Child assent is recommended in addition to parental consent when enrolling children in clinical research; however, appreciation and relevance ascribed to these concepts vary in different contexts, and information on attitudes towards storage of biological samples for future research is limited, especially in developing countries. We assessed caregivers’ understanding and appreciation of consent and assent procedures, and their attitudes towards use of stored blood samples for future research prior to enrolling a child in clinical research. A total of 17 in-depth (...) interviews were conducted with primary caregivers of children at enrolment or on the immediate follow-up date. All caregivers recalled significant amount information from the study information sheet and were able to appropriately link such information to the consent process. While all participants confirmed information received prior to blood sampling as adequate, a few noted that the purpose was not sufficiently well communicated. Caregivers felt children were cognitively vulnerable, and prone to decisions that were not necessarily in their best interest. Nearly all caregivers felt it was their right and responsibility to overrule objections from their ward’s regarding enrolment into specific study or receipt of a therapeutic procedure. There were no objections or concerns regarding use of stored biological samples for future research purposes. There is thus, a need to improve understanding of caregivers on the information provided during the informed consent process. Context-specific studies on the age of assent in specific populations are needed. (shrink)

"Practice in Christianity is the second volume in what could be called the "collected Works" of "Anti-Climacus," Kierkegaard's new pseudonym. Anti-Climacus's first volume, The Sickness Unto Death, appeared just a year earlier in 1849. The use of a pseudonym is consistent with Kierkegaard's usual practice when presenting an idealized statement of his subject, be it sexual seduction or Christian theology. Anti-Climacus argues the conceptual content of Christianity against the "leading thought of the times" and also against the ethical and social (...) import of the comforts and consolations of bourgeois culture and religion which he called "Christendom." In his own mind at least, Kierkegaards presents Christianity as it must be thought and lived if it is to be authentic. The Sickness unto Death and Practice in Christianity can be and are read quite independently, but jointly they provide the basis of Kierkegaard's devastating critique of a secularized, culturally homogenized, and tame Christianity. The authors of the studies in this present volume, Merold Westphal, Paul R. Sponheim, Murray A. Rae, Niels Jorgen Cappelorn, Sylvia Walsh, David D. Possen, Andrew J. Burgess, Christian Fink Tolstrup, Robert L. Perkins, and Wanda Warren Berry, raise a wide spectrum of issues regarding Practice in Christianity, its theology, its moral and religious psychology, and its cultural, social, and political world" --. (shrink)

Proposed educational outcomes for the health humanities in medical education range from empathy to visual thinking skills to social accountability. This lack of widely agreed-upon high-level curricular goals limits humanities educators’ ability to design purposeful curricula toward clear, common ends and threatens justifications for scarce curricular time. We propose a novel approach to the hoped-for outcomes of health humanities training in medical schools, which has the potential to encompass traditional health humanities knowledge, skills, and behaviors while also being concrete and (...) measurable: humanistic practice. Humanistic practice, adapted from the concept of ethical sensitivity, is an intentional process of applying humanities knowledge and skills to a clinical scenario by 1) noticing that the scenario requires humanities knowledge or skills, 2) informing one’s clinical and interpersonal strategy and behavior with humanities knowledge or skills, 3) reflecting on the effectiveness of the strategy and behavior, and 4) reorienting to develop new approaches for future practice. The construct of humanistic practice may help address some of the foundational problems in health humanities outcomes research since it transcends the traditional diverse content domains in the health humanities, can link patient and provider experiences, and may bridge the divide among the additive, curative, and intrinsic epistemic positions of humanities to medical education. (shrink)

يقدم المؤلف لنا قانونا اجتماعيًا لعلماء النفس والاجتماع السياسي صاغه كالآتي: (إذا زاد عدد الأفراد الذين يمارسون تصرّفًا يعدّ خزيًا، وتساهل القانون في محاسبة مرتكبيه، وعجز الناس عن إيقافه أو وجدوا له تبريرًا، تحوّل إلى ظاهرة ولم يعد خزيًا كما كان). و من هذه العبارة التقديمية يمكن أن نؤكد أن هذا الكتاب لا يمكن إيفاءه حقه بنبذة موجزة، فهو سفر فكري ممتع، حيث يتناول المؤلف فيه بشكل تحليلي وعلمي مقنع أهم الموضوعات التي تشغل العقل العربي، ما بين شخصيات سياسية كصدام (...) وسليماني، وما بين فكرة الموت والانتحار، والبغاء والجريمة، والالحاد والإيمان، واللاوعي الجمعي العربي وما يحمله من أمراض وانحرافات، والتحرش والكبت، والفساد والسلطة، واللغة العربية والحضارة. (shrink)

Chercher à établir un commun, ou ce qui est commun à l’humanité, est une question qui bien souvent trouve comme seule résolution une définition claire de l’être humain, doté de caractéristiques et de facultés déterminées. Cette démarche nourrissant déjà amplement le débat philosophique, nous nous concentrerons plutôt sur une reconsidération du problème de la détermination de ce que pourrait être la communauté humaine. Notre travail de recherche a pour objet la nécessité et l’obligation chez K...

BackgroundStreet-connected children and youth in low- and middle-income countries have multiple vulnerabilities in relation to participation in research. These require additional considerations that are responsive to their needs and the social, cultural, and economic context, while upholding core ethical principles of respect for persons, beneficence, and justice. The objective of this paper is to describe processes and outcomes of adapting ethical guidelines for SCCY’s specific vulnerabilities in LMIC.MethodsAs part of three interrelated research projects in western Kenya, we created procedures to (...) address SCCY’s vulnerabilities related to research participation within the local context. These consisted of identifying ethical considerations and solutions in relation to community engagement, equitable recruitment, informed consent, vulnerability to coercion, and responsibility to report.ResultsSubstantial community engagement provided input on SCCY’s participation in research, recruitment, and consent processes. We designed an assent process to support SCCY to make an informed decision regarding their participation in the research that respected their autonomy and their right to dissent, while safeguarding them in situations where their capacity to make an informed decision was diminished. To address issues related to coercion and access to care, we worked to reduce the unequal power dynamic through street outreach, and provided access to care regardless of research participation.ConclusionsAlthough a vulnerable population, the specific vulnerabilities of SCCY can to some extent be managed using innovative procedures. Engaging SCCY in ethical research is a matter of justice and will assist in reducing inequities and advancing their health and human dignity. (shrink)

Background Inadequate knowledge among health care providers (HCPs) and parents of affected children limits the understanding and utility of secondary genetic findings (SFs) in under-represented populations in genomics research. SFs arise from deep DNA sequencing done for research or diagnostic purposes and may burden patients and their families despite their potential health importance. This study aims to evaluate the perspective of both groups regarding SFs and their choices in the return of results from genetic testing in the context of orofacial (...) clefts.Methods Using an online survey, we evaluated the experiences of 252 HCPs and 197 parents across participating cleft clinics in Ghana and Nigeria toward the return of SFs across several domains.Results Only 1.6% of the HCPs felt they had an expert understanding of when and how to incorporate genomic medicine into practice, while 50.0% agreed that all SFs should be returned to patients. About 95.4% of parents were willing to receive all the information from genetic testing (including SFs), while the majority cited physicians as their primary information source (64%).Conclusions Overall, parents and providers were aware that genetic testing could help in the clinical management of diseases. However, they cited a lack of knowledge about genomic medicine, uncertain clinical utility, and lack of available learning resources as barriers. The knowledge gained from this study will assist with developing guidelines and policies to guide providers on the return of SFs in sub-Saharan Africa and across the continent. (shrink)

ABSTRACT:Psychedelics have again become a subject of widespread interest, owing to the reinvigoration of research into their traditional uses, possible medical applications, and social implications. As evidence for psychedelics' clinical potential mounts, the field has increasingly focused on searching for mechanisms to explain the effects of psychedelics and therapeutic efficacy of psychedelic-assisted therapy (PAT). This paper reviews three general frameworks that encompass several prominent models for understanding psychedelics' effects—specifically, neurobiological, psychological, and spiritual frameworks. Following our review, the implications of each (...) framework for ethics and professional competencies in the implementation of psychedelics as medicines are explored. We suggest that interdisciplinary education may be necessary to improve communication between researchers, develop models that effectively incorporate multiple levels of analysis, and facilitate collaboration between professionals with diverse backgrounds in the implementation of psychedelic medicines. We also address pitfalls associated with overemphasis on neuro-mechanisms, risks associated with instigating vulnerable states of consciousness, and hurdles associated with the integration of spiritual frameworks in medicine. Ultimately, as psychedelics push the boundaries of explanatory frameworks focused on one level of analysis, developing new and more useful models to reflect knowledge being produced in this field should be a central aim of psychedelic science going forward. (shrink)

The Johns Hopkins-Fogarty African Bioethics Training Program (FABTP) has offered a fully-funded, one-year, non-degree training opportunity in research ethics to health professionals, ethics committee members, scholars, journalists and scientists from countries across sub-Saharan Africa. In the first 9 years of operation, 28 trainees from 13 African countries have trained with FABTP. Any capacity building investment requires periodic critical evaluation of the impact that training dollars produce. In this paper we describe and evaluate FABTP and the efforts of its trainees.Our data (...) show that since 2001, the 28 former FABTP trainees have authored or co-authored 105 new bioethics-related publications; were awarded 33 bioethics-related grants; played key roles on 78 bioethics-related research studies; and participated in 198 bioethics workshops or conferences. Over the past nine years, trainees have collectively taught 48 separate courses related to bioethics and have given 170 presentations on various topics in the field. Many former trainees have pursued and completed doctoral degrees in bioethics; some have become editorial board members for bioethics journals. Female trainees were, on average, less experienced at matriculation and produced fewer post-training outputs than their male counterparts. More comprehensive studies are needed to determine the relationships between age, sex, previous experience and training program outputs. (shrink)

Features of threatening cues and the associated context influence the perceived imminence of threat and the defensive responses evoked. To provide additional knowledge about how the directionality of a threat (i.e. directed-towards or away from the viewer) might impact defensive responses in humans, participants were shown pictures of a man carrying a gun (threat) or nonlethal object (neutral) directed-away from or towards the participant. Cardiac and electrodermal responses were collected. Compared to neutral images, threatening images depicting a gun directed-towards the (...) participant induced sustained bradycardia and an increased electrodermal response, interpreted as immobility under attack. This defensive immobility reaction is evoked by high perceived threat and inescapable situations and indicates intense action preparation. Pictures of guns directed-away from the participant induced shorter bradycardia and no significant modulation of the electrodermal response compared to neutral pictures, which might be consistent with the perception of a less threatening situation. The results show that the directionality of threat stimuli is a key factor that prompts different patterns of defensive responses. (shrink)

This publication features the stories and experiences of pharmacy professionals who identify as members of historically underrepresented groups. This collection of personal essays presents significant events in the lives of those in the pharmacy community whose experiences have been shaped by their race, ethnicity, gender or gender presentation, sexual orientation, ability, language, mental health, or other factors. The perspectives from the narratives highlight the importance of diversity, equity, and inclusion in the healthcare sector. The authors of the narratives also reflect (...) on their experience to consider what they wish would have happened in the experience, to offer advice for others that may be faced with similar situations. Access to these stories will deepen the collective understanding among pharmacy colleagues, patients, and society of the experiences that individuals from historically underrepresented groups within pharmacy have experienced. (shrink)

The influence of East on West - of Eastern ideas on Western thought - has become an increasingly vexed issue in recent times. Opinion is divided between two main schools: those who believe that Oriental ideas have exercised a considerable influence on Western thought, and those who, for a variety of reasons, believe that such influence has remained negligible.In this Reader A. L. Macfie suggests that the reality lies somewhere between these two extremes, and that the interest taken by Western (...) thinkers in Eastern thought in the modern period has moved from one of passing interest, through serious attention, to some level of assimilation and acceptance.Eastern Influences on Western Philosophy explores the extent of Oriental influence on European thought, primarily in the period of the Enlightenment and the nineteenth-century period of doubt and scepticism that followed it. As such it is the first Reader to bring together in one place a series of specific historical and textual studies of Oriental influence upon European thinkers. Starting with Malebranche and ending with Heidegger, other Western thinkers considered include Leibniz, Voltaire, Hume, Hegel, Schopenhauer, Emerson, Thoreau, Nietzsche, Jung and Buber.To accompany the readings the editor's introduction explores the idea of influence in the context of the chosen readings, and at the same time raises the question of how far Edwards Said's thesis regarding Orientalism actually applies to Western thought.Key Features:* Reflects increasing interest in relationship between Eastern and Western Philosophy* Covers major European figures from the 18th and 19th centuries and the way Eastern thought influenced them* Substantial editorial introduction places readings in context and explores the influence of the East on the West* Previous work by editor praised for its accessibility. (shrink)

The great number of contradictory statements which confront us when we examine the various explanations of Anaxagoras' philosophy make it more than usually important to decide what is to be admitted as first-hand evidence and what is not. I purpose, then, to begin by accepting the barest minimum of data, and I shall try to exclude any direct comments upon Anaxagoras' work by later writers. Sufficient justification for such a course may be found in the bewildering masses of confusion which (...) have gathered around his teaching. (shrink)