution to the history of ideas. (shrink)
This note analyses a recent case of the English Court of Appeal in which the applicant, R.G., a gay, H.I.V. positive Colombian claimed asylum on grounds of persecution due to his sexuality. Both the Asylum and Immigration Tribunal and the Court of Appeal rejected R.G.’s claim for asylum. The Court of Appeal’s first and most significant reason was that the alleged persecution was not sufficiently serious or life threatening, since R.G. had not suffered actual physical violence throughout the 13 years (...) that he had lived as a closeted gay man in Colombia. Secondly, the court considered the real reason for R.G.’s seeking asylum was his desire to access free health care in order to manage his H.I.V. His allegations of persecution on the grounds of sexuality were viewed as a sham. This note is critical of the approach taken by the Court, which, it is argued, displays an insensitivity to the complexity of sexual identity and its performance and has the effect of perpetuating and legitimating discrimination against lesbians and gay men. (shrink)
The prospect of using cell-based interventions to treat neurological conditions raises several important ethical and policy questions. In this target article, we focus on issues related to the unique constellation of traits that characterize CBIs targeted at the central nervous system. In particular, there is at least a theoretical prospect that these cells will alter the recipients' cognition, mood, and behavior—brain functions that are central to our concept of the self. The potential for such changes, although perhaps remote, is cause (...) for concern and careful ethical analysis. Both to enable better informed consent in the future and as an end in itself, we argue that early human trials of CBIs for neurological conditions must monitor subjects for changes in cognition, mood, and behavior; further, we recommend concrete steps for that monitoring. Such steps will help better characterize the potential risks and benefits of CBIs as they are tested and potentially used for treatment. (shrink)
Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.