BackgroundJunior medical doctors have a key role in discussions and decisions about treatment and end-of-life care for people with dementia in hospital. Little is known about junior doctors’ decision-making processes when treating people with dementia who have advance care directives, or the factors that influence their decisions. To describe among junior doctors in relation to two hypothetical vignettes involving patients with dementia: their legal compliance and decision-making process related to treatment decisions; the factors influencing their clinical decision-making; and the factors (...) associated with accurate responses to one hypothetical vignette. MethodA cross-sectional survey of junior doctors, including trainees, interns, registrars and residents, on clinical rotation in five public hospitals located in one Australian state. The anonymous, investigator-developed survey was conducted between August 2018 and June 2019. Two hypothetical vignettes describing patients with dementia presenting to hospital with an ACD and either: bacterial pneumonia; or suspected stroke were presented in the survey. Participants were asked to indicate whether they would commence treatment, given the ACD instructions described in each vignette.ResultsOverall, 116 junior doctors responded. In Vignette 1, 58% of respondents selected the legally compliant option. Participants who chose the legally compliant option perceived ‘following patient wishes’ and ‘legal requirements to follow ACDs’ as equally important reasons for complying with the ACD. The most common reason for not selecting the legally compliant option in Vignette 1 was the ‘ACD is relevant in my decision-making process, but other factors are more relevant’. In Vignette 2, 72% of respondents indicated they would commence treatment and 18% selected they would not commence treatment.. Similar reasons influenced participant decision-making in Vignette 2, a less legally certain scenario.ConclusionsThere are critical gaps in junior doctors’ compliance with the law as it relates to the implementation of ACDs. Despite there being differences in relation to the legal answer and its certainty, clinical and ethical factors guided decision-making over and above the law in both vignettes. More education and training to guide junior doctors’ clinical decision-making and ensure compliance with the law is required. (shrink)

Background In 2001 a report on the provision of clinical ethics support in UK healthcare institutions identified 20 clinical ethics committees. Since then there has been no systematic evaluation or documentation of their work at a national level. Recent national surveys of clinical ethics services in other countries have identified wide variation in practice and scope of activities. Objective To describe the current provision of ethics support in the UK and its development since 2001. Method A postal/electronic questionnaire survey administered (...) to the chairs of all 82 clinical ethics services registered with the UK Clinical Ethics Network in July 2010. Results Response rate was 62% with the majority of responding services situated in acute trusts. All services included a clinical ethics committee with one service also having a clinical ethicist. Lay members were present in 72% of responding committees. Individual case consultation has increased since 2001 with 29% of chairs spending more than 50% of their time on this. Access to and involvement in the process of case consultation is less for patients and families than for clinical staff. There is wide variation in committee processes and levels of institutional support. Over half of the responding committees undertook some form of evaluation. Conclusion Clinical ethics services in the UK are increasing as is their involvement in case consultation. However, the significant variation in committee processes suggests that further qualitative research is needed to understand how these committees function and the role they play in their institution. (shrink)

_From Illiteracy to Literature_ presents innovative material based on research with ‘non-reading’ children and re-examines the complex relationship between psychoanalysis and literature, through the lens of the psychical significance of reading: the forgotten adventure of our coming to reading. Anne-Marie Picard draws on two specific fields of interest: firstly the wish to understand the nature of literariness or the "literary effect", i.e. the pleasures we derive from reading; secondly research on reading pathologies carried out at St Anne’s Hospital, Paris. The (...) author uses clinical observations of non-reading children to answer literary questions about the reading experience, using psychoanalytic theory as a conceptual framework. The notion that reading difficulties or phobias should be seen as a symptom in the psychoanalytic sense, allows Picard to shed light on both clinical vignettes taken from children’s case histories and reading scenes from literary texts. Children experiencing difficulties in learning to read highlight the imaginary stakes of the confrontation with the arbitrary nature of the letter and the "price to pay" for one’s entrance into the Symbolic. Picard applies the lesson "taught" by these children to a series of key literary texts featuring, at their very core, this confrontation with the signifier, with the written code itself.. This book argues that there is something in literature that drives us back, again and again, to the loss we have suffered as human beings, to what we had to undergo to become human: our subjection to the common place of language. Picard shows complex Lacanian concepts "at work" in the field of reading pathologies, emphasizing close reading and a clinical attention to the "letter" of the texts, far from the "psychobiographical" attempts at psychologizing literary authors. _From Illiteracy to Literature_ presents a novel psychodynamic approach that will be of great interest to psychotherapists and language pathologists, appealing to literary scholars and those interested in the process of reading and "literariness.". (shrink)

Fair competition law and public health law talk past each other when discussing pharmaceutical pricing and distribution. The former cannot agree on the relevant definition of consumer welfare. The latter does not fully comprehend the highly complex but inherently collective nature of pharmaceutical drug acquisition in the United States. This essay proposes to inject public health discourse into this debate to enrich it, focus it, and render it more accessible to those who must live by its outcome.

We thank the authors of the five commentaries for their careful and highly constructive consideration of our paper,1 which has enabled us to develop our proposal. Participation in research has traditionally been viewed as altruistic. Over time, payments for inconvenience and lost wages have been allowed, as have small incentives, usually in kind. The problem, particularly with controlled human infection model research or ‘challenge studies’, is that they are unpleasant and time-consuming. Researchers want to offer carrots to incentivise participation. We (...) are proposing that research participation be viewed as a job with the full suite of financial entitlements of fairly remunerated work, including payment for risk and labour law protections. This would be a significant shift from current practice and standards. Ambuehl, Ockenfels and Roth have grasped this basic point and have beautifully elaborated how a fair price could be arrived at using economic theory. They build on our proposal helpfully and suggest ‘ salary for time involvement that is adjusted to account for the amount of discomfort experienced during participation, insurance against ex post adverse outcomes and ex ante compensation for risks that cannot be compensated ex post.’3 This effectively addresses Fernandez Lynch and Largent’s2 concern that compensation for risk is inappropriate for harms which do not eventuate. However, because death cannot be compensated for, there must be payment for risk of death, as Ambuehl, Ockenfels and Roth convincingly argue.3 Indeed, the three-part model suggested by Ambuehl, Ockenfels and Roth makes us realise that job model would be a better title for our model than a payment for risk model. The alternative to a properly remunerated job model is the original altruistic model. However, this …. (shrink)

Mary Anne Warren investigates a theoretical question that is at the centre of practical and professional ethics: what are the criteria for having moral status? That is: what does it take to be an entity towards which people have moral considerations? Warren argues that no single property will do as a sole criterion, and puts forward seven basic principles which establish moral status. She then applies these principles to three controversial moral issues: voluntary euthanasia, abortion, and the status of (...) non-human animals. (shrink)

Does birth make a difference to the moral rights of the fetus/infant? Should it make a difference to its legal rights? Most contemporary philosophers believe that birth cannot make a difference to moral rights. If this is true, then it becomes difficult to justify either a moral or a legal distinction between late abortion and infanticide. I argue that the view that birth is irrelevant to moral rights rests upon two highly questionable assumptions about the theoretical foundations of moral rights. (...) If we reject these assumptions, then we are free to take account of the contrasting biological and social relationships that make even relatively late abortion morally different from infanticide. (shrink)

"Readers interested in feminist studies, applied ethics, or social and political philosophy should find Gendercide especially interesting and informative. Highly recommended."-CHOICE.

By a potential person I shall mean an entity which is not now a person but which is capable of developing into a person, given certain biologically and/or technologically possible conditions. This is admittedly a narrower sense than some would attach to the term ‘potential'. After all, people of the twenty-fifth century, if such there will be, are in some sense potential people now, even though the specific biological entities from which they will develop, i.e. the particular gametes or concepti, (...) do not yet exist. For there do exist, in the reproductive capacities of people now living and in the earth's resources, conditions adequate to produce these future people eventually, provided of course that various possible catastrophes are avoided. Indeed, in some sense of ‘potential’ there have been countless billions of potential people from the beginning of time. But I am concerned not with such remote potentialities but with currently existing entities that are capable of developing into people. (shrink)

This chapter contains sections titled: What is Moral Status? The Moral Agency Theory The Genetic Humanity Theory The Sentience Theory The Organic Life Theory Two Relationship‐based Theories Combining these Criteria Principles of Moral Status Human Zygotes, Embryos, and Fetuses Are All Animals Equal? Machines and Artificial Life‐forms Conclusion.

In the Philippines, all transplant centers are mandated by the Department of Health (DOH) to have a Hospital Transplant Ethics Committee (HTEC) to ensure that donations are altruistic, voluntary and free of coercion/commercial transactions. This study was undertaken primarily to describe the organizational and functional profile of existing HTECs and identify areas for improvement. This is a descriptive cross‐sectional study. There was variation in their logistical arrangements (support from hospital, filing systems, office spaces), operations (length and frequency of meetings, number (...) of referrals) and membership (composition, qualifications, occupation, training). The approval rate for donor‐recipient pairs is high with the majority of cases made by living non‐related donors. Appropriate reasons were cited for rejection. The perception of HTECs is that they are competent and confident in their decision‐making. However, there is a need to standardize HTEC composition, provide operating procedures and additional training which can be done by the DOH. (shrink)

A History of Women Philosophers, Volume I: Ancient Women Philoophers, 600 B.C. - 500 A.D., edited by Mary Ellen Waithe, is an important but somewhat frustrating book. It is filled with tantalizing glimpses into the lives and thoughts of some of our earliest philosophical foremothers. Yet it lacks a clear unifying theme, and the abrupt transitions from one philosopher and period to the next are sometimes disconcerting. The overall effect is not unlike that of viewing an expansive landscape, illuminated (...) only by a few tiny spotlights. (shrink)

This chapter contains sections titled: The Arguments for the Freedom to Choose Fetal Life and Humanity The Argument from Fetal Potential Abortion and Fetal Development Making Abortion Difficult to Obtain Ideological Bases of the Abortion Debate Conclusion References.

In an age where digital images are omnipresent, the use of participant photography in qualitative research has become accessible and commonplace. Yet, scant attention is paid to the social justice impact of photovoice amongst studies that have used this innovative method as a way to promote social justice. There is a need to review this method to understand its contributions and possibilities. This literature review of photovoice research studies (i) explores whether authors implicitly or explicitly related the methodologies to their (...) aims of promoting social justice (methodology–method fit) and (ii) outlines the social justice research impact of photovoice findings using the framework of social justice awareness, amelioration and transformation. PubMed, Scopus, PsycINFO and Web of Science databases were searched from the years 2008–13 using the following keywords: photovoice; photonovella; photovoice and social justice; and photovoice and participatory action research. Of the 30 research studies reviewed, only thirteen identified an underlying methodology guiding the photovoice method. The social justice impacts emphasized were more related to social justice awareness (n = 30) than amelioration (n = 11) or transformation (n = 3). Future researchers using photovoice as a way to promote social justice are encouraged to assess and plan for the social justice impact desired. (shrink)

The Forum and the Tower tackles a fascinating and perennial topic: the relationship between the academy and the world of politics. The accomplished Harvard law professor Mary Ann Glendon traces this crucial relationship from Classical Greece taking readers through the Roman Empire, Renaissance Italy, the English revolution, the Federalist era in the US, the French Revolution, the Napoleonic wars, the Concert of Europe, the progressive era, and the New Deal/World War II era.

When deciding what disorders to screen newborns for, we should be guided by evidence of real effectiveness, take opportunity cost into account, distribute costs and benefits fairly, and respect human rights. Current newborn screening policy does not meet these requirements.