Consent remains a crucial, yet challenging, cornerstone of clinical practice. The ethical, legal and professional understandings of this construct have evolved away from a doctor-centred act to a patient-centred process that encompasses the patient’s values, beliefs and goals. This alignment of consent with the philosophy of shared decision-making was affirmed in a recent high-profile Supreme Court ruling in England. The communication of information is central to this model of health care delivery but it can be difficult for doctors to gauge (...) the information needs of the individual patient. The aim of this paper is to describe ‘core information sets’ which are defined as a minimum set of consensus-derived information about a given procedure to be discussed with all patients. Importantly, they are intended to catalyse discussion of subjective importance to individuals. The model described in this paper applies health services research and Delphi consensus-building methods to an idea orginally proposed 30 years ago. The hypothesis is that, first, large amounts of potentially-important information are distilled down to discrete information domains. These are then, secondly, rated by key stakeholders in multiple iterations, so that core information of agreed importance can be defined. We argue that this scientific approach is key to identifying information important to all stakeholders, which may otherwise be communicated poorly or omitted from discussions entirely. Our methods apply systematic review, qualitative, survey and consensus-building techniques to define this ‘core information’. We propose that such information addresses the ‘reasonable patient’ standard for information disclosure but, more importantly, can serve as a spring board for high-value discussion of importance to the individual patient. The application of established research methods can define information of core importance to informed consent. Further work will establish how best to incorporate this model in routine practice. (shrink)

Context Physicians are regularly confronted with research that is funded or presented by industry. Objective To assess whether physicians discount for conflicts of interest when weighing evidence for prescribing a new drug. Design and setting Participants were presented with an abstract from a single clinical trial finding positive results for a fictitious new drug. Physicians were randomly assigned one version of a hypothetical scenario, which varied on conflict of interest: ‘presenter conflict’, ‘researcher conflict’ and ‘no conflict’. Participants 515 randomly selected (...) Fellows in the American College of Obstetricians and Gynecologists' Collaborative Ambulatory Research Network; 253 surveys (49%) were returned. Main object measures The self-reported likelihood that physicians would prescribe the new drug as a first-line therapy. Results Physicians do not significantly discount for conflicts of interest in their self-reported likelihood of prescribing the new drug after reading the single abstract and scenario. However, when asked explicitly to compare conflict and no conflict, 69% report that they would discount for researcher conflict and 57% report that they would discount for presenter conflict. When asked to guess how favourable the results of this study were towards the new drug, compared with the other trials published so far, their perceptions were not significantly influenced by conflict of interest information. Conclusion While physicians believe that they should discount the value of information from conflicted sources, they did not do so in the absence of a direct comparison between two studies. This brings into question the effectiveness of merely disclosing the funding sources of published studies. (shrink)

One of the areas of concern raised by cross-border reproductive travel regards the treatment of women who are solicited to provide their ova or surrogacy services to foreign consumers. This is particularly troublesome in the context of developing countries where endemic poverty and low standards for both medical care and informed consent may place these women at risk of exploitation and harm. We explore two contrasting proposals for policy development regarding the industry, both of which seek to promote ethical outcomes (...) and social justice: While one proposal advocates efforts to minimize cross-border demand for female reproductive resources through the pursuit of national self-sufficiency, the other defends cross-border trade as a means for meeting the needs of vulnerable groups. Despite the conflicting objectives of the proposed strategies, the paper identifies common values and points of agreement between the two, including the importance of regulations to safeguard those providing ova or surrogacy services. (shrink)

International medical travel occurs when patients cross national borders to purchase medical goods and services. On occasion, physicians in home countries will be the last point of domestic contact for patients seeking healthcare information before they travel abroad for care. When this is the case, physicians have a unique opportunity to inform patients about their options and help guide them towards ethical practices. This opportunity brings to the fore an important question: What role should physicians in more-developed home countries play (...) in promoting or constraining international medical travel towards less-developed destination countries? In our view, critical attention to the decision spaces of patients—defined by the personal circumstances, socio-cultural cues, and legal constraints that inform decision-making—is a useful starting point for evaluating the proper response of physicians to various forms of international medical travel. (shrink)

In ‘Why not NIMBY?’, Simon Feldman and Derek Turner mount a compelling case that NIMBY claims are not intrinsically morally unjustified, despite the fact that NIMBY-claimants...

Drawing on conceptual tools from philosophical bioethics, economics, and materialist feminism, we advocate viewing transnational commercial surrogacy as labor and consider what it means to compensate women for this work. We find two distinct but interrelated concerns emerge in our discussion of wages for surrogates: how to value and compensate for social reproduction, and how to establish a fair wage for surrogates. We explore limitations of minimum wage policy in addressing the undervaluation of biological and emotional labor in the transnational (...) commercial surrogacy industry. We argue that subsidization is a superior method of addressing at least one cause of undervaluation. (shrink)

Dutch developments on euthanasia have drawn much attention over the years. Defenders and opponents have been telling very different stories about the practice of euthanasia and the frequency of cases, and the Dutch government has been struggling with the legal and moral problems involved. Concern about the procedures followed by physicians as well as questions on the “real” figures led the government to decide to organize an epidemiological study on the extent and the decision making. The results of the study (...) were published in November 1991. Interpretation of the data may lead to a final settlement of the debate on euthanasia and has inevitably led to a revival of the moral debate of the 1970s. For the moment it has been decided that euthanasia will remain officially illegal under the Penal Code. However, in cases where euthanasia does occur, Attorneys General will continue to check the procedures followed by physicians to ensure no abuses have occurred and to safeguard physicians against prosecution. In this contribution, we discuss the development and intertwinement of legal, medical, and moral aspects of euthanasia in The Netherlands and the effects of the empirical studies of 1991, both on definitions and procedures for medical decisions at the end of life. (shrink)

Varieties of chemical and phase equilibria are controlled by the minimum Gibbs energy principle, according to which the Gibbs energy for a system will have the minimum value at any given temperature and pressure. It is understood that the minimum is with respect to all nonequilibrium states at the same temperature and pressure. The abstract relation between Gibbs energy and the equilibrium constant is deduced from fundamental laws of thermodynamics. However, actual use of this relation calls for the Gibbs energy (...) as a function of concentrations of the chemicals. Since thermodynamics is formulated without any reference to materials, how does one get that relation? This article provides the answer, and in the process shows that application of theory to experiments requires several intermediate layers where theory and experiment commingle. (shrink)

In this article I intend to describe an issue of the Dutch euthanasia practice that is not common knowledge. After some general introductory descriptions, by way of formulating a frame of reference, I shall describe the effects of this practice on patients, physicians and families, followed by a more philosophical reflection on the significance of these effects for the assessment of the authenticity of a request and the nature of unbearable suffering, two key concepts in the procedure towards euthanasia or (...) physician-assisted suicide. This article does not focus on the arguments for or against euthanasia and the ethical justification of physician-assisted dying. These arguments have been described extensively in Kimsma and Van Leeuwen (Asking to die. Inside the Dutch debate about euthanasia, Kluwer Academic Publishers, Dordrecht, 1998). (shrink)

Feminist Care Ethics has much to offer in an analysis of the international migration of care workers. This paper argues, however, that Joan Tronto’s analysis of this international care regime is incomplete insofar as it overlooks the ways in which the current global care market is progressive for the workers and the significant harms this market is inflicting on care receivers in source countries. In order for Feminist Care Ethics to fulfill its potential, it must be developed beyond a visionary (...) tool for revaluing care—it must also produce analytic tools for evaluating real alternatives under pressing, real-time constraints. (shrink)

2011 Reprint of 1943 Edition. Full facsimile of the original edition, not reproduced with Optical Recognition Software. "St. Thomas Aquinas" is enriched by the author's unique ability to see the world through the saint's eyes, a fresh and animated view that shows us Aquinas as no other biography has. Acclaimed as the best book ever written on Aquinas by such outstanding Thomists as Jacques Maritain, Etienne Gilson, and Anton Pegis, this brilliant biography will completely capture the reader and leave him (...) desirous of reading Aquinas' own monumental work. (shrink)

A directory of archives and manuscript repositories, with links to web pages for the repositories and to online finding aids. Searchable by: collection name; city; state; National Inventory of Documentary Sources (NIDS) number; and National Union Catalog of Manuscript Collections (NUCMC) number.

We argue that the ecological research community should develop a plan for improving the ethical consistency and moral robustness of the field. We propose a particular ethics strategy—specifically, an ongoing process of collective ethical reflection that the community of ecological researchers, with the cooperation of applied ethicists and philosophers of biology, can use to address the needs we identify. We suggest a particular set of conceptual and analytic tools that, we argue, collectively have the resources to provide an empirically grounded (...) and conceptually complete foundation for an ethics strategy for ecological research. We illustrate our argument with information gathered from a survey of ecologists conducted at the 2013 meeting of the Canadian Society of Ecology and Evolution. (shrink)

In the debates surrounding the ethical dimensions of interventions in the human genome, much attention is paid to determining whether—and if so, how—market access to these technologies ought to be managed in order to maximize social benefit. There are those who advocate a “laissez-faire” free-market approach to the development and use of genetic and genomic interventions. We are sympathetic to this view insofar as we understand the workings of the market stimulus effect. We use the term “market stimulus effect” to (...) refer to the outcome of a set of mechanisms whereby early adoption of a new technology by wealthy consumers promotes the development of versions of this product that are cheaper to produce, or are simply .. (shrink)

Like other science, technology, engineering, and mathematics fields, ecological research needs ethics. Given the rapid pace of technological developments and social change, it is important for scientists to have the vocabulary and critical-thinking skills necessary to identify, analyze, and communicate the ethical issues generated by the research and practices within their fields of specialization. The goal of introducing ethics education for ecological researchers would be to promote a discipline in which scientists are willing and able to engage in ethical questions (...) and problem solving, even if they do so inadequately at first. Practicing ecologists ought to be able to identify and critically evaluate the ethical dimensions of their field studies because ecologists are at the forefront of important interfaces between humans and other-than-human organisms and natural systems. They are among the first to identify the impact of anthropogenic changes to the environments. Rapidly changing local and global environments mean that ecologists will be on the front line of any efforts to create a sustainable lifestyle for humans on this planet. (shrink)

In the current global care regime, care shortages in wealthy nations such as the United States, Canada, Italy, and Hong Kong are being addressed through the global supply of cheap migrant care labor from less wealthy nations. This paper argues that Feminist Care Ethics has a great deal to offer in the analysis of this global care regime. Joan Tronto's own critiques of the migration of care workers have focused on analogies between workers and imported slaves: both are intrinsically exploited, (...) vulnerable, excluded, and stigmatized. She argues that this situation undermines human virtue and the possibility of adequate care, and she advocates instead a model wherein caregiving is seen as a basis for .. (shrink)