Advancements in fetal assessment and therapeutic intervention in medical practice and clinical research call for corresponding progress in regulatory and ethical guidance. In “A new ethical framewo...

Background The ethical governance of Artificial Intelligence (AI) in health care and public health continues to be an urgent issue for attention in policy, research, and practice. In this paper we report on central themes related to challenges and strategies for promoting ethics in research involving AI in global health, arising from the Global Forum on Bioethics in Research (GFBR), held in Cape Town, South Africa in November 2022. Methods The GFBR is an annual meeting organized by the World Health (...) Organization and supported by the Wellcome Trust, the US National Institutes of Health, the UK Medical Research Council (MRC) and the South African MRC. The forum aims to bring together ethicists, researchers, policymakers, research ethics committee members and other actors to engage with challenges and opportunities specifically related to research ethics. In 2022 the focus of the GFBR was “Ethics of AI in Global Health Research”. The forum consisted of 6 case study presentations, 16 governance presentations, and a series of small group and large group discussions. A total of 87 participants attended the forum from 31 countries around the world, representing disciplines of bioethics, AI, health policy, health professional practice, research funding, and bioinformatics. In this paper, we highlight central insights arising from GFBR 2022. Results We describe the significance of four thematic insights arising from the forum: (1) Appropriateness of building AI, (2) Transferability of AI systems, (3) Accountability for AI decision-making and outcomes, and (4) Individual consent. We then describe eight recommendations for governance leaders to enhance the ethical governance of AI in global health research, addressing issues such as AI impact assessments, environmental values, and fair partnerships. Conclusions The 2022 Global Forum on Bioethics in Research illustrated several innovations in ethical governance of AI for global health research, as well as several areas in need of urgent attention internationally. This summary is intended to inform international and domestic efforts to strengthen research ethics and support the evolution of governance leadership to meet the demands of AI in global health research. (shrink)

RESUMEN El presente trabajo describe los cambios estratégicos del Centro de Inmunología y Productos Biológicos de la Universidad de Ciencias Médicas de Camagüey que contribuyen a la formación profesional, la investigación y los servicios científico técnicos. Recoge los resultados obtenidos desde el 2015 hasta el 2017. Los referentes teóricos permiten un acercamiento epistémico que facilita la relación con el conocimiento y la creación de concepciones para abordar los problemas de salud. El centro tiene cuatro proyectos asociados a programas y 11 (...) institucionales. Se posee 2,7 publicaciones por autor y 18 participaciones en eventos, de ellos, ocho internacionales. Se perfecciona un sistema de gestión de la calidad, nueve servicios científico-técnicos, diversos servicios a la docencia y proyectos de investigaciones. Se aprovecha el potencial que genera el proceso de auto-organización del trabajo colectivo, para un mejor funcionamiento, sinergia y sustentabilidad de la gestión de una unidad de desarrollo e innovación. ABSTRACT The present work describes the strategic changes of the Center of Immunology and Biological Products of the University of Medical Sciences of Camagüey that contributes to the professional training, the investigation and the technical-scientist services. It gathers the results obtained from 2015 to 2017. The theoretical bases allow an epistemic approach that facilitates the relation with the knowledge and the creation of conceptions to tackle the health problems. The center has four projects associated with programs and 11 institutional ones. There are possessed 2.7 publications per author and 18 participations in events, of them, eight international ones. Scientist - technical staff perfects a system of management of the quality, nine services, diverse services to the teaching and projects of investigations. One makes use of the potential that generates the auto-organization process of collective work, for a better functioning, synergy and sustainability of the management of a unit of development and innovation. (shrink)

Background: Autonomy is a central concept in both bioethics and rehabilitation. Bioethics has emphasized autonomy as self-governance and its application in treatment decision-making. In addition to discussing decisional autonomy, rehabilitation also focuses on autonomy as functional independence. In practice, responding to patients with diminished autonomy is an important component of rehabilitation care, but also gives rise to tensions and challenges. Our objective was to better understand the complex and distinctive ways that autonomy is understood and upheld in the context of (...) rehabilitation care by reviewing how autonomy is discussed in the rehabilitation literature. Methods: We conducted a scoping review addressing issues of autonomy in the context of mental and physical rehabilitation. Our process followed three sequential steps. We extracted and analyzed bibliometric information. We then examined how autonomy was defined and conceptualized. Finally, we examined how the articles discussed the roles of rehabilitation health professionals in responding to patient autonomy. Findings: The articles include 16 empirical reports, 17 case studies and 30 theoretical papers. The most common conceptual accounts of autonomy drew upon principlism, rights-based and legal analyses, and relational/social approaches. We identified four broad approaches for responding to patient autonomy: supporting, promoting, respecting and advocating. Conclusion: This review helps clarify some of the ambiguities and conceptual distinctions underlying discussions and practices related to autonomy in rehabilitation. It also draws attention to a wide range of activities that health professionals can undertake with the goal of supporting, promoting, respecting and advocating for patient autonomy in rehabilitation care. (shrink)

Background: Autonomy is a central concept in both bioethics and rehabilitation. Bioethics has emphasized autonomy as self-governance and its application in treatment decision-making. In addition to discussing decisional autonomy, rehabilitation also focuses on autonomy as functional independence. In practice, responding to patients with diminished autonomy is an important component of rehabilitation care, but also gives rise to tensions and challenges. Our objective was to better understand the complex and distinctive ways that autonomy is understood and upheld in the context of (...) rehabilitation care by reviewing how autonomy is discussed in the rehabilitation literature. Methods: We conducted a scoping review addressing issues of autonomy in the context of mental and physical rehabilitation. Our process followed three sequential steps. We extracted and analyzed bibliometric information. We then examined how autonomy was defined and conceptualized. Finally, we examined how the articles discussed the roles of rehabilitation health professionals in responding to patient autonomy. Findings: The articles include 16 empirical reports, 17 case studies and 30 theoretical papers. The most common conceptual accounts of autonomy drew upon principlism, rights-based and legal analyses, and relational/social approaches. We identified four broad approaches for responding to patient autonomy: supporting, promoting, respecting and advocating. Conclusion: This review helps clarify some of the ambiguities and conceptual distinctions underlying discussions and practices related to autonomy in rehabilitation. It also draws attention to a wide range of activities that health professionals can undertake with the goal of supporting, promoting, respecting and advocating for patient autonomy in rehabilitation care. (shrink)

The humanitarian sector continually faces organizational and operational challenges to respond to the needs of populations affected by war, disaster, displacement, and health emergencies. With the goal of improving the effectiveness and efficiency of response efforts, humanitarian innovation initiatives seek to develop, test, and scale a variety of novel and adapted practices, products, and systems. The innovation process raises important ethical considerations, such as appropriately engaging crisis-affected populations in defining problems and identifying potential solutions, mitigating risks, ensuring accountability, sharing benefits (...) fairly, and managing expectations. This paper aims to contribute to knowledge and practice regarding humanitarian innovation ethics and presents two components related to a value-sensitive approach to humanitarian innovation. First is a mapping of how ethical concepts are mobilized in values statements that have been produced by a diverse set of organizations involved in humanitarian innovation. Analyzing these documents, we identified six primary values (do-no-harm, autonomy, justice, accountability, sustainability, and inclusivity) around which we grouped 12 secondary values and 10 associated concepts. Second are two proposed activities that teams engaged in humanitarian innovation can employ to foreground values as they develop and refine their project’s design, and to anticipate and plan for challenges in enacting these values across the phases of their project. A deliberate and tangible approach to engaging with values within humanitarian innovation design can help to ground humanitarian innovation in ethical commitments by increasing shared understanding amongst team members, promoting attentiveness to values across the stages of innovation, and fostering capacities to anticipate and respond to ethically challenging situations. (shrink)

Relational representation abilities are a crucial cognitive difference between human and nonhuman animals. We argue that relational reasoning and representation supports the development of culture that increases in complexity. Thus, these abilities are a force that magnifies the apparent difference in cognitive abilities between humans and nonhumans.

Understanding terrestrial carbon metabolism is critical because terrestrial ecosystems play a major role in the global carbon cycle. Furthermore, humans have severely disrupted the carbon cycle in ways that will alter the climate system and directly affect terrestrial metabolism. Changes in terrestrial metabolism may well be as important an indicator of global change as the changing temperature signal. Improving our understanding of the carbon cycle at various spatial and temporal scales will require the integration of multiple, complementary and independent methods (...) that are used by different research communities. Tools such as air sampling networks, inverse numerical methods, and satellite data allow us to study the strength and location of the global- and continental-scale carbon sources and sinks. Bottom-up studies provide estimates of carbon fluxes at finer spatial scales and examine the mechanisms that control fluxes at the ecosystem, landscape, and regional scales. Bottom-up approaches include comparative and process studies that provide the necessary mechanistic information to develop and validate terrestrial biospheric models. An iteration and reiteration of top-down and bottom-up approaches will be necessary to help constrain measurements at various scales. We propose a major international effort to coordinate and lead research programs of global scope of the carbon cycle. (shrink)

The authors empirically examine the nature and extent of ethical problems confronting senior level AICPA members (CPAs) and examine the effectiveness of partner actions and codes of ethics in reducing ethical problems. The results indicate that the most difficult ethical problems (frequency reported) were: client requests to alter tax returns and commit tax fraud, conflict of interest and independence, client requests to alter financial statements, personal-professional problems, and fee problems. Analysis of attitudes toward ethics in the accounting profession indicated that (...) (1) CPAs perceive that opportunities exist in the accounting profession to engage in unethical behavior, (2) CPAs, in general, do not believe that unethical behavior leads to success, and (3) when top management (partners) reprimand unethical behavior, the ethical problems perceived by CPAs seem to be reduced. (shrink)

Historical injustice and global inequality are basic problems embedded in territorial rights. In Global Justice and Territory Cara Nine advances a general theory of territorial rights adapting a theoretical framework from natural law theory to ground all territorial claims.

In Propositional Attitudes, Mark Richard claims that some natural and formal language sentences of the form(∀ x)(∀ y)(x = y → α → α [y/x])are false. He suggests a substitution for α that is sensitive to certain ancillary features of the variable letter as well as the assignment, and then argues that this substitution generates a false instance of the above-mentioned schema. I reject Richard's argument and argue further that the sentence is not an instance of that schema. I then (...) argue that his putative natural language example fails as well. Finally, I suggest that although Richard's mistake here does not present any technical problem for his semantics for attitude ascriptions, it undermines his claim that his semantic theory is better able to respect the surface form of attitude ascriptions in natural languages than competing theories. (shrink)

Predictive genetic testing is now routinely offered to asymptomatic adults at risk for genetic disease. However, testing of minors at risk for adult-onset conditions, where no treatment or preventive intervention exists, has evoked greater controversy and inspired a debate spanning two decades. This review aims to provide a detailed longitudinal analysis and concludes by examining the debate's current status and prospects for the future. Fifty-three relevant theoretical papers published between 1990 and December 2010 were identified, and interpretative content analysis was (...) employed to catalogue discrete arguments within these papers. Novel conclusions were drawn from this review. While the debate's first voices were raised in opposition of testing and their arguments have retained currency over many years, arguments in favour of testing, which appeared sporadically at first, have gained momentum more recently. Most arguments on both sides are testable empirical claims, so far untested, rather than abstract ethical or philosophical positions. The dispute, therein, lies not so much in whether minors should be permitted to access predictive genetic testing but whether these empirical claims on the relative benefits or harms of testing should be assessed. (shrink)

Some time ago, John Perry argued that the content of an indexical belief, that is, a belief expressible with a sentence containing an indexical or demonstrative, cannot be a proposition. I consider several of his arguments for this view, and show that they can be extended to show that belief expressible with other non-indexical expressions such as natural kind terms and proper names presents the very same problem for the traditional picture. I then suggest that if indexical belief has any (...) special status, this is not because it has a special kind of content, but rather because action is impossible if agents do not have indexical belief. (shrink)

In Sharing Territories, Cara Nine defends a river model of territorial rights. On a river model, groups are assumed to be interdependent and overlapping. Drawing on natural law philosophy, Nine's theory argues for the establishment of foundational territories around geographical areas like rivers.

The Russellian approach to the semantics of attitude ascriptions faces a problem in explaining the robust speaker intuitions that it does not predict. A familiar response to the problem is to claim that utterances of attitude ascriptions may differ in their Gricean conversational implicatures. I argue that the appeal to Grice is ad hoc. First, we find that speakers do not typically judge an utterance false merely because it implicates something false. The apparent cancellability of the putative implicatures is irrelevant, (...) since cancellability does not indicate conversational implicature. Finally, the appeal assumes, implausibly, that ordinary speakers generally subscribe to a particular philosophical theory about belief. (shrink)

Inside and outside of a Christian worldview, bioethicists have discussed ectopic pregnancy at some length as a maternal-fetal vital conflict. Most bioethicists agree that methotrexate and salpingostomy are low-risk, successful interventions for this life-threatening pathology, and are thus beneficent, just, and wholly acceptable. A small cohort of Christian, largely Catholic, bioethicists have reservations about methotrexate and salpingostomy, but cannot resolve their internal disputes about these because of flawed casuistry. This paper aims to settle the issue about whether methotrexate and salpingostomy (...) are acceptable within a Catholic worldview: despite the best arguments in favor of methotrexate as a moral option, it is morally unacceptable, and despite hesitation about salpingostomy related to analogies with previable delivery, it is the optimal procedure for ectopic pregnancy. (shrink)

Objective Standards of care regarding obstetric management of life-threatening anomalies are not defined. It is hypothesised that physicians' management of these pregnancies is variable and influenced by demographic factors. Design A questionnaire was mailed to members of the Society of Maternal–Fetal Medicine with valid US addresses assessing obstetric management of both ‘uniformly lethal’ (eg, anencephaly, renal agenesis) and ‘uniformly severe, commonly lethal’ (eg, trisomy 13 and 18) anomalies. Respondents were asked to answer as if not limited by state/institutional restrictions. Fisher's (...) exact or χ2 tests were used as appropriate and correction made for multiple comparisons in analyses that were not prespecified. Results The response rate was 36% (732/2038). Nearly 100% of respondents discuss termination for both uniformly and commonly lethal anomalies. In continuing pregnancies, with patient request for obstetric non-intervention 99% of providers would comply for either uniformly or commonly lethal anomalies. The majority ‘encourage’ such management, but some were non-directive or discouraged this management. In continuing pregnancies, with patient request for full obstetric intervention the majority of respondents was willing to comply for both uniformly (71%) and commonly (82%) lethal anomalies. While most practitioners ‘discouraged’ full intervention, some were non-directive or encouraged this management. Demographics and severity of anomaly influenced counselling. Conclusion Discrepancies exist regarding the management of life-threatening fetal anomalies. Patients may be offered different options based on practitioner demographics. The majority of physicians comply with patient wishes. Differences were noted when comparing the management of lethal with that of severe commonly lethal anomalies, suggesting that practitioners make a distinction when counselling patients. (shrink)

This paper investigates how principals can be supported in their work as teacher leaders. My focus is on how principals can help teachers respond ethically to classroom challenges. I argue that in aiding teachers, school leaders themselves need support and ongoing development. I turn to the care of the self to conceptually explore ethical self-cultivation. I then argue that a practice, Descriptive Inquiry, serves as a way for principals to care for themselves. To make this argument, I draw on a (...) qualitative study of four long-term elementary school principals. (shrink)

In this paper, I take issue with the familiar view that the problem of the essential indexical is a merely technical problem, which can be solved through a straightforward revision of the familiar model of belief content. (The familiar model just says that the content of belief is a proposition.) I do not object to these technical fixes, but I think they leave some questions unanswered. Specifically, they deny us an attractive account of what it is for different people to (...) completely agree on their conception of what the world is like, according to which complete agreement consists in having beliefs with the same propositional content, but they do not give us anything to replace it with. Here, I consider whether we can say anything general about the relation between my beliefs and your beliefs (including, of course, our indexical beliefs), when you and I completely agree about what the world is like. (shrink)

In response to the abundance of parenting literature and a contemporary emphasis on expertise, recent scholars have suggested that how we parent should be determined by values and a family’s particular needs, a combination often referred to as practical wisdom. In this article, I build on previous calls for an ethical approach to being a parent. I argue that being able to share and cultivate one’s unique personality and have one’s aptitudes and interests recognized is a key condition of living (...) well and that parents play an important role in helping their children know and realize their gifts. I put forth an exercise for attending to children, the descriptive review of the child. In doing so, I first describe this practice, illustrate it, and then explain how it can help one live well as a parent. (shrink)

Early in Peter Abelard's Dialogue between a Philosopher, a Jew, and a Christian, the philosopher and the Christian easily come to agreement about what the point of ethics is: “[T]he culmination of true ethics … is gathered together in this: that it reveal where the ultimate good is and by what road we are to arrive there.” They also agree that, since the enjoyment of this ultimate good “comprises true blessedness,” ethics “far surpasses other teachings in both usefulness and worthiness.” (...) As Abelard understood them, both fundamental elements of his twelfth-century ethical culture — Greek philosophy and Christian religion — held a common view of the nature of ethical inquiry, one that was so obvious to them that his characters do not even state it in a fully explicit way. They take for granted, as we take the ground we stand on, the premise that the most important function of ethical theory is to tell you what sort of life is most desirable, or most worth living. That is, the point of ethics is that it is good for you, that it serves your self-interest. (shrink)

Ecological refugees are expected to make up an increasing percentage of overall refugees in the coming decades as predicted climate change related disasters will displace millions of people. In this essay, I focus on those rights ecological refugees may claim on the basis of collective self-determination. To this end, I will focus on a few specific cases that I call cases of ‘ecological refugee states’. Tuvalu, the Maldives, and to a certain extent, Bangladesh are predicted to be ecological refugee states (...) in the near future. These are states whose entire (or close to it) geographical territory is predicted to be lost to rising sea levels; the collective body of the people will itself become an ecological refugee.The question is: what may the people of an ecological refugee state legitimately claim on the basis of their right to self-determination? Should we redraw state borders to accommodate a New Tuvalu? I argue that a plausible position regarding territorial rights is that when (1) a people clearly is (or recently was) self-determining and has a legitimate claim to continue to be self-determining, and (2) the self-determination of a people is existentially threatened because the people lacks territorial rights, that (3) the people becomes a candidate for sovereign over a new territory. The result is that existing state borders may need to change to accommodate something like a New Tuvalu. To generate these results on behalf of ecological refugee states, I examine the principles of the system of territorial states. Because the system of territorial states is a system of exclusive rights over goods, especially land, it is possible that it is subject to the conditions of a Lockean proviso mechanism. This paper is dedicated mainly to adapting a version of the Lockean proviso for use in territorial rights theory. (shrink)

Competition is pervasive in modern society, affecting work, education, and recreation. The question arises whether competition is consistent with scriptural teaching. The context for this enquiry is that Christians today disagree among themselves about whether Scripture has any normative content relating to competition. Some view competition as incompatible with Scripture, while for others it is compatible. On the basis of a given definition of competition, Christian contributions to the debate in the last decade are reviewed. Only six inputs were discovered, (...) with five arguing that Scripture takes no normative position toward competition. Most of this article is taken up with evaluating their cases that are found to be unpersuasive. A sixth paper claims that Scripture is incompatible with competition, examined in the penultimate section. From reviewing the six contributions to the debate, the conclusion is that that Scripture does not have a favorable attitude toward competition. (shrink)

The semantics of belief reports has recently received a great deal of attention. Speech reports have largely been left behind in this discussion. Here I extend a familiar recent account of attitude reports, the Russellian theory, to the special case of speech reports. I then consider how it compares to Davidson’s paratactic theory with respect to a few examples that raise special problems about speech reports. Neither theory accounts for everything we want to say about these cases. I suggest that (...) the problem lies in an assumption common to both theories, that in reporting what others say, we aim to represent what was said exactly as the original speaker represented it, in so far as this is possible. (shrink)

Do territorial rights include the right to exclude? This claim is often assumed to be true in territorial rights theory. And if this claim is justified, a state may have a prima facie right to unil...

In ‘What’s Wrong with Colonialism,’ Lea Ypi argues that the wrong of colonialism can be expressed as procedural wrongs, not as wronging territorial rights. On her view, colonial practices went wrong in two ways: they forced residents into political associations, and the terms of the political association were not established through equal and reciprocal negotiations. I argue that because Ypi’s account successfully side-lines all but essential claims to territory, her theory ends up being vulnerable to an objection it means to (...) avoid. Historical residents may be subject to unequal treatment under newly formed political associations because their historical patterns of land use are not considered to have any independent moral weight. My analysis does not rely on any appeal to property or territorial rights. Instead, I appeal to pre-existing obligations holding between residents. (shrink)

Disability scholars have critiqued medical models that pathologize disability as an individual flaw that needs treatment, rehabilitation, and cure, favoring instead a social-constructionist approach that likens disability to other identity categories such as gender, race, class, and sexuality. However, the emphasis on social constructionism has left chronic illness and pain largely untheorized. This article argues that feminist disability studies must attend to the common, chronic gynecological condition endometriosis when theorizing pain. Endo is particularly important for FDS analysis because the highly (...) feminized and sexualized nature of endo pain is a major source of disability. Because medical treatments of endo enhance fertility rather than provide pain relief, those with endo must not only have access to medical services to manage their pain, but also demand better medical management of their pain as well as disability accommodations for their pain. Thus, I propose a pain-centric model of disability that politicizes pain through social-constructionist and medical models of disability by attending to the lived experiences of pain. (shrink)

Emotions situate actors in relationships and shape their social interactions. Culture defines both the qualities of individual identity and the constitution of social groups with distinctive values and practices. Emotions, then, are necessarily experienced and acted upon in culturally inflected forms that define not only the conventions of their articulation through individual and collective action, but also the very words that name them. This article develops theoretical arguments to support these claims and illustrates their application in a description of differing (...) emotional repertoires, and their consequences, in Aotearoa New Zealand. The effects of resentment and shame in an ethnic politics of rights and antidiscrimination law demonstrate that context is central to a nuanced understanding of how law and emotions connect in the practicalities of enforcing the protections of anti-discrimination law. (shrink)