‘Medically unexplained symptoms’, through the lens of the biopsychosocial model, are understood in mainstream psy disciplines and related literature as a primarily psychosocial phenomenon perpetuated by ‘dysfunctional’ psychology on the part of people labelled with such. Biopsychosocial discourse and practice in this field, underpinned by little empirical foundation and lacking theoretical coherency, are associated with harms sustained by people labelled with MUS. Yet, little attention is paid to the psychology of social actors and institutions whose practice and policy derives from (...) biopsychosocial theorising, or whose vested interests produce such theorising. This article contends that lack of reflexivity among psy practitioners and other social actors on individual, institutional and structural levels furthers biopsychosocial hegemony and contributes to harms. Non-reflexive behaviour on the part of practitioners within clinical and ‘therapeutic’ encounters and on the part of social actors within institutions and broader power structures is examined, and possible psychological underpinnings of non-reflexivity are explored. Notably, the concept of gain, drawn from dominant discourse around MUS, is applied broadly to explore what might be gained from eschewing reflexivity and from adhering to biopsychosocial narratives. Implications for practice, supervision, training and research are discussed, notably highlighting a need for critical reflexivity in all domains. (shrink)

Cultural differences can be a source of ambiguity in coordination games. As players are likely to experience more ambiguity when playing a different culture, we expect players to choose safer strategies. We run experiments with a stag hunt and bargaining coordination game. Using a between-subjects design, we vary the identity of the opponent between someone of the same culture or a different culture. We compare the responses of British and East Asian students at the University of Exeter and show (...) the cultural identity of the opponent by physical appearance. While we find no significant differences between treatments for East Asians, the British choose the safer option in the stag hunt and demand more of the pie in the bargaining game when faced with an opponent from a different culture. (shrink)

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)

Generative artificial intelligence systems based on transformers, including both text-generators like GPT-4 and image generators like DALL-E 3, have recently entered the popular consciousness. These tools, while impressive, are liable to reproduce, exacerbate, and reinforce extant human social biases, such as gender and racial biases. In this paper, we systematically review the extent to which DALL-E Mini suffers from this problem. In line with the Model Card published alongside DALL-E Mini by its creators, we find that the images it produces (...) tend to represent dozens of different occupations as populated either solely by men (e.g., pilot, builder, plumber) or solely by women (e.g., hairdresser, receptionist, dietitian). In addition, the images DALL-E Mini produces tend to represent most occupations as populated primarily or solely by White people (e.g., farmer, painter, prison officer, software engineer) and very few by non-White people (e.g., pastor, rapper). These findings suggest that exciting new AI technologies should be critically scrutinized and perhaps regulated before they are unleashed on society. (shrink)

Randomized controlled trial trial designs exist on an explanatory-pragmatic spectrum, depending on the degree to which a study aims to address a question of efficacy or effectiveness. As conceptualized by Schwartz and Lellouch in 1967, an explanatory approach to trial design emphasizes hypothesis testing about the mechanisms of action of treatments under ideal conditions, whereas a pragmatic approach emphasizes testing effectiveness of two or more available treatments in real-world conditions. Interest in, and the number of, pragmatic trials has grown substantially (...) in recent years, with increased recognition by funders and stakeholders worldwide of the need for credible evidence to inform clinical decision-making. This increase has been accompanied by the onset of learning healthcare systems, as well as an increasing focus on patient-oriented research. However, pragmatic trials have ethical challenges that have not yet been identified or adequately characterized. The present study aims to explore the views of key stakeholders with respect to ethical issues raised by the design and conduct of pragmatic trials. It is embedded within a large, four-year project that seeks to develop guidance for the ethical design and conduct of pragmatic trials. As a first step, this study will address important gaps in the current empirical literature with respect to identifying a comprehensive range of ethical issues arising from the design and conduct of pragmatic trials. By opening up a broad range of topics for consideration within our parallel ethical analysis, we will extend the current debate, which has largely emphasized issues of consent, to the range of ethical considerations that may flow from specific design choices. Semi-structured interviews with key stakeholders, across multiple jurisdictions, identified based on their known experience and/or expertise with pragmatic trials. We expect that the study outputs will be of interest to a wide range of knowledge users including trialists, ethicists, research ethics committees, journal editors, regulators, healthcare policymakers, research funders and patient groups. All publications will adhere to the Tri-Agency Open Access Policy on Publications. (shrink)

The first work to introduce Foucault's ideas on law to both graduates and undergraduates.

The paper argues that ‘All varieties of gratitude are only overall fitting when targeted towards agents,’ for instance that any variety of gratitude for the beautiful sunset is only overall fitting if a supernatural agent such as God exists. The first premise is that ‘Prepositional gratitude is overall fitting only when targeted towards agents.’ For this premise, intuitive judgments are offered. The second premise is that ‘Prepositional gratitude is the paradigmatic variety of gratitude.’ For this premise, an aspect of the (...) common consent of philosophers about gratitude is noted and the metaphysical basicness of prepositional gratitude is argued for. This gives the intermediate conclusion that ‘The paradigmatic variety of gratitude is overall fitting only when targeted towards agents.’ The fourth premise is that ‘If the paradigmatic variety of gratitude is overall fitting only when targeted towards agents, then all varieties of gratitude are overall fitting only when targeted towards agents.’ To supply the conditional of this premise, the Paradigmatic Fittingness Principle is offered, which states that ‘Paradigmatic emotions set the fittingness conditions for their non-paradigmatic varieties.’ This principle is argued for by noting that it vindicates some popular and plausible intuitive judgements and gives an error theory of why one might think that gratitude could be fittingly targeted towards non-agents, and by suggesting the absence of any other plausible source of fittingness conditions for non-paradigmatic emotions. (shrink)

Although previous ethical analyses of management buyouts have presented useful insights, they have been flawed in three major ways. First, they define the transaction too narrowly, emphasizing the going private aspect and ignoring the leveraged aspect. Leveraging alters the nature of the transaction substantially and warrants additional ethical analysis. Second, these previous analyses ignore the impact of buyouts on non-stockholder constituents of the firm, an omission which renders their implicit utilitarian approach incomplete. Third, these analyses do not include Rawlsian, libertarian, (...) or Kantian perspectives on ethics. This paper addresses these shortcomings and finds the ethical status of leveraged management buyouts to be highly suspect. (shrink)

Whether due to simplicity or hypocrisy, the question of access to patient data for biomedical research is widely seen in the public discourse only from the angle of patient privacy. At the same time, the desire to live and to live without disability is of much higher value to the patients. This goal can only be achieved by extracting research insight from patient data in addition to working on model organisms, something that is well understood by many patients. Yet, most (...) biomedical researchers working outside of clinics and hospitals are denied access to patient records when, at the same time, clinicians who guard the patient data are not optimally prepared for the data’s analysis. Medical data collection is a time- and cost-intensive process that is most of all tedious, with few elements of intellectual and emotional satisfaction on its own. In this process, clinicians and bioinformaticians, each group with their own interests, have to join forces with the goal to generate medical data sets both from clinical trials and from routinely collected electronic health records that are, as much as possible, free from errors and obvious inconsistencies. The data cleansing effort as we have learned during curation of Singaporean clinical trial data is not a trivial task. The introduction of omics and sophisticated imaging modalities into clinical practice that are only partially interpreted in terms of diagnosis and therapy with today’s level of knowledge warrant the creation of clinical databases with full patient history. This opens up opportunities for re-analyses and cross-trial studies at future time points with more sophisticated analyses of the same data, the collection of which is very expensive. (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)

Health professionals are involved in humanitarian assistance and development work in many regions of the world. They participate in primary health care, immunization campaigns, clinic- and hospital-based care, rehabilitation and feeding programs. In the course of this work, clinicians are frequently exposed to complex ethical issues. This paper examines how health workers experience ethics in the course of humanitarian assistance and development work. A qualitative study was conducted to consider this question. Five core themes emerged from the data, including: tension (...) between respecting local customs and imposing values; obstacles to providing adequate care; differing understandings of health and illness; questions of identity for health workers; and issues of trust and distrust. Recommendations are made for organizational strategies that could help aid agencies support and equip their staff as they respond to ethical issues. (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)

Although access to medicines is a vital feature of the right to the highest attainable standard of health (“right to health”), almost two billion people lack access to essential medicines, leading to immense avoidable suffering. While the human rights responsibility to provide access to medicines lies mainly with States, pharmaceutical companies also have human rights responsibilities in relation to access to medicines. This article provides an introduction to these responsibilities. It briefly outlines the new UN Guiding Principles on Business and (...) Human Rights and places the human rights responsibilities of pharmaceutical companies in this context. The authors draw from the work of the first UN Special Rapporteur on the right to the highest attainable standard of health, in particular the Human Rights Guidelines for Pharmaceutical Companies in Relation to Access to Medicines that he presented to the UN General Assembly in 2008, and his UN report on GlaxoSmithKline (GSK). While the Guiding Principles on Business and Human Rights are general human rights standards applicable to all business entities, the Human Rights Guidelines for Pharmaceutical Companies consider the specific human rights responsibilities of one sector (pharmaceutical companies) in relation to one area of activity (access to medicines). The article signals the human rights responsibilities of all pharmaceutical companies, with particular attention to patent-holding pharmaceutical companies. Adopting a right-to-health “lens,” the article discusses GSK and accountability. The authors argue that human rights should shape pharmaceutical companies' policies, and provide standards in relation to which pharmaceutical companies could, and should, be held accountable. They conclude that it is now crucial to devise independent, accessible, transparent, and effective mechanisms to monitor pharmaceutical companies and hold them publicly accountable for their human rights responsibilities. (shrink)

Brian Ellis has argued that the assigning of forces is, in the final analysis, a matter of convention. This conclusion is backed by the premises (1) that forces and force-effects are necessary and sufficient for each other, and (2) that the classification of some state of affairs as a force-effect is at least partly conventional. We argue that the first premise is false, that the second premise is ambiguous as between several senses of "conventional," and finally that he has not (...) established that force-effects are conventional in the sense required for the conclusion he wishes to draw. (shrink)

Healthcare user fees present an important barrier for accessing services for the poorest (indigents) in Burkina Faso and selective removal of fees has been incorporated in national healthcare planning. However, establishing fair, effective and sustainable mechanisms for the removal of user fees presents important challenges. A participatory action-research project was conducted in Ouargaye, Burkina Faso, to test mechanisms for identifying those who are indigents, and funding and implementing user fee removal. In this paper, we explore stakeholder perceptions of ethical considerations (...) relating to participation and partnership arising in the action-research. (shrink)

Reducing prejudice is a critical research agenda, and never before has counterfactual priming been evaluated as a potential prejudice-reduction strategy. In the present experiment, participants were randomly assigned to imagine a pleasant interaction with a homosexual man and then think counterfactually about how an incident of sexual discrimination against him might not have occurred (experimental condition) or to imagine a nature scene (control condition). Results demonstrated a significant reduction in sexual prejudice from baseline levels in the counterfactual simulation group. Importantly, (...) whereas intergroup anxiety and motivation to control prejudice were not predictive factors, number of counterfactual thoughts generated independently predicted variance in prejudice reduction. Mechanisms for, and implications of, prejudice-reduction strategies including counterfactual thinking are discussed. (shrink)

The concept of evolvability—the capacity of a population to produce and maintain evolutionarily relevant variation—has become increasingly prominent in evolutionary biology. Paleontology has a long history of investigating questions of evolvability, but paleontological thinking has tended to neglect recent discussions, because many tools used in the current evolvability literature are challenging to apply to the fossil record. The fundamental difficulty is how to disentangle whether the causes of evolutionary patterns arise from variational properties of traits or lineages rather than being (...) due to selection and ecological success. Despite these obstacles, the fossil record offers unique and growing sources of data that capture evolutionary patterns of sustained duration and significance otherwise inaccessible to evolutionary biologists. Additionally, there exist a variety of strategic possibilities for combining prominent neontological approaches to evolvability with those from paleontology. We illustrate three of these possibilities with quantitative genetics, evolutionary developmental biology, and phylogenetic models of macroevolution. In conclusion, we provide a methodological schema that focuses on the conceptualization, measurement, and testing of hypotheses to motivate and provide guidance for future empirical and theoretical studies of evolvability in the fossil record. (shrink)

Period homeostasis is the defining characteristic of a biological clock. Strict period homeostasis is found for the ultradian clocks of eukaryotic microbes. In addition to being temperature-compensated, the period of these rhythms is unaffected by differences in nutrient composition or changes in other environmental variables. The best-studied examples of ultradian clocks are those of the ciliates Paramecium tetraurelia and Tetrahymena sp. and of the fission yeast, Schizosaccharomyces pombe. In these single cell eukaryotes, up to seven different parameters display ultradian rhythmicity (...) with the same, species- and strain-specific period. In fission yeast, the molecular genetic analysis of ultradian clock mechanisms has begun with the systematic analysis of mutants in identified candidate genes. More than 40 “clock mutants” have already been identified, most of them affected in components of major regulatory and signalling pathways. These results indicate a high degree of complexity for a eukaryotic clock mechanism. BioEssays 22:16–22, 2000. ©2000 John Wiley & Sons, Inc. (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)

Health care professionals who travel from their home countries to participate in humanitarian assistance or development work experience distinctive ethical challenges in providing care and services to populations affected by war, disaster or deprivation. Limited information is available about organizational practices related to preparation and support for health professionals working with non-governmental organizations. In this article, we present one component of the results of a qualitative study conducted with 20 Canadian health care professionals who participated in international aid work. The (...) findings reported here relate to expatriate clinicians’ experiences and perceptions of ethics preparation, training and support. The strategies examined include pre-departure training and preparation, in-field supports and retrospective debriefing of ethical issues. Participants experienced a range of training and supports as beneficial for addressing ethical challenges in humanitarian assistance and development work. Participants also expressed ambivalence or scepticism about the benefits offered by specific modalities. This analysis can contribute to informing discussions of how organizations and individual practitioners can best develop, implement and utilize ethics training and support for international aid work. (shrink)

Background Despite news reports of morally distressing situations resulting from complex and demanding community-care delivery in Canada, there has been little research on the topic of ethical conflicts experienced by community-based health care professionals. Research aim To identify ethical conflicts experienced by community nurses. Research design Data were collected using semi-structured interviews and then relevant text was extracted and condensed using qualitative content analysis. This research was part of a larger grounded theory project examining how community nurses manage ethical conflict. (...) Research context and participants Community nurses, including 13 public health nurses and 11 home care nurses from two Canadian provinces, were interviewed. Ethical considerations Study approval was granted by the Health Research Ethics Authority of Newfoundland and Labrador and by provincial health authorities. Findings Seven ethical conflicts were identified and assigned to one of two groups. In the grouping categorized as challenges with obligations or risks, the ethical conflicts were: (1) screening for child developmental issues knowing there is a lack of timely early intervention services; (2) encountering inequities in the health care system; (3) not fulfilling principles, goals, and initiatives of primary and secondary prevention; and (4) feeling powerless to advocate for clients. The remaining ethical conflicts were categorized as challenges with process, risks, and consequences, and were: (5) jeopardizing therapeutic relationships while reporting signs of a child at risk; (6) managing confidentiality when neighbors are clients; and (7) supporting client autonomy and decision-making but uncertain of the consequences. Conclusions Research investigation will continue to be important to raise awareness and mobilize ethics supports as health care services are steadily shifted from institutional to community settings. Moreover, with heightened potential for communicable disease outbreaks across international borders from global warming, community nurses around the world will continue to be required to address ethically-difficult care situations with competence and compassion. (shrink)

—Grayson Hunt1In 2015, I visited Lake Cumberland in Kentucky for a day of boating and swimming with friends. At one end of the lake was an amazing waterfall. As I was swimming near it, I looked up and saw a man thirty feet above in the bushes on top of the falls. He waved. I waved back. Only he wasn’t boating; he was just standing there. So I stared at him, wondering what he was doing up there. Then I realized (...) he was masturbating. Stunned, I turned away to swim back to the boat, and I could feel shame sneaking into my chest and face. I began to feel responsible for what was happening to me, which was the very message I internalized after being sexually assaulted as a teen. This time, however, I decided that I... (shrink)

Utilizing a series of essays examining the broad philosophical concepts embedded in Rod Serling's series, The Twilight Zone, Philosophy in The Twilight Zone provides a platform for further philosophical discussion. Features essays by eminent contemporary philosophers concerning the over-arching themes in The Twilight Zone, as well as in-depth discussions of particular episodes Fuses popular cult entertainment with classical philosophical perspectives Acts as a guide to unearthing larger questions - from human nature to the nature of reality and beyond - posed (...) in the series Includes substantial critical and biographical information on series creator Rob Serling. (shrink)

Utilizing a series of essays examining the broad philosophical concepts embedded in Rod Serling's series, _The Twilight Zone_, __Philosophy in The Twilight Zone__ provides a platform for further philosophical discussion. Features essays by eminent contemporary philosophers concerning the over-arching themes in _The Twilight Zone,_ as well as in-depth discussions of particular episodes Fuses popular cult entertainment with classical philosophical perspectives Acts as a guide to unearthing larger questions - from human nature to the nature of reality and beyond - posed (...) in the series Includes substantial critical and biographical information on series creator Rob Serling. (shrink)

Gerald Cohen's critique of John Rawls's theory of justice is that it is concerned only with the justice of social institutions, and must thus arbitrarily draw a line between those inequalities excluded and those allowed by the basic structure. Cohen claims that a proper concern with the interests of the least advantaged would rule out 'incentives' for 'talented' individuals. I argue that Rawls's assumption that the subject of justice is the basic structure of society does not arbitrarily restrict the concerns (...) of political justice, as Cohen claims. Further, I argue that it does not allow 'deep' inequalities within a just basic structure. When properly understood, Rawls's theory of justice is strongly egalitarian, taken as a theory of fairness in the way the burdens and benefits of social cooperation are distributed, even if it is not as egalitarian as Cohen wishes. (shrink)

Social, legal and health-care changes have created an increasing need for ethical review within end-of-life care. Multiprofessional clinical ethics committees (CECs) are increasingly supporting decision-making in hospitals and hospices. This paper reports findings from an analysis of formal summaries from CEC meetings, of one UK hospice, spanning four years. Using qualitative content analysis, five themes were identified: timeliness of decision-making, holistic care, contextual openness, values diversity and consensual understanding. The elements of an engaged clinical ethics in a hospice context is (...) not generally acknowledged nor its elements articulated. Findings from this study have the potential to explain some of the most challenging ethical problems and to contribute to their resolution. It may also guide future deliberation and raise CEC members' awareness of the recurrent issues and values of their CEC practice. (shrink)

Canadian health professionals are involved in humanitarian assistance and development work in many regions of the world. They participate in primary health care, immunization campaigns, feeding programs, rehabilitation and hospital-based care. In the course of their work clinicians are frequently exposed to complex ethical issues. This thesis examines how health workers experience ethics in the course of humanitarian assistance and development work. A qualitative study was conducted to consider this question. Five core themes emerged from the data including experiencing a (...) tension between respecting local customs and imposing values, knowing how to respond when basic care is impossible, addressing differing understandings of health and illness, questions of identity for health workers, and issues of trust and distrust. Recommendations are made for standards and organizational strategies that could help aid agencies better support and equip their staff as they respond to ethical issues. (shrink)