Global short-term medical volunteerism is growing, and properly conducted, is a tool in the fight for greater global health equity. It is intrinsically ethical (i.e., it involves ethics at every step) and depends upon ethical conduct for its success. At present, ethical guidelines remain in their infancy, which presents a unique opportunity. This paper presents a set of basic ethical principles, building on prior work in this area and previously developed guidelines for international clinical research. The content of these principles, (...) and the benchmarks used to evaluate them, remain intentionally vague and can only be filled by collaboration with those on-the-ground in local communities where this work occurs. Ethical review must additionally take into consideration the different obligations arising from the type of institution, type of intervention, and type of relationship involved. This paper argues that frequent and formalized ethical review, conducted from the beginning with the local community (where this community helps define the terms of debate), remains the most important ethical safeguard for this work. (shrink)

Old habits die hard; so, it seems, do old arguments. Proponents of thoracoabdominal normothermic regional perfusion (TA-NRP, but more commonly referred to as NRP) continue to proffer arguments and...

This article examines the processes through which civilian fear was turned into a practicable investigative object in the inter-war period and the opening stages of the Second World War, and how it was invested with significance at the level of science and of public policy. Its focus is on a single historical actor, Solly Zuckerman, and on his early war work for the Ministry of Home Security-funded Extra Mural Unit based in Oxford’s Department of Anatomy (OEMU). It examines the process (...) by which Zuckerman forged a working relationship with fear in the 1930s, and how he translated this work to questions of home front anxiety in his role as an operational research officer. In doing so it demonstrates the persistent work applied to the problem: by highlighting it as an ongoing research project, and suggesting links between seemingly disparate research objects (e.g. the phenomenon of ‘blast’ exposure as physical and physiological trauma), the article aims to show how civilian ‘nerve’ emerged from within a highly specific analytical and operational matrix which itself had complex foundations. (shrink)

This article examines the processes through which civilian fear was turned into a practicable investigative object in the inter-war period and the opening stages of the Second World War, and how it was invested with significance at the level of science and of public policy. Its focus is on a single historical actor, Solly Zuckerman, and on his early war work for the Ministry of Home Security-funded Extra Mural Unit based in Oxford’s Department of Anatomy. It examines the process by (...) which Zuckerman forged a working relationship with fear in the 1930s, and how he translated this work to questions of home front anxiety in his role as an operational research officer. In doing so it demonstrates the persistent work applied to the problem: by highlighting it as an ongoing research project, and suggesting links between seemingly disparate research objects, the article aims to show how civilian ‘nerve’ emerged from within a highly specific analytical and operational matrix which itself had complex foundations. (shrink)

Medical aid in dying (MAiD), despite being legal in many jurisdictions, remains controversial ethically. Existing surveys of physicians’ perceptions of MAiD tend to focus on the legal or moral permissibility of MAiD in general. Using a novel sampling strategy, we surveyed physicians likely to have engaged in MAiD-related activities in Colorado to assess their attitudes toward contemporary ethical issues in MAiD.

Contemporary medical practice and health policy are increasingly animated by the concept of providing high value care. Nevertheless, there can be disagreements about how value is defined and from whose perspective. Individual patients suffering from terminal cancer, for example, may have a different perception of the value of an expensive chemotherapy when compared to health policymakers, insurers, or others responsible for the financial solvency of health care organizations. Thus it seems reasonable to ask what is meant by “value” in high (...) value care. In light of Edmund Pellegrino’s significant contributions to the philosophy of medicine, medical humanities, and bioethics, it seems equally reasonable to examine how he might answer it. This paper describes a Pellegrino-inspired theory of value that is instrumental, agent relative, and pluralistic. It then compares and contrasts this to the contemporary view and argues that only when individual patients incorporate concern for societal-level value into their conceptions of the highest good can the Pellegrino-inspired and contemporary views of value be reconciled. (shrink)

This essay’s principal objective is to examine how, when confronted with a case of possible criminal poisoning, early nineteenth-century English toxicologists sought to generate and to represent their evidence in the courtroom. Its contention is that in both these activities toxicologists were inextricably engaged in a complex communicative exercise. On the one hand, they distanced themselves from the instabilities of language, styling themselves as testifiers to fact alone. But at the same time, they saw themselves as deeply implicated in the (...) difficulties of forging a coherent signifying system out of a disparate collection of signs that in themselves bore no intrinsic meaning. The analysis has three main components: first, to suggest why criminal poisoning featured so prominently in the burgeoning legal literature on evidence which provided the framework for expert testimony in English courts; next, to show that the scientific evidence offered by toxicologists in poisoning cases can be usefully understood as a form of language; and finally, to suggest that this recourse to signs informed the toxicologist’s encounter with another type of courtroom expert—the legal advocate—who was equally interested in manipulating signs in order to construct legally sanctioned proof.Author Keywords: Evidence; Expertise; Poisoning; Testimony; Toxicology. (shrink)

The American Journal of Bioethics, Volume 12, Issue 8, Page 36-38, August 2012.

While acknowledging the potential benefits of pharmacogenomics as a methodology, a number of comprehensive reports in the past several years examine a multitude of ethical, legal, and social factors that may limit the extent to which these benefits are realized — and realized in ethically acceptable ways. This article aims to identify and explore the most basic ethical and regulatory issues that are likely to arise if pharmacogenomics becomes widely enough used to have a significant impact on research and clinical (...) practice. First, however, it addresses the question of whether pharmacogenomic tests are unique when compared to other genetic tests and thus deserving of more or less stringent ethical and regulatory requirements. (shrink)

There are several reasons for the current prominence of global health issues. Among the most important is the growing awareness that some risks to health are global in scope and can only be countered by global cooperation. In addition, human rights discourse and, more generally, the articulation of a coherent cosmopolitan ethical perspective that acknowledges the importance of all persons, regardless of where they live, provide a normative basis for taking global health seriously as a moral issue. In this paper (...) we begin the task of translating the vague commitment to doing something to improve global health into a coherent set of more determinate obligations. One chief conclusion of our inquiry is that the responsibilities of states regarding global health are both more determinate and more extensive than is usually assumed. We also argue, however, that institutional innovation will be needed to achieve a more comprehensive, fair distribution of concrete responsibilities regarding global health and to provide effective mechanisms for holding various state and nonstate actors accountable for fulfilling them. (shrink)

This paper examines technical, ethical and ecological science perspectives on environmental valuation, and discusses problems in terms of the implications for practical policy -making. It suggests that all these perspectives raise legitimate concerns about the use of stated preference methods, but concludes that such methods still have a role to play in policy making for nature conservation provided they are applied in the right circumstances, designed very carefully, and used in conjunction with other decision-making tools.

The Emergency Department is a crucial medical treatment unit of hospital specializing in emergency medicine. EDs are responsible for providing immediate healthcare facilities to patients arriving without prior appointment. Thus, evaluating patient satisfaction is of immense importance for efficient service delivery. Very few studies are found in Pakistan, related to patients’ satisfaction and utilization of ED services both from demand and supply perspective of ED-Services Supply Chains. Data was collected to assess 200 patient’s satisfaction towards quality of healthcare services of (...) ED of Sindh Government Qatar Hospital, Orangi town-a tertiary care hospital in Karachi. Structured questionnaire was developed to interview patients and their attendants. Results of SPSS analysis revealed that 55% of patients were transferred to ED within 5 minutes, which shows efficient patient queues and flow management. 64.5% patient’s average LOS was between 40-60 minutes. 71% get the availability of basic facilities in ED. Majority of patients i.e. 96.5% and 90.5%, showed satisfaction with the time spent and treatment given by the doctor. Majority of the patients are satisfied with the services and performance of ED of a tertiary care hospital and 76% patients showed willingness to recommend ED of Government Qatar Hospital, Karachi to others. (shrink)

The UN Convention against Torture defines torture as “any act by which severe pain or suffering, whether physical or mental, is intentionally inflicted on a person” by someone acting in an official capacity for purposes such as obtaining a confession or punishing or intimidating that person.1 It is unethical for healthcare professionals to participate in torture, including any use of medical knowledge or skill to facilitate torture or allow it to continue, or to be present during torture.2-7 Yet medical participation (...) in torture has taken place throughout the world and was a prominent feature of the US interrogation practice in military and Central Intelligence Agency (CIA) detention facilities in the years after the attacks of 11 September 2001.8-11 Little attention has been paid, however, to how a regime of torture affects the ability of health professionals to meet their obligations regarding routine clinical care for detainees. -/- The 2016 release of previously classified portions of guideline from the CIA regarding medical practice in its secret detention facilities sheds light on that question. These show that the CIA instructed healthcare professions to subordinate their fundamental ethical obligations regarding professional standards of care to further the objectives of the torturers. (shrink)

OBJECTIVE: How outside factors affect physician decision making remains an open question of vital importance. We sought to investigate the importance of various influences on physician decision making when clinical guidelines differ from patient preference. -/- METHODS: An online survey asking 469 primary care providers (PCPs) across four practice sites whether they would order magnetic resonance imaging for a patient with uncomplicated back pain. Participants were randomized to one of four scenarios: a patient's preference for imaging (control), a patient's preference (...) plus a colleague's opinion against imaging (colleague), a patient's preference plus a professional society's recommendation against imaging (profession), or a patient's preference plus an accountable care organization's quality metric that measures physician use of imaging (ACO). Demographic information and the reasoning behind participants' decisions also were obtained. -/- RESULTS: A total of 168 PCPs completed the survey, yielding a 36% completion rate. A majority chose not to pursue imaging: control 68%, colleague 85%, profession 87%, and ACO 78%. Multivariate logistic regression revealed that participants were more likely not to order advanced imaging only when reminded of a professional society recommendation (P = 0.017). Regression also suggested that practice site exerted an effect on the primary outcome. Evidence-based medicine and clinical judgment were the most cited reasons for the decision. -/- CONCLUSIONS: Our results reinforce the potential to leverage professional societies to advance evidence-based medicine and reduce unnecessary testing. At the same time, practice site appeared to exert influence, suggesting that these recommendations must be part of local institutional culture to be effective. (shrink)

Frances Burney is primarily known as a novelist and playwright, but in recent years there has been an increased interest in the medical writings found within her private letters and journals. John Wiltshire advocates Burney as the unconscious pioneer of the modern genre of pathography, or the illness narrative. Through her dramatic accounts of distinct medical events, such as her own infamous operation without anaesthetic, to those she witnessed, including the 'madness' of George III and the inoculation of (...) her son against smallpox, Burney exposes the ethical issues and conflicts between patients and doctors. Her accounts are linked to a range of modern narratives in which similar events occur in the changed conditions of the public hospital. The genre that Burney initiated continues to make an important contribution to our understanding of medical practice in the modern world. (shrink)

Joseph Burney Trapp, a Fellow of the British Academy, was librarian; editor and teacher; scholar of humanism, letters, and the humanities; and an enlightened but efficient administrator. His career, or rather his life from first encounter, was bound up with the Warburg Institute in London. Trapp was born in New Zealand, at Carterton, near Wellington, on July 16, 1925. His maternal grandfather had founded an agency there for registering and distributing land tenure, which his father, Burney Trapp, had (...) joined. Trapp attended Dannevirke School, a small state boarding school where his elder sister Phyllis taught English. He went on, with a national scholarship, to Victoria University College, Wellington, graduating in 1946 in English and Greek, with subsidiary qualifications in Latin and French. From the late 1950s, Thomas More's work, both in English and Latin, became a preoccupation. It was at this time that Trapp was commissioned to edit the volume on the Apology for the Complete Works of More for Yale University Press. (shrink)

This review essay examines the emergence of the patient narrative or “pathography” in the late eighteenth and early nineteenth century in relation to the great cultural, epistemological, and ethical transformations that enabled the formation of modern medicine. John Wiltshire’s book provides an historical overview of this complex process, as well as laying the basis for a contemporary critique of some of its key assumptions.

_ Source: _Volume 53, Issue 2-4, pp 294 - 321 Manuscript London, British Library, Burney 330 contains an anonymous collection of grammatical sophisms, dating in all probability from early 13th-century France or England, and all based on problematic biblical, liturgical or religious propositions. After a presentation of the manuscript and collection, this article examines two analysis tools that are applied in the majority of the sophisms, viz. a distinction between three layers of grammatico-semantic perfection or completeness, and the grammatical (...) and semantic supposition doctrines. It appears that these sophisms pay prominent attention to improper or figurative supposition, but are not intended for highly advanced readers. These preliminary results suggest that the Burney Sophismata Collection constituted an exercise tool to support textbook-based instruction in theological grammar, which was developed by such masters as Peter the Chanter and William de Montibus in the late 12th and early 13th centuries. (shrink)

This article looks at Frances Burneys contribution to life writing through her composition, preservation and curatorship of her own personal archive and management of family papers. It charts Burneys chronic anxieties about the possible interpretation of the record that she had created, and the tension between self-expression and self-exposure which underlay her very revealing difficulties with editing, archivism and publication.