Dr de Zulueta articulates some important and commonly held concerns about the anonymised screening programme for HIV in pregnant women, which is one of a number of such programmes that are current. However, in my view, many of these concerns reflect a failure to understand two key distinctions.In both these regards, there is a danger of putting up a “straw man” for challenge. In this commentary, I wish to pick up some of these issues to help to resolve the apparent (...) ethical tensions that Dr de Zulueta has set out.Firstly, the unlinked seroprevalence surveillance programmes, including that on pregnant women, comprise research studies that are designed to inform policy and practice, as well as individual decision making. They are not screening for the purpose of clinical care. The anonymisation is a procedural research tool, which enables the studies to be done in a way that does not undermine consent or individual autonomy. The ethical standards and duties expected of professionals are thus, in this specific regard, those that relate to the conduct of clinical research. That research is evidently designed to improve the quality of clinical care as a result of the information and insight gained. The duty of care is to apply the results of properly conducted and valid research in order to improve clinical practice on behalf of the individuals receiving care, in this case the mother and unborn child. The research conducted, in this case by a particular form of screening procedure, is not the same as a screening procedure done for clinical purposes to identify individuals who could benefit from an intervention. The ethical debate must therefore focus on the purpose in applying the procedure, not on the procedure itself, regardless of intent.Secondly, it is vital to distinguish, in debating such …. (shrink)

This thoughtful reflection on a valuable questionnaire survey of patients' attitudes regarding being told that their dentist had been infected with hepatitis B is of very direct relevance to HIV, as the authors show.1 The measured tone and analytical approach are a welcome change from the stridency that has characterised some of the debate elsewhere. I am very conscious that more time and effort has gone into drafting and redrafting, amending, revising and refining policy in this area than in any (...) other area of HIV control, with the probable exception of blood transfusion. Yet this is the setting that has the lowest risk among all established routes. Why has it been so hard to establish a satisfactory policy and practice to deal with this situation?Many factors, of course, apply. However, much seems to stem from a prevailing view, fostered by recent political administrations, that health care can be delivered in a risk-free way. This has also been linked with a “blame culture”, where adverse outcomes are seen as someone's fault, and where the professions are regarded with distrust. It has been fuelled by levels of concern about risk for HIV that have stemmed more from media “stories” about risk than careful risk assessment.Hence Blatchford et al comment that public anxiety about HIV relative to hepatitis B was a factor in assessing how the incident was handled, implying that HIV was of greater concern - even though the risk of transmission is some two orders of magnitude less. Interestingly, they also comment that, because the risk of death with HIV is higher than for hepatitis B, this balances the overall risk. I am not sure of the validity of this argument, …. (shrink)

A group of activist clinicians have offered to volunteer for clinical trials of live attenuated HIV vaccines. This has provided an important conceptual challenge to medical ethics, and to work on the development of HIV vaccines. In exploring these issues, this article highlights how the HIV field has altered the content as well as the tone of ethical discourse. The balance of expertise and authority between research subjects and triallists is profoundly changed, raising questions about the limits of voluntarism and (...) differing perspectives on risk-benefit analysis. Care is needed to ensure that the novelty of the situation does not confuse the central ethical and scientific issues. (shrink)

Guest Editors' introductionFor this special issue of the Journal of Medical Ethics we have assembled articles that reflect some of the newer issues or fresh perspectives. There is a mix of approaches including forward looks, present dilemmas and reflections on the past, now that sufficient time has elapsed to allow a considered view. We are most grateful to our wide range of contributors for their thoughtful analyses of several key areas of contemporary debate. Our own contributions include the following editorials (...) in which each of us has considered, from his own perspective, the impact of AIDS on medical ethics, a case study and a lexicon that allows brief probing of some topics.The impact of aids on medical ethics -1ANTHONY J PINCHINGMedical ethics has been matured through being tested and refined through the multifaceted challenge of AIDS. As with the society and social values from which its moral framework is derived, so medical ethics has been subjected to intense scrutiny by the emergence of this new disease. Few areas of ethical discourse have been untouched. This infection is so intensely private in its transmission, the disease so isolating and so personally devastating in its impact, it readily distinguishes the reality of what people are and do, from the rhetoric of what others may feel they should be and do. AIDS has forced us to recognise that respecting individual rights is a critical safeguard for the health of the community, as well as for the person. These issues are well illustrated by the interweaving issues of patient empowerment, respect for confidentiality, and patient advocacy and activism.EMPOWERMENTPhysicians in this field have been struck by the way in which people affected have wanted to be involved in decision making. While this has often been ascribed to their social groups, it probably was more a reflection of their younger age and a generation change …. (shrink)

Ethical dilemmas abound in the neonatal intensive care unit as hour-to-hour life and death decisions are made for premature or compromised newborns. This book is a rich tapestry of parental perceptions woven from the many stories parents tell about their experiences with a baby in the unit, as well as major events after discharge related to the ethical decision making.

A project featuring scholars in nursing ethics was planned in 2005. The goal was to document the contributions of some 24 selected American nurse ethicists to bioethics, and to discuss and explore the future trajectory of that work through a two-day working seminar. This article outlines the beginnings of bioethics in the USA and the specific contribution of nurse scholars to the debate, the preparation for the seminar, the results of the project, and the possible application of such a model (...) for teaching and archiving in the future. Documentation of the work carried out at the seminar resulted in the publication of a book. Short biographies of the participants at the seminar are included in Appendix 1. (shrink)

Knowledge about moral development and elderly persons is very limited. A hermeneutical interpretative study was conducted with healthy elderly persons (n = 20) in order to explore and describe their moral orientation based on the paradigms of justice (Kohlberg) and care (Gilligan). The types of moral reasoning, dominance, alignment and orientation were determined. All but one participant included both types of reasoning when discussing an ethical conflict. None of the men’s moral reasoning was dominated by caring, but justice dominated the (...) reasoning of four women. The implications for ethical decision-making and future research are discussed. (shrink)

First published in 1952, British Empirical Philosophers is a comprehensive picture of one of the most important movements in the history of philosophic thought. In his introduction, Professor A. J. Ayer distinguishes the main problems of empiricism and gives a critical account of the ways in which the philosophers whose writings are included in this volume attempted to solve them. Editors Ayer and Raymond Winch bring together an authoritative abridgement of John Locke’s Essay Concerning Human Understanding ; Bishop George Berkeley’s (...) Principles of Human Knowledge ; almost the entire first book of David Hume’s Treatise Concerning Human Nature ; and extracts from Thomas Reid’s Essay on the Intellectual Powers of Man and John Stuart Mill’s Examination of Sir William Hamilton’s Philosophy. (shrink)

First published in 1952, British Empirical Philosophers is a comprehensive picture of one of the most important movements in the history of philosophic thought. In his introduction, Professor A. J. Ayer distinguishes the main problems of empiricism and gives a critical account of the ways in which the philosophers whose writings are included in this volume attempted to solve them. Editors Ayer and Raymond Winch bring together an authoritative abridgement of John Locke’s Essay Concerning Human Understanding ; Bishop George Berkeley’s (...) Principles of Human Knowledge ; almost the entire first book of David Hume’s Treatise Concerning Human Nature ; and extracts from Thomas Reid’s Essay on the Intellectual Powers of Man and John Stuart Mill’s Examination of Sir William Hamilton’s Philosophy. (shrink)

Passmore is one of the most outstanding historians of the contemporary philosophical scene. He seems to have read everything, digested it, and has an uncanny ability to empathize with diverse philosophical viewpoints and elucidate them in a clear, witty, cogent style. Although the first three quarters of this revised edition is basically the same as earlier editions, we now have additions to his account of Ayer, Popper, Wittgenstein and Sartre; enlarged sections on Austin, Jaspers and Heidegger; a new section on (...) Merleau-Ponty and a chapter bringing us right up to the present discussions of the mind-body problem in Anglo-Saxon philosophy. With this revised edition, one feels more acutely the pinch of the limitations that Passmore initially set for himself, viz., to treat the ideas of those writers that entered into the public domain of philosophical discussion in England during the past hundred years. Consequently his treatment of continental thinkers is not nearly as complete or perceptive as his treatment of British philosophers, or his chapters on "classical" American thinkers which are among the best written by anybody.—R. J. B. (shrink)

This book outlines the realist and pluralist philosophy of John Anderson, Australia's most original thinker. His teaching at Sydney University and his arti6es have deeply influenced Australian intellectual life. Several main themes run through his work, but Anderson never gave an overall account of his views. This is remedied here: exhibiting the range of Anderson's thought from logic, epistemology and theory of mind, to language and social theory, this volume sketches realism as a systematic philosophical position, while showing something of (...) the history of ideas in Australia. (shrink)

The dictionary shows philosophers at their best (and their worst), at their most perverse and their most elegant. Organised by philosopher, and indexed by thought, concept and phrase, it enables readers to discover who said what, and what was said by whom. Over 300 philosophers are represented, from Aristotle to Zeno, including Einstein, Aquinas, Sartre and De Beauvoir, and the quotations range from short cryptic phrases to longer statements. This Dictionary of Philosophical Quotations d will not change your life. It (...) will change your mind. (shrink)

The criterion of truth is the measure of the truthfulness and reliability of our knowledge. It is also the basis for determining the correctness of our concepts and how much our perceptions, ideas, and concepts accord with objective reality. Idealism holds to the idea that the criterion of truth does not involve the integration between theory as created by human intelligence and objective reality, but rather that the criterion of truth involves the "clarity and correctness" of perception, viewpoints, and concepts (...) by the subject. For instance, the Machists 1 think that the criterion of truth is experience, however, they neither interpret experience from a materialistic viewpoint, nor view experience as the result of humans interacting with nature as they reform it. The Machists view experience as a summary of perceptions and as the subjective experience of humans. In this sense, perception must be tested by perception itself. In attempting to escape the trap of solipsism , they proposed "collective experience" as the criterion of truth. According to such a view, anything that involves "common significance," that is, anything acknowledged by everyone, is the truth. Lenin exposed the absurdity of idealist theory by pointing out that by following the view of "socially formed experience" it is very easy to consider as normal the most absurd and farcical notions, such as ghosts, for such beliefs are also a form of human "experience." Religion also possesses a "common significance," for innumerable people believe in ghosts and miracles, etc. Nevertheless, religion does not become the truth because of this. The concept of the "criterion of truth" held by the Machists played a dominant role in modern bourgeois philosophy. Jean Jacques Rousseau and John Dewey, along with other reactionaries in philosophy all denied scientific criteria. They would rather that the masses remain ignorant of how to understand and determine the truth. (shrink)

A. J. Ayer was one of the foremost analytical philosophers of the twentieth century, and was known as a brilliant and engaging speaker. In essays based on his influential Dewey Lectures, Ayer addresses some of the most critical and controversial questions in epistemology and the philosophy of science, examining the nature of inductive reasoning and grappling with the issues that most concerned him as a philosopher. This edition contains revised and expanded versions of the lectures and two additional essays. Ayer (...) begins by considering Hume's formulation of the problem of induction and then explores the inferences on which we base our beliefs in factual matters. In other essays, he defines the three kinds of probability that inform inductive reasoning and examines the various criteria for verifiability and falsifiability. In his extensive introduction, Graham Macdonald discusses the arguments in _Probability and Evidence_, how they relate to Ayer's other works, and their influence in contemporary philosophy. He also provides a brief biographical sketch of Ayer, and includes a bibliography of works about and in response to _Probability and Evidence_. (shrink)