First ed. published in 1946 under title: Medical ethics for nurses.

Survival of the fittest in evolutionary biology has a counterpart in the evolution of research paradigms. It’s called survival of the funded, and there is a sense in which paradigms are even more adaptable than species. Whereas species may become extinct if their fitness declines below a critical threshold, paradigms can rise again, perhaps with a new name, following fiscal collapse, provided only that funding is once again made available.A current example is the born-again concept of comparative effectiveness research , (...) which achieved resurrection status with the passage of the Affordable Care Act of 2010. The ACA established a private, nonprofit entity to oversee publicly financed CER. According to .. (shrink)

David Sackett and Jack Wennberg have each introduced and developed ideas and methods that have had major impacts on how we think about and perform clinical research. Sackett is best known for his work in Evidence-Based Medicine (Sackett et al. 1997); Wennberg, upon noting wide geographic (and other) variations in best practices for the same conditions, stressed the importance of comparative effectiveness in clinical decision-making (Wennberg et al. 1993). When these two collaborated in an editorial about the current state of (...) the art and science of clinical research, it comes as no great surprise that they produced some truly memorable guidance. And, as is so often the case for inspired—and inspiring—advice, their .. (shrink)

In a recent paper in this journal, John Worrall (2008) used the example of a series of trials involving extracorporeal membrane oxygenation (ECMO), a technology for the treatment of respiratory failure in newborns, to illustrate the relationship between ethics and epistemology in medical research. One of the issues considered was whether or not it was ethical to perform a particular clinical trial at all, and he showed clearly that the answer was intimately related to epistemological judgments about the weight to (...) be given existing evidence concerning treatment effectiveness. In the case of ECMO, a trial was initiated at the University of Michigan (Bartlett et al. 1985), despite the fact that the researchers had .. (shrink)

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This book is a first attempt to cover the whole area of aesthetics from the point of view of critical rationalism. It takes up and expands upon the more narrowly focused work of E. H. Gombrich, Sheldon Richmond, and Raphael Sassower and Louis Ciccotello. The authors integrate the arts into the scientific world view and acknowledge that there is an aesthetic aspect to anything whatsoever. They pay close attention to the social situatedness of the arts. Their aesthetics treats art as (...) emerging from craft in the form of luxurious and playful challenge to the audience. In developing it they place emphasis on the number of questions and claims that can be settled by appeal to empirical facts; on the historical character of aesthetic judgements; and on the connection of aesthetic truth to true love and true friendship, i.e. fidelity and integrity, not to informative truth. (shrink)

Much has been written recently about both the urgency and efficacy of teaching business ethics. The results of our survey of AACSB member schools confirm prior reports of similar surveys: The teaching of business ethics is indiscriminate, unorganized, and undisciplined in most North American schools of business. If universities are to be taken seriously in their efforts to create more ethical awareness and better moral decision-making skills among their graduates, they must provide a rigorous and well-developed system in which students (...) can "live ethics" instead of merely learn ethics. A system must be devised to allow students to discover and refine their own values rather than simply learning ethical theories from an intellectual point of view. After reviewing the literature on business ethics in undergraduate curricula, we make a series of recommendations to deliver experiential ethical education for business students. The recommendations include student and faculty written codes of ethics, emphasis on ethical theory within the existing required legal environment course, applied ethics in the functional area capstones using alternative learning, a discussion of employee rights and responsibilities during the curriculum capstone course, and a public service requirement for graduation. These recommendations may be implemented without substantive additional cost or programming requirements. (shrink)

Informed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching (...) Hospitals in a low resource setting. (shrink)

Embodied, embedded, enactive, and extended theorists do not typically focus on the ontological frameworks in which they develop their theories. One exception is 4E theories that embrace New Mechanism. In this paper, we endorse the New Mechanist’s general turn to ontology, but argue that their ontology is not the best on the market for 4E theories. Instead, we advocate for a different ontology: causal powers realism. Causal powers realism posits that psychological manifestations are the product of mental powers, and that (...) mental powers are empirically-discoverable features of individuals that account for the causal work those individuals do. We contend that causal powers realism provides a unifying framework for the central commitments of 4E theories, as well as additional resources for theorizing in a 4E framework. And while New Mechanism offers some of these resources as well, we argue that causal powers realism is ultimately the better of the two. (shrink)

Post-abortion care research is increasingly being conducted in low- and middle-income countries to help reduce the high burden of unsafe abortion. This study aims to help address the evidence gap about ethical challenges that researchers in LMICs face when carrying out PAC research with adolescents. Employing an explorative qualitative approach, the study identified several ethics challenges encountered by PAC researchers in Zambia, including those associated with seeking ethics and regulatory approvals at institutional and national levels. Persistent stigma around abortion and (...) community perceptions that PAC studies encourage adolescents to seek abortion affected adolescents’ right to exercise their autonomy and to make decisions as well as exposed adolescents to social stigmatization risks. Challenges with recruitment was reported to result in abandoning of studies, thereby undermining development of PAC services that are more responsive to adolescent needs. Training needs identified included knowledge of best practices for conducting and disseminating PAC research. Strategies for addressing the ethical challenges included trust building and using less value-laden terminology when seeking permission and consent. It is essential to the future of PAC research in Zambia and globally that these important challenges be addressed through the development of comprehensive ethics guidance. (shrink)

Cultural psychologists often describe the relationship between mind and culture as ‘dynamic.’ In light of this, we provide two desiderata that a theory about encultured minds ought to meet: the theory ought to reflect how cultural psychologists describe their own findings and it ought to be thoroughly naturalistic. We show that a realist theory of causal powers — which holds that powers are causally-efficacious and empirically-discoverable — fits the bill. After an introduction to the major concepts in cultural psychology and (...) describing causal power realism, we use a case study — the effects of pathogen prevalence on culture and cognition — to show the explanatory capacities of the powers framework. (shrink)

Double Effect Donation claims it is permissible for a person meeting brain death criteria to donate vital organs, even though such a person may be alive. The reason this act is permissible is that it does not aim at one’s own death but rather at saving the lives of others, and because saving the lives of others constitutes a proportionately serious reason for engaging in a behavior in which one foresees one’s death as the outcome. Double Effect Donation, we argue, (...) opens a novel position in debates surrounding brain death and organ donation, and does so without compromising the sacredness and fundamental equality of human life. (shrink)

"Les Dilemmes de la métaphysique pure" de Charles Renouvier. Philosophe français (1815-1903).

We discuss how academically-based interdisciplinary teams can address the extreme challenges of the world’s poorest by increasing access to the basic necessities of life. The essay’s first part illustrates the evolving commitment of research universities to develop ethical solutions for populations whose survival is at risk and whose quality of life is deeply impaired. The second part proposes a rationale for university responsibility to solve the problems of impoverished populations at a geographical remove. It also presents a framework for integrating (...) science, engineering and ethics in the efforts of multidisciplinary teams dedicated to this task. The essay’s third part illustrates the efforts of Howard University researchers to join forces with African university colleagues in fleshing out a model for sustainable and ethical global development. (shrink)

BackgroundHIV prevention research in resource-limited countries is associated with a variety of ethical dilemmas. Key amongst these is the question of what constitutes an appropriate standard of health care (SoC) for participants in HIV prevention trials. This paper describes a community-focused approach to develop a locally-appropriate SoC in the context of a phase III vaginal microbicide trial in Mwanza City, northwest Tanzania.MethodsA mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional and modern (...) bars, restaurants, hotels and guesthouses has been established in 10 city wards. Wards were divided into geographical clusters and community representatives elected at cluster and ward level. A city-level Community Advisory Committee (CAC) with representatives from each ward has been established. Workshops and community meetings at ward and city-level have explored project-related concerns using tools adapted from participatory learning and action techniques e.g. chapati diagrams, pair-wise ranking. Secondary stakeholders representing local public-sector and non-governmental health and social care providers have formed a trial Stakeholders' Advisory Group (SAG), which includes two CAC representatives.ResultsKey recommendations from participatory community workshops, CAC and SAG meetings conducted in the first year of the trial relate to the quality and range of clinic services provided at study clinics as well as broader standard of care issues. Recommendations have included streamlining clinic services to reduce waiting times, expanding services to include the children and spouses of participants and providing care for common local conditions such as malaria. Participants, community representatives and stakeholders felt there was an ethical obligation to ensure effective access to antiretroviral drugs and to provide supportive community-based care for women identified as HIV positive during the trial. This obligation includes ensuring sustainable, post-trial access to these services. Post-trial access to an effective vaginal microbicide was also felt to be a moral imperative.ConclusionParticipatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting.Trial registrationCurrent Controlled Trials ISRCTN64716212. (shrink)

In this paper, we describe causal powers realism as a conjunction of four claims: causal powers are not reducible to counterfactuals; they are empirically-discoverable; they manifest effects in conjunction with partners; and their manifestations empower further manifestations. We describe four challenges to extended mind theory and for each show how an ontology of causal powers realism either avoids or dissolves the problem. We close by suggesting that causal powers realism isn’t a competitor with extended mind theory but rather a new (...) way to understand what it means for minds to be extended. (shrink)

YVES CHARLES ZARKA ET SABINE CHOQUET. — Est-ce qu’il y a un acte de naissance du souverainisme au Québec ? Et, si tel est le cas, est-il lié à la visite du général de Gaulle au Québec et à la célèbre phrase : « Vive le Québec libre ! » qu’il a prononcée à Montréal le 24 juillet 1967 ?JOSEPH FACAL. — On..

YVES CHARLES ZARKA ET SABINE CHOQUET. — Est-ce qu’il y a un acte de naissance du souverainisme au Québec ? Et, si tel est le cas, est-il lié à la visite du général de Gaulle au Québec et à la célèbre phrase : « Vive le Québec libre ! » qu’il a prononcée à Montréal le 24 juillet 1967 ?JOSEPH FACAL. — On..

Anthropologists have documented substantial cross-society variation in people’s willingness to treat strangers with impartial, universal norms versus favoring members of their local community. Researchers have proposed several adaptive accounts for these differences. One variant of the pathogen stress hypothesis predicts that people will be more likely to favor local in-group members when they are under greater infectious disease threat. The material security hypothesis instead proposes that institutions that permit people to meet their basic needs through impartial interactions with strangers reinforce (...) a tendency toward impartiality, whereas people lacking such institutions must rely on local community members to meet their basic needs. Some studies have examined these hypotheses using self-reported preferences, but not with behavioral measures. We conducted behavioral experiments in eight diverse societies that measure individuals’ willingness to favor in-group members by ignoring an impartial rule. Consistent with the material security hypothesis, members of societies enjoying better-quality government services and food security show a stronger preference for following an impartial rule over investing in their local in-group. Our data show no support for the pathogen stress hypothesis as applied to favoring in-groups and instead suggest that favoring in-group members more closely reflects a general adaptive fit with social institutions that have arisen in each society. (shrink)

A geographically stratified cross-sectional survey was conducted in 2002 to investigate household-level factors associated with use of mosquito control measures and self-reported malaria in Malindi, Kenya. A total of 629 households were surveyed. Logistic regressions were used to analyse the data. Half of all households (51%) reported all occupants using an insecticide-treated bed net and at least one additional mosquito control measure such as insecticides or removal of standing water. Forty-nine per cent reported a history of malaria in the household. (...) Of the thirteen household factors analysed, low (OR=0·23, CI 0·11, 0·48) and medium (OR=0·50, CI 0·29, 0·86) education, mudcoral (OR=0·0·39, CI 0·24, 0·66) and mud block–plaster (OR=0·47, CI 0·25, 0·87) wall types, farming (OR=1·38, CI 1·01, 1·90) and travel to rural areas (OR=0·48, CI 0·26, 0·91) were significantly associated with the use of mosquito control, while controlling for other covariates in the model. History of reported malaria was not associated with the use of mosquito control (OR=1·22, CI 0·79, 1·88). Of the thirteen covariates analysed in the second model, only two household factors were associated with history of malaria: being located in the well-drained stratum (OR=0·49, CI 0·26, 0·96) and being bitten while in the house (OR=1·22, CI 0·19, 0·49). These results suggest that high socioeconomic status is associated with increased household-level mosquito control use, although household-level control may not be enough, as many people are exposed to biting mosquitoes while away from the house and in areas that are more likely to harbour mosquitoes. (shrink)

A vision of a living code of ethics is proposed to counter the emphasis on negative phenomena in the study of organizational ethics. The living code results from the harmonious interaction of authentic leadership, five key organizational processes (attraction–selection–attrition, socialization, reward systems, decision-making and organizational learning), and an ethical organizational culture (characterized by heightened levels of ethical awareness and a positive climate regarding ethics). The living code is the cognitive, affective, and behavioral manifestation of an ethical organizational identity. We draw (...) on business ethics literature, positive organizational scholarship, and management literature to outline the elements of positive ethical organizations as those exemplary organizations consistently practicing the highest levels of organizational ethics. In a positive ethical organization, the right thing to do is the only thing to do. (shrink)