The unknown nature of tomorrow’s research makes informed consent in biobank research a challenge. Whether the consent given by biobank participants is ‘broad’ or ‘narrow’, the ever present question remains the same: are new activities covered by the original consent? In this article, we focus on the meaning of, and the relation between, broad consent and re-consent in biobank research. We argue that broad consent should be understood as consenting to a framework—a framework which covers aims, core conditions for acceptable (...) use, governance and how these affect participants. Changes that alter the framework in a fundamental way call for re-consent. Three biobank cases of current international interest are used to debate when re-consent is an ethical necessity: whole-genome sequencing, data sharing and commercial utilization. These reflections give us a more nuanced view on what consent is for. We claim that the introduction of broad consents in biobank research has not represented a betrayal of individual participant interests, as some critics have asserted. Broad consents combined with the possible use of re-consent are in certain settings not inferior, but rather ethically superior to narrow consents. In population-based research biobanks, they allow for a reconciliation between individual interest and public matters in society at large. (shrink)

Trust relations in the health services have changed from asymmetrical paternalism to symmetrical autonomy-based participation, according to a common account. The promises of personalized medicine emphasizing empowerment of the individual through active participation in managing her health, disease and well-being, is characteristic of symmetrical trust. In the influential Kantian account of autonomy, active participation in management of own health is not only an opportunity, but an obligation. Personalized medicine is made possible by the digitalization of medicine with an ensuing increased (...) tailoring of diagnostics, treatment and prevention to the individual. The ideal is to increase wellness by minimizing the layer of interpretation and translation between relevant health information and the patient or user. Arguably, this opens for a new level of autonomy through increased participation in treatment and prevention, and by that, increased empowerment of the individual. However, the empirical realities reveal a more complicated landscape disturbed by information ‘noise’ and involving a number of complementary areas of expertise and technologies, hiding the source and logic of data interpretation. This has lead to calls for a return to a mild form of paternalism, allowing expertise coaching of patients and even withholding information, with patients escaping responsibility through blind or lazy trust. This is morally unacceptable, according to Kant’s ideal of enlightenment, as we have a duty to take responsibility by trusting others reflexively, even as patients. Realizing the promises of personalized medicine requires a system of institutional controls of information and diagnostics, accessible for non-specialists, supported by medical expertise that can function as the accountable gate-keeper taking moral responsibility required for an active, reflexive trust. (shrink)

This paper explores one aspect of the political in the early Hegel, that of criminal action and its relationship to the concept of recognition in the System of Ethical Life. While it is clear that in this work Hegel thinks that criminal action plays an important role in the transformation of simple ethical communities, it is not clear that, for Hegel, the formal character of crime in the struggle for recognition is anything but negative. I attempt to show how this (...) role for crime leads Hegel to a legalistic conception of Right that has no solid connection with recognition as a social force. (shrink)

The Socio-Cultural pluralism and its fabrics in our society have been under the threat of religious fundamentalism and ideological extremism, which firmly believe that there can only one way of true expression and all other forms, are either substandard or false. This attitude has torn away the world into different isolated islands of human settlements. This state of affair is the outcome of multidimensional causes and one among them, no doubt, is related to one of the central issues of Philosophy, (...) i.e., the relation between ‘one and many’. The ontological dimension of the problem of ‘one and many’ cannot be solved withouthaving the proper understanding of epistemological solutions. The epistemic tools of the Advaita Vedanta are powerful enough to suggest pragmatic solutions to the good old problem of ‘one and many’ that attains new relevance in the era of Globalization. The logic of identity in difference and the logic of difference are the two types of logical systems, which are instrumental for the formulation of various types of claims to know of the western tradition. The logic of identity in difference has been clearly designed and defined by the classical logic or the Aristotelian logic. The symbolic logic encarves the various nuances of the logic of difference. The Advaita System has envisaged a new logic i.e., the logic of identity, which is implicit in the Upanisdic mahavakyya ‘Ayam Āthmam Brahma’. The paper intents to explore the possibility of application of the logic of identity in socio-cultural issues of the present day world. (shrink)

Increasingly, national governments across the globe are prioritizing investments in neuroscience. Currently, seven active or in-development national-level brain research initiatives exist, spanning four continents. Engaging with the underlying values and ethical concerns that drive brain research across cultural and continental divides is critical to future research. Culture influences what kinds of science are supported and where science can be conducted through ethical frameworks and evaluations of risk. Neuroscientists and philosophers alike have found themselves together encountering perennial questions; these questions are (...) engaged by the field of neuroethics, related to the nature of understanding the self and identity, the existence and meaning of free will, defining the role of reason in human behavior, and more. With this Perspective article, we aim to prioritize and advance to the foreground a list of neuroethics questions for neuroscientists operating in the context of these international brain initiatives. (shrink)

In this paper I argue that Direct realism is less prone to internal incoherence as a theory of knowledge than alternative theories. The theory of Direct realism best grounds our capacity for cognition of the external world, whereas other epistemological theories claim to ground our capacity for cognition, but end in skepticism in the final analysis. I propose to show this contrast by bringing in different theories of a well-known Indirect realist, Bertrand Russell. Illustrating this point mainly through Russell makes (...) the approach purely historical in nature even when the paper includes a brief discussion of two theories in the current debate that support Direct realism. (shrink)

Nonadherence to treatment continues to be one of psychiatry's greatest challenges. To improve adherence and thus improve the care of patients, clinicians and patients' family members sometimes resort to hiding medication in food or drink, a practice referred to as covert/ surreptitious medication. The practice of covert drug administration in food and beverages is well known in the treatment of psychiatrically ill world-wide but no prevalence rates exist. Covert medication may seem like a minor matter, but it touches on legal (...) and ethical issues of a patient's competence, autonomy, and insight. Medicating patients without their knowledge is not justifiable solely as a shortcut for institutions or families wishing to calm a troublesome patient and thus alleviate some of the burdens of care giving. The paramount principle is ensuring the well-being of a patient who lacks the competence to give informed consent. Ethically, covert/surreptitious administration can be seen as a breach of trust by the doctor or by family members who administer the drugs. Covert medication contravenes contemporary ethical practice. Legally, treatment without consent is permissible only where common law or statute provides such authority. The practice of covert administration of medication is not specifically covered in the mental health legislation in developing countries. Many of the current dilemmas in this area have come to public attention because of two important developments in medical ethics and the law - the increasing importance accorded to respect for autonomy and loss of the parens patriae jurisdiction of the courts [parens patriae means 'parent of the country'; it permitted a court to consent or refuse treatment on behalf of an 'incapacity', or alternatively to appoint a guardian with such powers]. (shrink)