The ramifications of including genetic components in the clinical studies conducted in non-academic settings create unique ethical challenges. We used a qualitative research design consisting of semi-structured interviews that took place between October 2010 and September 2012. The sample consisted of 80 participants − 38 physicians and 42 coordinators − who worked across a number of different settings, including clinics, private practices, small hospitals, free standing research centers, and blended hospital-institutes in both rural and urban communities in 13 states across (...) the United States. The respondents primarily conducted industry sponsored trials and recruited their own patients as research participants. A majority of the respondents (65%) reported that most of the studies they conducted included an additional genetics component, and so participants were asked to donate specimens for genomics or biobanking. While genomics association studies were perceived as being of benefit, awareness of ethical implications associated with such studies was limited. The rapid advances in genetic technologies make it hard for clinicians and coordinators to help patients make informed decisions about participating in clinical research, and underscore the need to ensure that the regulations governing research on human subjects keep pace with the social and technological changes. It seems essential to discern legitimate ethical concerns and find ways to convey what is going on, what is possible and what might not be possible in terms of protecting privacy, anonymity, and confidentiality. (shrink)

Hospital ethics committees have evolved as a response to complicated legal, ethical, and social dilemmas that accompany modern medicine. In the United States, their growth has been augmented by Joint Commission for the Accreditation of Healthcare Organizations standards and the Patient Self-Determination Act. There appears to be an implicit presumption that all clinical ethics consultation practices are relatively similar. Finally, there is heightened awareness of the needs for quality standards and assessment of the outcomes of ethics consultations.

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

Clinical research is increasingly conducted in settings that include private physicians’ offices, clinics, community hospitals, local institutes, and independent research centers. The migration of such research into this new, non–academic environment has brought new cadres of researchers into the clinical research enterprise and also broadened the pool of potential research participants. Regulatory approaches for protecting human subjects who participate in research have also evolved. Some institutions retain their own Institutional Review Boards (IRBs), but Independent IRBs, community hospital IRBs and community–based (...) IRBs also fulfill oversight responsibilities. This article sheds light on this evolving world by discussing the findings gleaned from two studies: a study of the decision making processes used by members who serve on different kinds of IRBs and a study of the decision making processes employed by research participants. The article then discusses how the key findings may inform proposed revisions to the Common Rule. (shrink)

A few weeks ago, a rural hospital administrator phoned with a question posed by his management team. “If you were going to give us some ethics resources,” he queried, “just exactly what would they...

Over the past 20 years, clinical research has migrated from academic medical centers to community-based settings, including rural settings. This evolving research environment may present some moral hazards or challenges that could undermine traditionally accepted standards for the protection of human subjects. The study described in this article was designed to explore the influence of motives driving the decisions to conduct clinical trial research in rural community settings. The researchers conducted semi-structured interviews with 80 participants who conducted clinical trials with (...) rural subjects. The interviews provided a way to examine the influence of budgetary factors when deciding to conduct a clinical study, how information about the budget and the purpose of the study is conveyed to research participants, and the potential willingness of clinicians and coordinators to enroll in the kinds of studies they offer. The findings suggest that clinical trial research in rural communities may challenge clinicians’ abilities to balance the needs of the patient with the needs of the research enterprise. Few respondents seemed to recognize the traditionally recognized hazards of a dual relationship, specifically the moral risks of trying to attend to the interests of both patient and industry. It seems important to re-examine how we protect human subjects and what such protection should look like as research becomes part of the way medical care is provided, even in very rural areas. (shrink)

Relatively few articles discuss the ethical issues that accompany healthcare in rural areas. This article presents and discusses the key findings obtained from multi-method research studies conducted over a 9-year period of time in a multi-state rural area. It challenges the efficacy of current models for bioethics, shows what kinds of ethical issues develop in rural communities, and offers a framework for envisioning resources and approaches that may be more appropriate.

To better understand the available publications addressing ethical issues in rural health care we sought to identify the ethics literature that specifically focuses on rural America. We wanted to determine the extent to which the rural ethics literature was distributed between general commentaries, descriptive summaries of research, and original research publications. We identified 55 publications that specifically and substantively addressed rural health care ethics, published between 1966 and 2004. Only 7 (13%) of these publications were original research articles while (12) (...) 22% were descriptive summaries of research and 36 (65%) were general commentaries. The majority of publications examined (55%) were clinically focused while 27% addressed organizational ethics and 18% addressed ethical ramifications of rural health care policy at a national or community level. Our findings indicate that there are a limited number of publications focusing on rural health care ethics, suggesting a need for scholars and researchers to more rigorously address rural ethics issues. (shrink)

The political unaccountability of ordinary citizens in classical Athens was originally raised as a challenge by ancient critics of democracy. In tension with that criticism, the authors argue that attention to the above challenge is consistent with a defence of Athenian democratic politics. In fact, ordinary citizens' function in the Assembly and courts implicitly included the burden of justifying their own political decisions to an imagined authority, as if they could be brought to account. Byeans of practices that encouraged this (...) self-scrutiny, Athenians marked the challenge of citizens' political unaccountability as an unavoidable but manageable aspect of their democracy. (shrink)

Este artigo narra os encontros de jovens periféricos na Praça do Final da Linha, localizada no bairro de Sapiranga, em Fortaleza. Exploramos a praça como um espaço multifacetado e multifuncional, que desempenha diversos papéis essenciais na comunidade, servindo como escritório, palco e local de louvor. Entre 2019 e 2020, diferentes coletivos juvenis e jovens moradores das comunidades do bairro passaram a ocupar a praça, realizando feiras, exibições de filmes, cursos de empreendedorismo e o festival Sapiranga Sound System, entre outras atividades. (...) Essas iniciativas projetaram artistas locais e foram vinculadas ao debate sobre questões de classe, etnia, gênero e sexualidade. A arte emergiu como a alternativa encontrada por esses jovens para enfrentar desafios como a violência, a ausência de políticas públicas e a vulnerabilidade econômica. (shrink)

The right to refuse medical intervention is well established, but it remains unclear how best to respect and exercise this right in life support. Contemporary ethical guidelines for critical care give ambiguous advice, largely because they focus on the moral equivalence of withdrawing and withholding care without confronting the very real differences regarding who is aware and informed of intervention options and how patient values are communicated and enacted. In withholding care, doctors typically withhold information about interventions judged too futile (...) to offer. They thus retain greater decision-making burden and face weaker obligations to secure consent from patients or proxies. In withdrawing care, there is a clearer imperative for the doctor to include patients in decisions, share information and secure consent, even when continued life support is deemed futile. How decisions to withhold and withdraw life support differ ethically in their implications for positive versus negative interpretations of patient autonomy, imperatives for consent, definitions of futility and the subjective evaluation of benefits and burdens of life support in critical care settings are explored. Professional reflection is required to respond to trends favouring a more positive interpretation of patient autonomy in the context of life support decisions in critical care. Both the bioethics and critical care communities should investigate the possibilities and limits of growing pressure for doctors to disclose their reasoning or seek patient consent when decisions to withhold life support are made. (shrink)

The time and opportunity have finally arrived for the next phase of Septuagint research. Even though not all the books of the LXX have been completed by the Septuaginta-Unternehmen in Göttingen, by far the largest number of books have been assigned and are being prepared. Thus, text-critical work has largely been completed, or is in the process of being prepared. The next phase, hermeneutical research, is at hand. This phase naturally requires correct methodology. This applies to an acceptable textual theory (...) as well as to the reconstruction of the textual history of the LXX. This article takes the Septuagint of Proverbs as its point of comparison and discusses the following issues: novel research (monographs) and new research projects in conjunction with existing projects (exegetical commentaries, a theology of the Septuagint). (shrink)

Macphail’s comparative approach to intelligence focused on associative processes, an orientation inconsistent with more multifaceted lay and scientific understandings of the term. His ultimate emphasis on associative processes indicated few differences in intelligence among vertebrates. We explore options more attuned to common definitions by considering intelligence in terms of richness of representations of the world, the interconnectivity of those representations, the ability to flexibly change those connections, knowledge, and individual differences. We focus on marine mammals, represented by the amphibious pinnipeds (...) and the aquatic cetaceans and sirenians, as animals that transitioned from a terrestrial existence to an aquatic one, experiencing major changes in ecological pressures. They adapted with morphological transformations related to streamlining the body, physiological changes in respiration and thermoregulation, and sensory/perceptual changes, including echolocation capabilities and diminished olfaction in many cetaceans, both in-air and underwater visual focus, and enhanced senses of touch in pinnipeds and sirenians. Having a terrestrial foundation on which aquatic capacities were overlaid likely affected their cognitive abilities. Vocal and behavioral observational learning capabilities in the wild and in laboratory experiments suggest versatility in group coordination. Empirical reports on aspects of intelligent behavior like problem-solving, spatial learning, and concept learning by various species of cetaceans and pinnipeds, suggest rich cognitive abilities. The high energy demands of the brain suggest brain-intelligence relationships might be fruitful areas for the study when specific hypotheses are considered, e.g., brain mapping indicates hypertrophy of specific sensory areas in marine mammals. Modern neuroimaging techniques provide ways to study neural connectivity, and the patterns of connections between sensory, motor, and other cortical regions provide a biological framework for exploring how animals represent and flexibly use information in navigating and learning about their environment. At this stage of marine mammal research, it would still be prudent to follow Macphail’s caution that it is premature to make strong comparative statements without more empirical evidence, but an approach that includes learning more about how animals flexibly link information across multiple representations could be a productive way of comparing species by allowing them to use their specific strengths within comparative tasks. (shrink)

Background Moral distress is a serious problem for health care personnel. Surveys, individual interviews, and focus groups may not capture all of the effects of, and responses to, moral distress. Therefore, we used a new participatory action research approach—moral conflict assessment (MCA)—to characterize moral distress and to facilitate the development of interventions for this problem. Aim To characterize moral distress by analyzing responses of intensive care unit (ICU) personnel who participated in the MCA process. Research Design In this qualitative study, (...) we invited all ICU personnel at 3 urban hospitals to participate in individual or group sessions using the 8-step MCA tool. These sessions were facilitated by either a clinical ethicist or a counseling psychologist who was trained in this process. During each session, one of the researchers took notes and prepared a report for each MCA which were analyzed using qualitative content analysis. Participants and Research Context A total of 24 participants took part in 15 sessions, individually or in groups; 14 were nurses and nurse leaders, 2 were physicians, and 8 were other health professionals. Ethical Considerations This study was approved by the Providence Health Care/University of British Columbia Behavioural Research Ethics Board. Each participant provided written informed consent. Results The main causes of moral distress related to goals of care, communication, teamwork, respect for patient’s preferences, and the managerial system. Suggested solutions included communication strategies and educational activities for health care providers, patients, family members, and others about teamwork, advance directives, and end-of-life care. Participants acknowledged that using the MCA process helped them to reflect on their own thoughts and use their moral agency to turn a distressing situation into a learning and improvement opportunity. Conclusions Using the MCA tool helped participants to characterize their moral distress in a systematic way, and to arrive at new potential solutions. (shrink)

The posthumanist project proposes directing the evolution of human beings by promoting their improvement through technological means to create a variety of entities that will have few or no common...

Este artigo busca ampliar a reflexão a respeito da escolha profissional de jovens, assentado na premissa de que novos sentidos e compreensões heurísticas se descortinam com a consideração do conceito de identificação, conforme sua formulação em Freud e em Lacan. Considerando a adolescência, período ..

In What is Philosophy?, Deleuze and Guattari think the concept of concept otherwise. In keeping with Deleuze’s professed empiricism, he and Guattari study various concepts and ‘extract’ a new concept of the concept. This constructive method does not illuminate how and why their proposed concept differs from the traditional. This paper considers how Deleuze and Guattari’s concept does differ, as a first step towards arriving at some evaluation of their analysis.Dans Qu’est-ce que la philosophie?, Deleuze et Guattari pensent le concept (...) autrement. Tout en s’en tenant à I’empirismé avoué de Deleuze, ce dernier et Guattari analysent différents concepts et en ‘extraient’ un nouveau concept de concept. Cette méthode constructive n’éclaire cependant pas comment et pourquoi le concept qu’ils proposent diffère du concept traditionnel. Après avoir considéré la façon dont le concept de Deleuze et Guattari diffère en effet de I’acception traditionnelle, cet article pourra se pencher sur la question de I’évaluation de leur analyse. (shrink)

I offer a reading of the Diapeira episode based on the semantics and thematics of akhos. My findings resolve a crux at 2.171, where Homer identifies akhos as the reason Odysseus is not launching his ship. Homer clearly signposts the nature of Odysseus' akhos as grief over loss of time in Athene's subsequent speech to him, but the reference is proleptic and has consequently eluded the commentators.

Spinoza shared with his contemporaries the conviction that the passions are, on the whole, unruly and destructive. A life of virtue requires that the passions be controlled, if not entirely vanquished, and the preferred means of imposing this control over the passions is via the power of reason. But there was little agreement in the seventeenth century about just what gives reason its strength and how its power can be brought to bear upon the wayward passions.