Following promulgation of the Nuremberg code in 1947, the ethics of research on human subjects has been a challenging and often contentious topic of debate. Escalation in the use of research participants in low-income countries over recent decades , has intensified the debate on the ethics of international research and led to increasing attention both to exploitation of vulnerable subjects and to considerations of how the 10:90 gap in health and medical research could be narrowed. In 2000, prompted by the (...) discussions over several years that led to the US NIH launching a capacity building programme on research ethics for members of research ethics committees in developing countries, we advanced a ‘new look’ for the ethics of international research.1 Since then progress has been made on several fronts.First, our ideas—considered somewhat radical and impractical at the time—have been provocatively addressed by scholars who have either contested them or advanced similar conceptions of what obligations international researchers have to research participants and communities in low income countries before, during and after clinical trials. Second, those researchers who have been sympathetic to our ideas have either endeavoured to put these into practice or have investigated the feasibility of doing so. Third, the intractability of the 10/90 gap and the escalation of interest in global health have sensitised many to the need to amplify the uptake of these ideas in practice.Here, we briefly review the conceptual and practical developments in international research ethics. While much conceptual progress has been made (and the concepts are now appearing …. (shrink)

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

A person's values are what that person regards as or thinks important; a society's values are what that society regards as important. A society's values are expressed in laws and legislatively enacted policies, in its mores, social habits, and positive morality. Any body's values—an individual person's or a society's—are subject to change, and in our time especially. An individual manifests his or her values in expressions of approval or disapproval, of admiration or disdain, by seeking or avoidance behaviour, and by (...) his or her characteristic activities. What one values one seeks for or tries to maintain. Sometimes attaining it leads to unexpected enlightenment—that isn't what one wanted after all. But a person's values are discovered most significantly in a reflective way by becoming aware of what one is willing to give up to attain or maintain one's values. This is the price one is willing to pay for it, and values are occasionally, and in the money and stock markets always, expressed in terms of price. This can be significant or it can be misleading; it depends on how it is interpreted. Not everything has a monetary equivalent, despite the attempts of the law to provide recovery for damages in monetary terms, and despite the cynical maxim, ‘Everyone has his price’. (shrink)

Nozick's genetic supermarket has arrived on the wings of angels brought to us by Ron Harris, the founder of ronsangels.com. How should we respond to this and other options that will soon be beckoning? To assist us in answering these questions, I shall begin by considering a technique that has been with us for some time, but has the effect of changing the nature of children. Understanding the basis on which this technique can be supported may help us to grapple (...) with the more difficult question of what we should do about newer options that also change the nature of our children. It is not, however, my aim here to deal with all the objections that could be urged against these options. My purpose is the narrower one of developing a clear understanding of the central values at stake. (shrink)

This book presents the work of Polish and American philosophers about Poland's transition from Communist domination to democracy. Among their topics are nationalism, liberalism, law and justice, academic freedom, religion, fascism, and anti-Semitism. Beyond their insights into the ongoing situation in Poland, these essays have broader implications, inspiring reflection on dealing with needed social changes.

In his Axel Hägerström Lectures, given in Sweden in 1991, Dick Hare referred to Hägerström as a pioneer in ethics who had made the most important breakthrough that there had been in ethics during the twentieth century. Although Hägerström's development of a nondescriptivist approach to ethics certainly was pioneering philosophical work, when the history of twentieth century ethics comes to be written, I believe that it is Hare's own work that will be seen as having made the most important contribution.

Dr. Brown, a hospitalist, admits Mark, a patient transferred from a local jail for management of cellulitis. The patient, who was taken into custody two days prior to hospital admission, has a history of intravenous heroin use. Mark explains that he had been prescribed buprenorphine-naloxone maintenance therapy for opioid use disorder for several years prior to being arrested and had not used other opioids during that time. As a policy, the jail where Mark is detained does not prescribe opioid agonists, (...) and his maintenance therapy was stopped upon his arrival there. Dr. Brown discovers that Mark is diaphoretic and appears distressed. Mark's symptoms suggest to Dr. Brown that, in addition to having cellulitis, Mark is actively withdrawing from opioids. Mark tells Dr. Brown that he has felt “horrible” since his buprenorphine-naloxone therapy was stopped and that he now has intense cravings for opioids. He asks Dr. Brown to help alleviate the withdrawal symptoms. Dr. Brown, who is accustomed to treating opioid withdrawal with opioid replacement therapy, wonders if she should initiate ORT for Mark while he is in the hospital. (shrink)

Graphical AbstractGene editing with engineered nucleases introduce double-strand breaks that are repaired by error-prone nonhomologous end-joining (NHEJ). In article number 1900126, Sara G. Trimidal et al. propose that the length and type or resulting indels can now be controlled by editing with different engineered nucleases or by manipulating the expression of NHEJ genes.

Genome editing with engineered nucleases (GEENs) introduce site‐specific DNA double‐strand breaks (DSBs) and repairs DSBs via nonhomologous end‐joining (NHEJ) pathways that eventually create indels (insertions/deletions) in a genome. Whether the features of indels resulting from gene editing could be customized is asked. A review of the literature reveals how gene editing technologies via NHEJ pathways impact gene editing. The survey consolidates a body of literature that suggests that the type (insertion, deletion, and complex) and the approximate length of indel edits (...) can be somewhat customized with different GEENs and by manipulating the expression of key NHEJ genes. Structural data suggest that binding of GEENs to DNA may interfere with binding of key components of DNA repair complexes, favoring either classical‐ or alternative‐NHEJ. The hypotheses have some limitations, but if validated, will enable scientists to better control indel makeup, holding promise for basic science and clinical applications of gene editing. Also see the video abstract here https://youtu.be/vTkJtUsLi3w. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

This volume collects a wealth of articles covering a range of topics of practical concern in the field of ethics, including active and passive euthanasia, abortion, organ transplants, capital punishment, the consequences of human actions, slavery, overpopulation, the separate spheres of men and women, animal rights, and game theory and the nuclear arms race. The contributors are Thomas Nagel, David Hume, James Rachels, Judith Jarvis Thomson, Michael Tooley, John Harris, John Stuart Mill, Louis Pascal, Jonathan Glover, Derek Parfit, R.M. Hare, (...) Janet Radcliffe Richards, Peter Singer, and Nicholas Measor. (shrink)

Bioethicist Peter Singer got a respectful reception Friday as he told advocates for the disabled it is morally acceptable to kill severely disabled newborns. The Governor's Commission on Disability was harshly criticized for inviting Singer to Friday's conference because of that stance, first enunciated in a 1979 book.

The traditional solutions to the Sleeping Beauty problem say that Beauty should have either a sharp 1/3 or sharp 1/2 credence that the coin flip was heads when she wakes. But Beauty’s evidence is incomplete so that it doesn’t warrant a precise credence, I claim. Instead, Beauty ought to have a properly imprecise credence when she wakes. In particular, her representor ought to assign \(R(H\!eads)=[0,1/2]\) . I show, perhaps surprisingly, that this solution can account for the many of the intuitions (...) that motivate the traditional solutions. I also offer a new objection to Elga’s restricted version of the principle of indifference, which an opponent may try to use to collapse the imprecision. (shrink)