BackgroundStudies on different methods to supplement the traditional informed consent process have generated conflicting results. This study was designed to evaluate whether participants who received group counseling prior to administration of informed consent understood the key components of the study and the consent better than those who received individual counseling, based on the hypothesis that group counseling would foster discussion among potential participants and enhance their understanding of the informed consent.MethodsParents of children participating in a trial of nutritional supplementation were (...) randomized to receive either group counseling or individual counseling prior to administration of the informed consent. To assess the participant's comprehension, a structured questionnaire was administered approximately 48-72 hours afterwards by interviewers who were blinded to the allocation group of the respondents.ResultsA total of 128 parents were recruited and follow up was established with 118 (90.2%) for the study. All respondents were aware of their child's participation in a research study and the details of sample collection. However, their understanding of study purpose, randomization and withdrawal was poor. There was no difference in comprehension of key elements of the informed consent between the intervention and control arm.ConclusionsThe results suggest that the group counseling might not influence the overall comprehension of the informed consent process. Further research is required to devise better ways of improving participants' understanding of randomization in clinical trials.Trial RegistrationClinical Trial Registry - India (CTRI): CTRI/2009/091/000612. (shrink)

The purpose of this article is to examine the relationship of leadership effectiveness and psychological well-being with the work outcomes of intention to quit, job involvement and organization-based self-esteem, and whether workplace spirituality plays a role in mediating the associations of leadership effectiveness and psychological well-being with work outcomes. The study is cross-sectional and non-experimental. Data were obtained from 630 information technology employees from South India, adopting ‘power calculations’. The analysis was performed using SPSS version 20 for Windows and LISREL (...) version 8.72. Results reveal that leadership effectiveness and psychological well-being have a significant positive association with workplace spirituality, and this, in turn, has an impact on the work outcomes of intention to quit, job involvement and OBSE. Workplace spirituality can limit any negative associations of leadership effectiveness and psychological well-being with work outcomes. This research adds to the existing body of knowledge in the spirituality literature by drawing attention to the positive aspects of the interplay between spirituality, leadership transformation and well-being at work. The article concludes that building core values anchoring spirituality would lead to greater connectedness and healthier employee outcomes. (shrink)

The three works brought together in this collection explore Buddhism as a rich source of literary legend, an austere ethical guide, and a contemporary philosophy very relevant in the modern world in view of the resurgence of interest in the Buddha and his philosophy. Matthew T. Kapstein in his Introduction provides a concise historical overview of Buddhism in India and the renewal of interest in the Buddha s teachings and also situates the works in their proper contexts. Gautama Buddha by (...) Iqbal Singh views the life of the Buddha in the context of the eventful age in which he lived, keeping in mind the significant connection of the personality of Gautama and his understanding of the nature of human experience and destiny, the deeper problems of our age. The Dhammapada or the path of virtue is the founding text of Buddhist teaching. The verses of the Dhammapada are believed to have been the utterances of Gautama the Buddha himself. Presented here in both Pali and English this classic edition was translated, edited, and annotated by S. Radhakrishnan, one of India s foremost philosophers. The Philosophy of Religion by Arvind Sharma interrogates key philosophical issues such as the nature of evil, belief or disbelief in God, human destiny, immortality, karma, and reincarnation, from the perspective of Buddhist philosophy and compares them with the tenets of the Western-dominated philosophy of religion. (shrink)

Background In the coronavirus disease 2019 era, doctors have tried to decrease hospital visits and admissions. To this end, telemedicine was implemented in a non-systematic manner according. The objective of this study was to assess the current knowledge and attitudes of physicians in Alexandria, Egypt, and Punjab, India, toward telemedicine and its ethical and medico-legal issues. Method A cross-sectional study was implemented using an anonymous self-administered questionnaire carried out over two months. A four-point Likert scale was used to collect data (...) about background knowledge, training in telemedicine and ethical and medico-legal issues in telemedicine practice. Results The questionnaire was completed by 175 Egyptian and 51 Indian physicians from different specialties. A significantly higher percentage of Indian physicians practiced telemedicine than Egyptian physicians during the coronavirus disease 2019 era. Although most physicians had no specific training or licensing to practice telemedicine, most of them practiced telemedicine through their social media accounts. Ethical violations involving waiving patient consent were detected. Significant ethical violations to doctors, for example, blackmail, defamation, hate speech, accusations in a court and violations of privacy, were observed. Indian physicians and Egyptian physicians thought the penalties should be lower in telemedicine than in traditional practice. Finally, most participants would like to continue using telemedicine after the coronavirus disease 2019 era but with improvements. Conclusions Coronavirus disease 2019 changed the acceptance of telemedicine by physicians. Many ethical and legal issues need to be addressed and clarified using formal training before implementation and standardization of telemedicine services. (shrink)

BackgroundIn this study, medical errors are defined as unintentional patient harm caused by a doctor’s mistake. This topic, due to limited research, is poorly understood in Malaysia. The objective of this study was to determine the proportion of doctors intending to disclose medical errors, and their attitudes/perception pertaining to medical errors.MethodsThis cross-sectional study was conducted at a tertiary public hospital from July- December 2015 among 276 randomly selected doctors. Data was collected using a standardized and validated self-administered questionnaire intending to (...) measure disclosure and attitudes/perceptions. The scale had four vignettes in total two medical and two surgical. Each vignette consisted of five questions and each question measured the disclosure. Disclosure was categorised as “No Disclosure”, “Partial Disclosure” or “Full Disclosure”. Data was keyed in and analysed using STATA v 13.0.ResultsOnly 10.1% intended to disclose medical errors. Most respondents felt that they possessed an attitude/perception of adequately disclosing errors to patients. There was a statistically significant difference when comparing the intention of disclosure with perceived disclosures. Most respondents were in common agreement that disclosing an error would make them less likely to get sued, that minor errors should be reported and that they experienced relief from disclosing errors.ConclusionMost doctors in this study would not disclose medical errors although they perceived that the errors were serious and felt responsible for it. Poor disclosure could be due the fear of litigations and improper mechanisms/procedures available for disclosure. (shrink)

Singh's study of 150 UK and US children diagnosed with attention deficit hyperactivity disorder and prescribed psychotropic medication concludes on the basis of interviews with the children that ‘stimulants improve their capacity for moral agency … an ability to meet normative expectations’.1 Reinterpreted in lay language, she finds that, when taking Ritalin, the children conform to the wishes and expectations of their parents and teachers. They get better grades at school and show less ‘oppositional-defiance’. This is not surprising as (...) it is precisely what Ritalin is supposed to do. However, it begs a number of crucial questions. Might it not be that the failure of the child to conform to the expected norms in the non-medicated state is a legitimate expression of the child's own moral agency, rebelling against what he/she experiences as inappropriate …. (shrink)

Biobanks are precariously situated at the intersection of science, genetics, genomics, society, ethics, the law and politics. This multi-disciplinarity has given rise to a new discourse in health research involving diverse stakeholders. Each stakeholder is embedded in a unique context and articulates his/her biobanking activities differently. To researchers, biobanks carry enormous transformative potential in terms of advancing scientific discovery and knowledge. However, in the context of power asymmetries in Africa and a distrust in science born out of historical exploitation, researchers (...) must balance the scientific imperative of collecting, storing and sharing high quality biological samples with obligations to donors/participants, communities, international collaborators, regulatory and ethics authorities. To date, researcher perspectives on biobanking in South Africa have not been explored and documented. In-depth qualitative interviews were conducted with a purposive sample of 21 researchers – 8 in the Western Cape, 3 in Gauteng and 10 in Kwa-Zulu Natal. Interviews lasted approximately 40–60 min and were audiotaped with consent. Thematic analysis of the transcribed interviews was conducted by the co-authors. Researchers articulated serious concerns over standardised regulatory approaches that failed to consider the heterogeneity of biobanks. Given that biobanks differ considerably, guidelines and RECs need to stratify risk accordingly and governance processes and structures must be flexible. While RECs were regarded as an important component of the governance structure researchers expressed concern about their expertise in biobanking. Operational management of biobanks was regarded as an ethical imperative and a pre-requisite to building trust during consent processes. While broad general consent was preferred, tiered consent was thought to be more consistent with respect for autonomy and building trust. Material Transfer Agreements were often lacking when biosamples were exported and this was perceived to impact negatively on trust. On the other hand, researchers believed that authentic community engagement would help to build trust. Building trust will best be achieved via a system of governance structures and processes that precede the establishment of a biobank and monitor progress from the point of sample collection through to future use, including export. Such governance structures must be robust and must include comprehensive national legislation, policy and contextualised guidelines. Currently such governance infrastructure appears to be lacking in many African countries including South Africa. Capacity development of all stakeholders including REC members will enhance expeditious and efficient review of biobanking protocols which in turn will reinforce trust in the researcher-donor relationship. Science translation and community engagement in biobanking is integral to the success of biobanking in South Africa. (shrink)

Hegel's India presents all of Hegels writings on and about India. It is remarkable how much effort Hegel expended on what he ultimately characterized merely as fantastic, subjective, wild, dreamy, frenzied, absurd, and repetitive. If Indian art, religion, and philosophy, are so grossly inadequate, what explains his life-long fascination in this unparalleled way? This reinterpretation of Hegel argues that Indian thought haunted Hegel, representing a sort of nemesis to his own philosophy.

According to Whitehead’s rectified principle, two individuals are connected just in case there is something self-connected which overlaps both of them, and every part of which overlaps one of them. Roberto Casati and Achille Varzi have offered a counterexample to the principle, consisting of an individual which has no self-connected parts. But since atoms are self-connected, Casati and Varzi’s counterexample presupposes the possibility of gunk or, in other words, things which have no atoms as parts. So one may still wonder (...) whether Whitehead’s rectified principle follows from the assumption of atomism. This paper presents an atomic countermodel to show the answer is no. (shrink)

Through engagement with key informants and review of ethical theories applicable to refugee policy, this paper examines the ethical and policy considerations that policy-level stakeholders believe should factor into setting the refugee resettlement ceiling. We find that the ceiling traditionally has been influenced by policy goals, underlying values, and practical considerations. These factors map onto several ethical approaches to resettlement. There is significant alignment between U.S. policy interests and ethical obligations toward refugees. We argue that the refugee ceiling should be (...) restored to historical norms, and that there exists a corresponding obligation to counter negative public perceptions about refugees and the costs of resettlement. (shrink)

Increasingly, national governments across the globe are prioritizing investments in neuroscience. Currently, seven active or in-development national-level brain research initiatives exist, spanning four continents. Engaging with the underlying values and ethical concerns that drive brain research across cultural and continental divides is critical to future research. Culture influences what kinds of science are supported and where science can be conducted through ethical frameworks and evaluations of risk. Neuroscientists and philosophers alike have found themselves together encountering perennial questions; these questions are (...) engaged by the field of neuroethics, related to the nature of understanding the self and identity, the existence and meaning of free will, defining the role of reason in human behavior, and more. With this Perspective article, we aim to prioritize and advance to the foreground a list of neuroethics questions for neuroscientists operating in the context of these international brain initiatives. (shrink)

This study compares the coverage of coping strategies and emotions portrayed in news regarding COVID-19 by The New York Times in the U.S. and People’s Daily of China via social media. By employing corpus assisted discourse analysis to scrutinize the text corpora, our study uncovered prominent keywords and themes. Findings indicate that a comprehensive range of themes relating to coping strategies was more common in People’s Daily while a relatively smaller number of themes was apparent in The New York Times. (...) In terms of emotions exhibited in the news coverage, positive emotions such as cheer, gratitude, and good wishes predominated in People’s Daily whereas in The New York Times, negative emotions in the form of fears and anxiety were salient. The differences are explained with reference to the political context intertwined with the news environment and prior experiences in handling epidemics, with practical implications. (shrink)

The catch 22 situation in psychiatry is that for precise diagnostic categories/criteria, we need precise investigative tests, and for precise investigative tests, we need precise diagnostic criteria/categories; and precision in both diagnostics and investigative tests is nonexistent at present. The effort to establish clarity often results in a fresh maze of evidence. In finding the way forward, it is tempting to abandon the scientific method, but that is not possible, since we deal with real human psychopathology, not just concepts to (...) speculate over. Search for clear-cut definitions/diagnostic criteria in psychiatry must be relentless. There is a greater need to be ruthless and blunt in this, rather than being accommodative of diverse opinions. Investigative tests - psychological, serum, CSF, or neuroimaging - are only corroborative at present; they need to become definitive. Medicalisation appears most prominent in psychiatry; so, diagnostic proliferation and fuzziness appear inevitable. And yet, the established diagnostic entities need to forward greater and conclusive precision. Also, the need for clarity and precision must outweigh pandering to and mollifying diverse interests, moreso in the upcoming revision of diagnostic manuals. This is specially because the DSM-5, being an Association manual, may need to accommodate powerful member lobbies; and ICD-11 may similarly need to cater to diverse country lobbies. Finding precise biological correlates of psychiatric phenomena, whether through neuroimaging, molecular neurobiology and/or neurogenomics, is the right way forward. It is in the 1.5-kg structure in the cranium that all secrets of psychiatric conditions lie. Social forces, behavioural modification, psychosocial restructuring, study of intrapsychic processes, and philosophical insights are not to be discounted, but they are supplementary to the primary goal - studying and deciphering those brain processes that result in psychiatric malfunction. Experimental breakthroughs, both in psychiatric aetiology and therapeutics, will come mainly from biology and its adjunct, psychopharmacology; while supplementary and complementary breakthroughs will come from the psychosocial, cognitive and behavioural approaches; the support base will come from phenomenology, epidemiology, nosology and diagnostics; while insights and leads can hopefully come from many fields, especially the psychosocial, the behavioural, the cognitive and the philosophical. Major energies must now be marshalled towards finding biomarkers and deciphering the precise phenotype-genotype-endophenotype axis of psychiatric disorders. Energies also need to be focussed on unravelling those critical processes in the brain that tip the scale towards psychiatric disorders. At how those critical processes are set into motion by forces de novo, in utero, in the genes and their expression, by the environment's psychopathological social forces - stress, peer pressure, poverty, deprivation, alienation, malnutrition, discrimination of various types (caste, gender, race, etc.), mass conflicts (war, terror attacks, etc.), disasters (natural and man-made), religious/ideological fascism - or social institutions like marriage, family, work place, political governance, etc. Ultimately, we must decipher how the brain goes into malfunction when such varied forces impinge on it, which precise cortical areas and neuronal cellular and molecular processes are involved in such malfunction and its manifestation, as also which of these are involved when malfunction ceases and health is restored, and the psychosocial processes and institutions which aid such health restoration, as also those which promote well-being and help in primary prevention. Emphasis on the brain and its intimate neurological and molecular mechanisms will not impinge on, or nullify, importance of the 'mind,' wherein subtle and gross brain functions in the form of behaviour, thought and emotions in all their ramifications will continue to be the focus of psychological, cognitive, sociological, psychopharmacological, behavioural and philosophical research. Progress in brain research must move in tandem with progress in 'mind' research. (shrink)

Metaethical constitutivists seek to ground normativity in facts about what is constitutive of agency. One strand of constitutivism locates the foundations of normativity in constitutive aims, which are standardly conceived of in teleological terms. I present three challenges that show that the teleological conception of constitutive aims is inadequate for the constitutivist project. I then sketch an alternative conception of constitutive aims in the form of a commitment-based conception. On the commitment-based conception, actions and attitudes constitutively represent their objects as (...) having certain properties, and their constitutive aims are fixed by the accuracy-conditions of these representations. Because such representations constitutively involve a commitment on the part of the agent to the object’s having the relevant property, they generate authoritative norms for the agent. I conclude that, unlike the teleological conception, the commitment-based conception promises to yield a unified constitutivism that delivers authoritative normative standards for both actions and attitudes. (shrink)