As a neonatal neurologist, I serve families facing tragic decisions in which they must balance trade-offs between death and life with profound disability. I often find myself in complex discussions about future outcome, in which families sort through in real-time what information they value most in making such a choice. Will he laugh? Will he be in pain? Will he know how much he’s loved? In this month’s feature article, Brick et al share the results of an online survey aimed (...) at assessing public views on when a life is not worth living, in an effort to inform ongoing legal and clinical debates about withdrawal of life-sustaining treatment for children. These findings raise important questions about how we define and measure outcomes that matter to parents as they make these tragic decisions. It is challenging to interpret these findings in the absence of context of how decision-making for infants occurs in real-time. The nature of this study and its objective required that cases be substantially simplified. As the authors acknowledge, the prognoses and function of the children involved in these cases were often deeply contested. Prognostic uncertainty is common for children with significant …. (shrink)

Volume 19, Issue 5, May 2019, Page 62-63.

The possible integration of genomic sequencing (including whole‐genome and whole‐exome sequencing) into the three contexts addressed in this special report—state‐mandated screening programs, clinical care, and direct‐to‐consumer services—raises related but distinct legal issues. This essay will outline the legal issues surrounding the integration of genomic sequencing into state newborn screening programs, parental rights to refuse and access sequencing for their newborns in clinical and direct‐to‐consumer care, and privacy‐related legal issues attending the use of sequencing in newborns.

Initial vaccine allocations for the coronavirus disease 2019 (COVID-19) will be limited. It is crucial to assess the ethical values associated with different methods of allocation, as well as important scientific and practical questions. This Viewpoint identifies three ethical values, benefiting people and limiting harm; prioritizing disadvantaged populations; and equal concern for all. It then explains why these values support prioritizing three groups: health care workers; other essential workers and people in high-transmission settings; and people with medical vulnerabilities associated with (...) poorer COVID-19 outcomes. In contrast, two other groups, people over 65 without medical vulnerabilities and participants in clinical research, present more complex ethical questions. This prioritization also encompasses valuing direct benefits to vaccinated individuals, indirect benefits to individuals protected from spread of infection, and indirect health and socioeconomic benefits to those protected from harm as health system and societal functioning improve. Vaccine allocation that recognizes important ethical values and avoids arbitrariness, waste, and corruption can ensure that the distribution of a COVID-19 vaccine is both fair and perceived as fair. (shrink)

The U.S. FDA has issued emergency use authorizations for monoclonal antibodies for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA’s Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants (...) with increased infectivity and/or severity emerge, further rationing may be required. We identify relevant ethical principles and priority groups for access to therapies based on an integrated approach to population health and medical factors. Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors. (shrink)

Is the relationship of self-moving (kinaesthesis) to itself a direct pre-reflective self-awareness, or is it mediated through an Other? This article attempts to address this question, taking the phenomenon of dance as a point of departure, since in dance, movement steps out of its everyday background function to become the principal theme. Rudolf zur Lippe extracts from a dance step of the dances of the Quattrocento, the posa, a concept of sensual reflection. Rather than a conceptual reflection, the posa can (...) be understood as an awareness of one’s own movement. In this article, in a dialogue between critical philosophy, dance science, and phenomenology, terms of a possible sensual reflection in dance will be discussed. (shrink)

In recent years, many studies have highlighted the changing nature of scholarly research, reflecting the new digital tools and techniques that have been developed. But researcher uptake of these tools is strongly influenced by existing information behaviour, itself affected by a number of factors, particularly discipline. This article outlines findings from a recent study which used six case studies to look at the information behaviours of researchers working in different disciplinary fields or academic departments, or using specific tools. The study (...) suggested that researchers’ uses of, and attitudes towards, digital technologies are affected by existing disciplinary habits and preconceptions. Furthermore, it found that the computational and collaborative complexity of the tools that researchers used was linked to their disciplinary backgrounds. (shrink)

For much of 2021, allocating the scarce supply of Covid‐19 vaccines was the world's most pressing bioethical challenge, and similar challenges may recur for novel therapies and future vaccines. In the United States, the Centers for Disease Control and Prevention's Advisory Committee on Immunization Practices (ACIP) identified three fundamental ethical principles to guide the process: maximize benefits, promote justice, and mitigate health inequities. We argue that critical components of the recommended protocol were internally inconsistent with these principles. Specifically, the ACIP (...) violated its principles by recommending overly broad health care worker priority in phase 1a, using being at least seventy‐five years of age as the only criterion to identify individuals at high risk of death from Covid‐19 during phase 1b, failing to recommend place‐based vaccine distribution, and implicitly endorsing first‐come, first‐served allocation. More rigorous empirical work and the development of a complete ethical framework that recognizes trade‐offs between principles may have prevented these mistakes and saved lives. (shrink)

We propose 4 equity-advancing operational improvements to eligibility and sign-up processes at mass vaccination sites: (1) preregistration using existing information, (2) eligibility rules that recognize the greater burden of COVID-19 in underserved neighborhoods, (3) appointment assignment that prioritizes those with disadvantage, and (4) socioculturally informed outreach to lottery selectees.

SummaryThis paper studies the context and textual structure of the Portuguese translation of Forbonnais's Elémens du commerce. This analysis is instrumental to understanding the place of this translation in the Portuguese discourse on trade, colonies and political economy in the age of Pombal. The translation of Forbonnais was one of the few to be published in Portugal in the eighteenth century. So, why the Elémens? This paper answers this question by profiling the translator, a key figure in the nomenklatura created (...) by Pombal to promote his commercial and colonial policies. This translation aimed at providing a theoretical background for Pombal's actions to defend Portuguese specialised agriculture against the exploitation of British traders, to substitute imported manufactures with local production, and to put colonial trade under national control. The paper also studies the contemporary debate on translation and its method in order to understand the reasons that led the translator to adopt a ‘paraphrastic style’, a choice that equated translation with a nationalistic politico-economic act, consisting in importing alien contents as ‘raw materials’ and ‘reselling’ them rephrased in what was considered the most ancient and perfect neo-Latin language. In this way, this paper also contributes to the history of translation in the Lusophone area. (shrink)

Pragmatic randomized controlled trials are designed to evaluate the effectiveness of interventions in real-world clinical conditions. However, these studies raise ethical issues for researchers and regulators. Our objective is to identify a list of key ethical issues in pragmatic RCTs and highlight gaps in the ethics literature. We conducted a scoping review of articles addressing ethical aspects of pragmatic RCTs. After applying the search strategy and eligibility criteria, 36 articles were included and reviewed using content analysis. Our review identified four (...) major themes: 1) the research-practice distinction; 2) the need for consent; 3) elements that must be disclosed in the consent process; and 4) appropriate oversight by research ethics committees. 1) Most authors reject the need for a research-practice distinction in pragmatic RCTs. They argue that the distinction rests on the presumptions that research participation offers patients less benefit and greater risk than clinical practice, but neither is true in the case of pragmatic RCTs. 2) Most authors further conclude that pragmatic RCTs may proceed without informed consent or with simplified consent procedures when risks are low and consent is infeasible. 3) Authors who endorse the need for consent assert that information need only be disclosed when research participation poses incremental risks compared to clinical practice. Authors disagree as to whether randomization must be disclosed. 4) Finally, all authors view regulatory oversight as burdensome and a practical impediment to the conduct of pragmatic RCTs, and argue that oversight procedures ought to be streamlined when risks to participants are low. The current ethical discussion is framed by the assumption that the function of research oversight is to protect participants from risk. As pragmatic RCTs commonly involve usual care interventions, the risks may be minimal. This leads many to reject the research-practice distinction and question the need for informed consent. But the function of oversight should be understood broadly as protecting the liberty and welfare interest of participants and promoting public trust in research. This understanding, we suggest, will focus discussion on questions about appropriate ethical review for pragmatic RCTs. (shrink)

It is widely assumed that informing prospective subjects about the risks and possible benefits of research not only protects their rights as autonomous decisionmakers, but also empowers them to protect their own interests. Yet interviews with patient‐subjects conducted under the auspices of the Advisory Committee on Human Radiation Experiments suggest this is not always the case. Patient‐subjects often trust their physician to guide them through decisions on research participation. Clinicians, investigators, and IRBs must assure that such trust is not misplaced.

Quality and service improvement (QSI) research employs a broad range of methods to enhance the efficiency of healthcare delivery. QSI research differs from traditional healthcare research and poses unique ethical questions. Since QSI research aims to generate knowledge to enhance quality improvement efforts, should it be considered research for regulatory purposes? Is review by a research ethics committee required? Should healthcare providers be considered research participants? If participation in QSI research entails no more than minimal risk, is consent required? The (...) lack of consensus on answers to these questions highlights the need for ethical guidance. Three distinct approaches to classifying QSI research in accordance with existing ethical principles and regulations can be found in the literature. In the first approach, QSI research is viewed as distinct from other types of healthcare research and does not require regulation. In the second approach, QSI research falls within regulatory guidelines but is exempt from research ethics committee review. In the third approach, QSI research is deemed to be part of the learning healthcare system and, as such, is subject to a different set of ethical principles entirely. In this paper, we critically assess each of these views. While none of these approaches is entirely satisfactory, we argue that use of the ethical principles governing research provides the best means of addressing the numerous questions posed by QSI research. (shrink)

The last decade has seen a slow but steady increase in the number of postdoctoral scholars employed in faculties of education. In this article, seven postdoctoral scholars who worked in the same Ca...

O estatuto do simples e a questão do real: o horizonte nominalista de David Hume.

Este artigo se insere no quadro maior dos estudos sobre as identidades no cristianismo antigo. A questão central é compreender de que formas as práticas populares se relacionam com o desenvolvimento e a manifestação das identidades cristãs. Como práticas populares elegemos as práticas de judaização, entre os não judeus adeptos da fé em Cristo, existentes no contexto das comunidades cristãs. A judaização é assim compreendida porque foge à instrução/controle das autoridades e da elite intelectual cristã. O recorte espaço-temporal do presente (...) estudo são as comunidades cristãs da província da Ásia Proconsular, no território imperial romano, no século II d.C. O conceito de etnicidade é empregado no exame das cartas do bispo Inácio de Antioquia a comunidades cristãs da Ásia Menor de forma a iluminar possíveis motivações para uma manutenção da judaização entre não judeus crentes em Jesus em detrimento da forte recomendação de seu abandono pelas autoridades cristãs. (shrink)

Este trabalho investigou características sócio-demográficas e vocacionais em 59 alunos de baixa renda, de ambos os sexos, com idades entre 16 e 48 anos. A maioria já prestou vestibular e tem escolha profissional definida. Os alunos relatam possuir pouca informação sobre profissões, processo de escol..

Pragmatic comparative effectiveness randomized controlled trials evaluate the effectiveness of one interventions under real-world clinical conditions. The results of ceRCTs are often directly generalizable to everyday clinical practice, providing information critical to decision-making by patients, clinicians, and healthcare policymakers. The PRECIS-2 framework identifies nine domains that serve to score a trial on a continuum between very explanatory to very pragmatic. According to the framework, pragmatic trials may have one or more of the following features: there are fewer eligibility criteria for (...) participants, in an... (shrink)

O artigo tem como objetivo responder como um cognitivista moral pode aceitar o experimento de pensamento da Terra Gêmea Moral sem aceitar o Cognitivismo não-descritivista de Terence Horgan e Mark Timmons. A fim de oferecer a resposta almejada, serão expostas as conclusões semânticas que esses filósofos extraem da versão desse experimento de pensamento que se aplica ao realismo moral naturalista de Peter Railton. Será proposto que mesmo que um defensor do cognitivismo moral descritivista, como Railton, aceite a objeção de Horgan (...) e Timmons, e abandone o realismo moral naturalista, ele não precisa aderir à teoria metaética do Cognitivismo não-descritivista e à sua ontologia moral antirrealista. Ele tem como saída aderir ao Cognitivismo não-realista de Derek Parfit, que, conforme será argumentado, possivelmente é uma teoria metaética superior ao Cognitivismo não-descritivista. (shrink)

Background Pragmatic randomized controlled trials are designed to evaluate the effectiveness of interventions in real-world clinical conditions. However, these studies raise ethical issues for researchers and regulators. Our objective is to identify a list of key ethical issues in pragmatic RCTs and highlight gaps in the ethics literature. Methods We conducted a scoping review of articles addressing ethical aspects of pragmatic RCTs. After applying the search strategy and eligibility criteria, 36 articles were included and reviewed using content analysis. Results Our (...) review identified four major themes: 1) the research-practice distinction; 2) the need for consent; 3) elements that must be disclosed in the consent process; and 4) appropriate oversight by research ethics committees. 1) Most authors reject the need for a research-practice distinction in pragmatic RCTs. They argue that the distinction rests on the presumptions that research participation offers patients less benefit and greater risk than clinical practice, but neither is true in the case of pragmatic RCTs. 2) Most authors further conclude that pragmatic RCTs may proceed without informed consent or with simplified consent procedures when risks are low and consent is infeasible. 3) Authors who endorse the need for consent assert that information need only be disclosed when research participation poses incremental risks compared to clinical practice. Authors disagree as to whether randomization must be disclosed. 4) Finally, all authors view regulatory oversight as burdensome and a practical impediment to the conduct of pragmatic RCTs, and argue that oversight procedures ought to be streamlined when risks to participants are low. Conclusion The current ethical discussion is framed by the assumption that the function of research oversight is to protect participants from risk. As pragmatic RCTs commonly involve usual care interventions, the risks may be minimal. This leads many to reject the research-practice distinction and question the need for informed consent. But the function of oversight should be understood broadly as protecting the liberty and welfare interest of participants and promoting public trust in research. This understanding, we suggest, will focus discussion on questions about appropriate ethical review for pragmatic RCTs. (shrink)

We asked a series of questions to Monica Cioli and David Rifkind, authors of two important books which focus on the process that enabled art and architecture to acquire a specific political meaning under fascism. The outcome is a dialogue that shows how the relationship between fascism and art is not characterized by a mere appropriation or a mutually functional exploitation between the artist or the architect and the fascist regime. Art prepares a specific appropriation of technology and serves (...) to introduce the political anthropology of the fascist man. Similarly, architecture establishes an organization of urban spaces coherent and necessary to the hierarchical order of the corporatist society. (shrink)

A prefrontal control system that is less mature than the limbic reward system in adolescence is thought to impede self-regulatory abilities, which could contribute to poor dietary choices and obesity. We, therefore, aimed to examine whether structural morphology of the prefrontal cortex and the amygdala are associated with dietary decisions and obesity in children and adolescents. Seventy-one individuals between the ages of 8–22 years participated in this study; each participant completed a computer-based food choice task and a T1- and T2-weighted (...) structural brain scans. Two indices of obesity were assessed, including age- and sex-specific body mass index and waist-to-height ratio. The behavioral task included rating 60 food stimuli for tastiness, healthiness, and liking. Based on each participant’s self-ratings, 100 binary food choices were then made utilizing a computer mouse. Dietary “self-control” was calculated as the proportion of trials where the individual chose the healthier food item over the total number of trials. Cortical thickness and amygdala subnuclei volumes were quantified using FreeSurfer 6.0 and CIT168 atlas, respectively. We found that WHtR was negatively associated with the thickness of bilateral superior frontal, left superior temporal, right insula, and right inferior temporal regions. We also found WHtR to be positively associated with the volume of the central nucleus region of the amygdala, after adjusting for the hemisphere, age, sex, and intracranial volumes. A similar data pattern was observed when BMIz was used. Moreover, we found that across all participants, thinner right superior frontal cortex and larger left CEN volumes predicted lower dietary self-control. These results suggest that differential development of the PFC and amygdala relate to obesity and dietary self-control. Further longitudinal studies are merited to determine causal relationships among altered PFC to amygdala neural circuitry, dietary self-control, and obesity. (shrink)

This article has, as an end in itself, the latent and pulsating objective of serving as a tool for introductory awakening to the process of racial literacy. As a further objective, I seek to point out the importance of this process in the family, institutional and social spheres, in order to minimally incite people to an anti-racist education. To this end, I start from the precision of concepts related to literacy and literacy systems, working with some concepts that are part (...) of this literacy repertoire such as race, racism and racial discrimination, in order to clarify them, so that they can be better understood in their applicability. In the second moment, to address the literacy, I start from a first question: who are the literate? Responding to this implies recognizing the place of white privilege with its implications. The other steps that make up this process are investigated throughout the article. I mainly use the elaborations of the Martinican philosopher, psychiatrist and psychoanalyst Frantz Fanon, from the work Pele Negra, Máscaras Brancas (1952), in order to, with this resumption, enter into the theme of the book by the New Zealand philosopher Annette Baier, Reflections On How We Live (2009) as a way of thinking about its feasibility, with a view to anti-racist education through racial literacy. (shrink)

O estudo filosófico da ética sobre as interações entre os seres humanos e as tecnologias que empregam a Inteligência Artificial se tornou um tópico popular e importante como nunca antes. O estudo dos problemas que concernem essas interações justifica-se por conta das transformações tecnológicas pelas quais as sociedades humanas têm passado, e que ainda podem acarretar profundas mudanças legais, políticas e sociais. O artigo tem como objetivo principal identificar o papel da ética, enquanto disciplina filosófica, com relação ao recente e (...) promissor domínio de investigação sobre a ética da Inteligência Artificial. Após apresentar a posição do filósofo Peter Railton na ética aplicada à Inteligência Artificial, o artigo reconstitui as suas explicações na ética normativa e na metaética. Ao ilustrar as conexões entre a ética aplicada à Inteligência Artificial e a teoria moral, o artigo argumenta que o papel da ética na ética da Inteligência Artificial pode ser explicitado com o auxílio da engenharia conceitual. Essa abordagem mostra que conceitos como ‘agente’ e ‘interesse’, que são cruciais para a ética, como pode ser visto nas explicações de Railton, não devem ser pensados exclusivamente pela ética, ou mesmo somente pela filosofia, mas necessitam ser informados pelas ciências naturais e humanas. O artigo enfatiza a necessidade de realizar a tarefa filosófica de pensar a ética para além da ética, em um contexto interdisciplinar capaz de lidar com os complexos problemas práticos que impactam as sociedades humanas. (shrink)

El objetivo de este artículo es describir la percepción de riesgo y los factores de protección y de riesgo frente al consumo de sustancias psicoactivas legales e ilegales en estudiantes de la Universidad de Boyacá. Es un estudio cuantitativo y descriptivo de corte transversal, para el cual se tomó una muestra de 573 estudiantes que fueron seleccionados mediante muestreo estratificado probabilístico. El instrumento utilizado fue la encuesta sobre consumo de drogas, factores y percepción de riesgo en estudiantes universitarios (CODEU) diseñado (...) por Beverido, Salas, De San Jorge, Pavón, Blázquez, Gogeascoechea y Cruz (2012), que consta de 73 preguntas. Este instrumento fue validado y obtuvo un alpha de Cronbach de 0.787. Los hallazgos muestran que entre los factores protectores se encuentran: adecuadas relaciones familiares y practicar un deporte, como factores de riesgo se identifican principalmente: la permisividad social y las construcciones de reconocimiento social presentes ante el consumo de sustancias legales. De las sustancias ilegales, la marihuana es la que se percibe como de menor riesgo frente a la cocaína, el bazuco, los inhalantes y la heroína. (shrink)