The teaching of ethics in UK medical schools has recently been reviewed, from the perspective of the teachers themselves. A questionnaire survey of medical undergraduates at King’s College London School of Medicine provides useful insight into the students’ perception of ethics education, what they consider to be the value of learning ethics and law, and how engaged they feel with the subject.

The Mental Capacity Act received Royal Assent on 7 April 2005, and it will be implemented in 2007. The Act defines when someone lacks capacity and it supports people with limited decision-making ability to make as many decisions as possible for themselves. The Act lays down rules for substitute decision making. Someone taking decisions on behalf of the person lacking capacity must act in the best interests of the person concerned and choose the options least restrictive of his or her (...) rights and freedoms. Decision making will be allowed without any formal procedure unless specific provisions apply, such as a written advance decision, lasting powers of attorney or a decision by the court of protection. (shrink)

Knowledge of the ethical and legal basis of medicine is as essential to clinical practice as an understanding of basic medical sciences. In the UK, the General Medical Council requires that medical graduates behave according to ethical and legal principles and must know about and comply with the GMC’s ethical guidance and standards. We suggest that these standards can only be achieved when the teaching and learning of medical ethics, law and professionalism are fundamental to, and thoroughly integrated both vertically (...) and horizontally throughout, the curricula of all medical schools as a shared obligation of all teachers. The GMC also requires that each medical school provides adequate teaching time and resources to achieve the above. We reiterate that the adequate provision and coordination of teaching and learning of ethics and law requires at least one full-time senior academic in ethics and law with relevant professional and academic expertise. In this paper we set out an updated indicative core content of learning for medical ethics and law in UK medical schools and describe its origins and the consultative process by which it was achieved. (shrink)

This article explores the attitudes of consultants in a large UK teaching hospital to the need for formal clinical ethics support. Data obtained through an anonymous online questionnaire illustrate the ways in which consultants deal with clinical ethical dilemmas and their confidence in such decision-making. In the absence of formal ethics support a large proportion of consultants who took part in the survey said that they would consult with colleagues when faced with a clinical ethical dilemma and the majority considered (...) that this satisfactorily resolved the issue. However, 80% of respondents stated that they would find a form of ethics support within the Trust to be useful. Consultants also noted the reasons for, and barriers to, using ethics support. The response rate to the survey was low, perhaps indicating a lack of interest in the topic or that clinical ethics discussion is of low priority. (shrink)

Professor Brian V. Johnstone, CSsR, has been quietly and unobtrusively contributing to the intellectual life of Catholicism, especially in the field of moral theology, for nearly four decades. Having published numerous theological articles on many topics, including biomedical ethics, peace and war, and fundamental moral theology, and directed many doctoral dissertations, it is no exaggeration to say that he has dedicated his entire life to teaching and writing theology. In honor of Johnstone's work, this felicitation volume covers a wide range (...) of themes in the Christian moral life with original articles written by internationally recognized theologians. In the spirit of Johnstone's thought and work, each article challenges the reader to reflect upon the present while contemplating the future of moral theology. (shrink)

BackgroundStructured, systematic methods to formulate consensus recommendations, such as the Delphi process or nominal group technique, among others, provide the opportunity to harness the knowledge of experts to support clinical decision making in areas of uncertainty. They are widely used in biomedical research, in particular where disease characteristics or resource limitations mean that high-quality evidence generation is difficult. However, poor reporting of methods used to reach a consensus – for example, not clearly explaining the definition of consensus, or not stating (...) how consensus group panellists were selected – can potentially undermine confidence in this type of research and hinder reproducibility. Our objective is therefore to systematically develop a reporting guideline to help the biomedical research and clinical practice community describe the methods or techniques used to reach consensus in a complete, transparent, and consistent manner.MethodsThe ACCORD project will take place in five stages and follow the EQUATOR Network guidance for the development of reporting guidelines. In Stage 1, a multidisciplinary Steering Committee has been established to lead and coordinate the guideline development process. In Stage 2, a systematic literature review will identify evidence on the quality of the reporting of consensus methodology, to obtain potential items for a reporting checklist. In Stage 3, Delphi methodology will be used to reach consensus regarding the checklist items, first among the Steering Committee, and then among a broader Delphi panel comprising participants with a range of expertise, including patient representatives. In Stage 4, the reporting guideline will be finalised in a consensus meeting, along with the production of an Explanation and Elaboration document. In Stage 5, we plan to publish the reporting guideline and E&E document in open-access journals, supported by presentations at appropriate events. Dissemination of the reporting guideline, including a website linked to social media channels, is crucial for the document to be implemented in practice.DiscussionThe ACCORD reporting guideline will provide a set of minimum items that should be reported about methods used to achieve consensus, including approaches ranging from simple unstructured opinion gatherings to highly structured processes. (shrink)

Warming temperatures in the circumpolar north have led to new discussions around climate-driven frontiers for agriculture. In this paper, we situate northern food systems in Canada within the corporate food regime and settler colonialism, and contend that an expansion of the conventional, industrial agriculture paradigm into the Canadian North would have significant socio-cultural and ecological consequences. We propose agroecology as an alternative framework uniquely accordant with northern contexts. In particular, we suggest that there are elements of agroecology that are already (...) being practiced in northern Indigenous communities as part of traditional hunter-gatherer food systems. We present a framework for agroecology in the North and discuss its components of environmental stewardship, economies, knowledge, social dimensions and governance using examples from the Dehcho region, Northwest Territories, Canada. Finally, we discuss several challenges and cautions in creating policy around agroecology in the North and encourage community-based research in developing and testing this framework moving forward. (shrink)

The aim of this paper is to look at the arguments advanced by three Parisian arts masters about how to understand Prior Analytics II 4 and the more general discussion that medieval authors situate...

The Alice Books, full of illogical thoughts, words, and contradictions, were unrivaled entertainment until the publication of the medical literature promoting electronic fetal monitoring for every pregnancy. The modern-day EFM advocates acknowledge EFM’s decades long failure but simultaneously recommend EFM use for lawsuit protection and because the profession has used EFM for every pregnancy for fifty years, therefore, it must be efficacious. These self-indulgent, illogical rationalizations ignore the half century of evidence-based scientific research proving that EFM is a complete failure (...) as well as ignoring the fact that continued EFM use violates the fundamental principles of modern bioethics. This blind advocacy perpetuates four pernicious EFM harms occurring to mothers, babies, and the medical profession itself. This article sets out these four EFM harms with the goal of abolishing the misguided, illogical, contradictory, arguments used by the twenty-first century EFM Lewis Carroll mimics. (shrink)

Objective Ethical standards state research participation must be voluntary and free of coercion and undue influence, but what if a third party appears to engage in research-relevant coercion, without the researchers’ knowledge? This case study describes this type of situation and its resolution. Methods We are engaged in a randomized clinical trial evaluating pedestrian safety with 7- and 8- years old. Depending on children's rate of learning, families receive up to $1275 for their time. We recently learned a third-party “talent (...) agency,” a firm placing children in modeling and acting jobs, was referring families to our research with the expectation that families would share 20% of study reimbursements. Results We sensed clear impropriety, but identified no ethical violations on our part as researchers. Once paid a study reimbursement, participants can spend funds how they wish. We were concerned, however, that the third-party was exploitatively coercing families to participate. Conclusions We pursued four avenues to resolve the issue. First, we documented the situation to our university Institutional Review Board. Second, we contacted the talent agency and requested they stop referring families to our research. They agreed. Third, we retained children engaged in our study who were referred from the talent agency; removing them partway through the clinical trial could impact study results. In doing so, we explained that we were unaware of the talent agency referral and that they were not obligated by us to offer a portion of the study reimbursement to the talent agency. Last, we asked newly enrolled families about their referral source. (shrink)

In the last 30 years there has been growing interest in and a greater appreciation of the unique contributions that medieval authors have made to the history of logic. In this thesis, we compare and contrast the modal logics of Robert Kilwardby and John Buridan and explore how their two conceptions of modality relate to and differ from modern notions of modal logic. We develop formal reconstructions of both authors' logics, making use of a number of different formal techniques. In (...) the case of Robert Kilwardby we show that using his distinction between per se and per accidens modalities, he is able to provide a consistent interpretation of the apodictic fragment of Aristotle's modal syllogism and that, by generalising this distinction to hypothetical construction, he can develop an account of connexive logic. In the case of John Buridan we show that his modal logic is a natural extension of the usual Kripke-style possible worlds semantics, and that this modal logic can be shown to be sound and complete relative to a proof-theoretic formalisation of Buridan's treatment of the expository syllogism. (shrink)

A collection of new essays on the influential medieval philosopher John Buridan, written by leading Buridan scholars. The volume places Buridan in his philosophical context and examines his writings on topics including logic, modal logic, paradoxes, metaphysics, epistemology, theory of knowledge, moral philosophy, and natural philosophy.

Robert Kilwardby occupies an important place in the history of logic, and the history of western thought more generally. Perhaps best known to scholars for his Oxford condemnations of 1277...

Labor and Global Justice combines conceptual and theoretical perspectives across a multiplicity of relevant differences, both geographical and disciplinary, to develop a transnational perspective on labor and justice and to make clear how justice requires a rethinking of the relation between labor and global capital.

Three standard psychometric tests were administered to parents who volunteered their children for a randomised, double-blind placebo-controlled trial of a new asthma drug and to a control group of parents whose children were eligible for the trial but had declined the invitation. The trial took place at a children's hospital in Australia. The subjects comprised 68 parents who had volunteered their children and 42 who had not, a participation rate of 94 per cent and 70 per cent, respectively. The responses (...) of these parents to the Gordon Survey of Interpersonal Values Questionnaire, the Coopersmith Self-Esteem Inventory and the Cattell Sixteen Personality Factor Questionnaire were analysed by computer. There was a marked difference between the psychological profiles of the two groups of parents. Volunteering parents put more value on benevolence while non-volunteering parents were more concerned with power and prestige. The self-esteem of volunteering parents was much lower than that of non-volunteering parents. Finally, volunteering parents were more introverted, exhibited greater anxiety and low supergo, while non-volunteering parents appeared to have greater social confidence and emotional stability. Since an individual's values, self-esteem and personality may be important antecedents of behaviour, these findings suggest that parents who volunteer their children for clinical research are not only socially disadvantaged and emotionally vulnerable, but may also be psychologically predisposed to volunteering. Furthermore, these findings provide evidence for the existence of a psychosocial 'filter' effect of the informed consent procedure, which may be discouraging the better educated, more privileged and psychologically resilient members of society from participation as research subjects. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five (...) school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

A half century ago electronic fetal monitoring was rushed into clinical use with the promise that the secrets of fetal heart rate decelerations had been discovered and that the newly discovered knowledge would prevent cerebral palsy with just in time cesarean sections preventing babies from experiencing asphyxia, which was thought to be the primary cause of cerebral palsy. In the years since electronic fetal monitoring’s debut, it has been discovered that asphyxia is a rare cause of cerebral palsy. At the (...) same time electronic fetal monitoring use increased to 85% of all labors, the C-section rate increased to 33% without an attributable decrease in the rate of cerebral palsy. What went wrong with electronic fetal monitoring? The answer lies in a new analysis of the physiologic theories concerning fetal heart rate decelerations, demonstrating that the earlier electronic fetal monitoring theories were wrong. This revelation is only the latest evidence that electronic fetal monitoring use today... (shrink)

We argue performance in the serial reaction time task is associated with gradations of awareness that provide examples of fringe consciousness [Mangan, B. . Taking phenomenology seriously: the “fringe” and its implications for cognitive research. Consciousness and Cognition, 2, 89–108, Mangan, B. . The conscious “fringe”: Bringing William James up to date. In B. J. Baars, W. P. Banks & J. B. Newman , Essential sources in the scientific study of consciousness . Cambridge, MA: The MIT Press.], and address limitations (...) of the traditional SRT procedure, including criticism of exclusion generation tasks. Two experiments are conducted with a modified SRT procedure where irrelevant stimulus attributes obscure the sequence rule. Our modified paradigm, which includes a novel exclusion task, makes it easier to demonstrate a previously controversial influence of response stimulus interval on awareness. It also allows identification of participants showing fringe consciousness rather than explicit sequence knowledge, as reflected by dissociations between different awareness measures. The NEO-PI-R variable Openness to Feelings influenced the diversity of subjective feelings reported during two awareness measures, but not the degree of learning and awareness as previously found with traditional SRT tasks [Norman, E., Price, M. C., & Duff, S. C. . Fringe consciousness in sequence learning: the influence of individual differences. Consciousness and Cognition, 15, 723–760.]. This suggests possible distinctions between two components of fringe consciousness. (shrink)