Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith (...) traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured. (shrink)

Savulescu maintains that our paper, which encourages clinicians to honour requests for "inappropriate treatment" is prejudicial to his atheistic beliefs, and therefore wrong. In this paper we clarify and expand on our ideas, and respond to his assertion that medicine, ethics and atheism are objective, rational and true, while religion is irrational and false.

The primary impediment to formulating a general theory for adaptive evolution has been the unknown distribution of fitness effects for new beneficial mutations. By applying extreme value theory, Gillespie circumvented this issue in his mutational landscape model for the adaptation of DNA sequences, and Orr recently extended Gillespie's model, generating testable predictions regarding the course of adaptive evolution. Here we provide the first empirical examination of this model, using a single-stranded DNA bacteriophage related to phiX174, and find that our data (...) are consistent with Orr's predictions, provided that the model is adjusted to incorporate mutation bias. Orr's work suggests that there may be generalities in adaptive molecular evolution that transcend the biological details of a system, but we show that for the model to be useful as a predictive or inferential tool, some adjustments for the biology of the system will be necessary. (shrink)

Background We aimed to examine the ethical concerns Singaporeans have about sharing health-data for precision medicine and identify suggestions for governance strategies. Just as Asian genomes are under-represented in PM, the views of Asian populations about the risks and benefits of data sharing are under-represented in prior attitudinal research. Methods We conducted seven focus groups with 62 participants in Singapore from May to July 2019. They were conducted in three languages and analysed with qualitative content and thematic analysis. Results Four (...) key themes emerged: nuanced understandings of data security and data sensitivity; trade-offs between data protection and research benefits; trust in the public and private sectors; and governance and control options. Participants were aware of the inherent risks associated with data sharing for research. Participants expressed conditional support for data sharing, including genomic sequence data and information contained within electronic medical records. This support included sharing data with researchers from universities and healthcare institutions, both in Singapore and overseas. Support was conditional on the perceived social value of the research and appropriate de-identification and data security processes. Participants suggested that a data sharing oversight body would help strengthen public trust and comfort in data research for PM in Singapore. Conclusion Maintenance of public trust in data security systems and governance regimes can enhance participation in PM and data sharing for research. Contrary to themes in much prior research, participants demonstrated a sophisticated understanding of the inherent risks of data sharing, analysed trade-offs between risks and potential benefits of PM, and often adopted an international perspective. (shrink)

In this paper, I argue that we can get surprisingly far in vindicating common intuitions about population ethics without assuming that the well-being of those we could create gives us moral reasons for or against creating them. According to the account I sketch, rather than generating procreative reasons, facts about our potential offspring’s well-being serve as normative background conditions—they enable, disable, or modify the strength of independent reasons we might have to procreate. It is unclear whether the account can capture (...) everything many of us want to say about population ethics. But whatever the answer, the point remains that background conditions are a powerful and underappreciated tool in population ethics. (shrink)

It is possible to retrieve viable sperm from a dying man or from a recently dead body. This sperm can be frozen for later use by his wife or partner to produce his genetic offspring. But the technical feasibility alone does not morally justify such an endeavour. Posthumous semen retrieval raises questions about consent, the respectful treatment of the dead body, and the welfare of the child to be.We present two cases, discuss these three issues, and conclude that such requests (...) should generally not be honoured unless there is convincing evidence that the dead man would want his widow to carry and bear his child. Even with consent, the welfare of the potential child must be considered. (shrink)

Clinical ethics is a relatively new discipline within medicine, generated not so much by the Can we . . . ? questions of fact and prognosis that physicians ...

Artificial intelligence is set to transform healthcare. Key ethical issues to emerge with this transformation encompass the accountability and transparency of the decisions made by AI-based systems, the potential for group harms arising from algorithmic bias and the professional roles and integrity of clinicians. These concerns must be balanced against the imperatives of generating public benefit with more efficient healthcare systems from the vastly higher and accurate computational power of AI. In weighing up these issues, this paper applies the deliberative (...) balancing approach of the Ethics Framework for Big Data in Health and Research. The analysis applies relevant values identified from the framework to demonstrate how decision-makers can draw on them to develop and implement AI-assisted support systems into healthcare and clinical practice ethically and responsibly. Please refer to Xafis et al. in this special issue of the Asian Bioethics Review for more information on how this framework is to be used, including a full explanation of the key values involved and the balancing approach used in the case study at the end of this paper. (shrink)

High degrees of uncertainty and a lack of effective therapeutic treatments have characterized the COVID-19 pandemic and the provision of drug products outside research settings has been controversial. International guidelines for providing patients with experimental interventions to treat infectious diseases outside of clinical trials exist but it is unclear if or how they should apply in settings where clinical trials and research are strongly regulated. We propose the Professional Oversight of Emergency-Use Interventions and Monitoring System as an alternative pathway based (...) on guidance developed for the ethical provision of experimental interventions to treat COVID-19 in Singapore. We support our proposal with justifications that establish moral duties for physicians to record outcomes data and for institutions to establish monitoring systems for reporting information on safety and effectiveness to the relevant authorities. Institutions also have a duty to support generation of evidence for what constitutes good clinical practice and so should ensure the unproven intervention is made the subject of research studies that can contribute to generalizable knowledge as soon as practical and that physicians remain committed to supporting learning health systems. We outline key differences between POEIMS and other pathways for the provision of experimental interventions in public health emergencies. (shrink)

The term "third wave" within contemporary feminism presents some initial difficulties in scholarly investigation. Located in popular-press anthologies, zines, punk music, and cyberspace, many third wave discourses constitute themselves as a break with both second wave and academic feminisms; a break problematic for both generations of feminists. The emergence of third wave feminism offers academic feminists an opportunity to rethink the context of knowledge production and the mediums through which we disseminate our work.

Recent developments in stem cell research with the creation of three-dimensional structures that resemble preimplantation embryos highlight the problems in regulating the uncertainties of emerging...

Although Levinas did not write about The Merchant of Venice, recent scholarship has explored Levinasian themes in the play. However, most of The Merchant instantiates not Levinasian ethics per se, but the cultural and other forces that work against ethics. In particular, theodicy, which Levinas sees as morally scandalous, is deployed by Christian characters to justify their ill-treatment of Shylock. A surface reading of the play would suggest that it is structured around clear binaries, with Christian “mercy” juxtaposed to legalistic, (...) vengeful Jewish “justice.” However, a more nuanced reading, particularly one informed by Levinas’s philosophy, reveals ways in which Shakespeare seems to call these distinctions into question, and uncovers two genuinely ethical moments in the play: Shylock’s “Hath not a Jew eyes?” speech, and his implied, biblically informed critique of the treatment of slaves by Christians in Venetian society. (shrink)

In the literature on conspiracy theories, the least contentious part of the academic discourse would appear to be what we mean by a “conspiracy”: a secretive plot between two or more people toward some end. Yet what, exactly, is the connection between something being a conspiracy and it being secret? Is it possible to conspire without also engaging in secretive behavior? To dissect the role of secrecy in con- spiracies – and thus contribute to the larger debate on the epistemology (...) of conspir- acy theories – we dene the concepts of “conspiracy,” “conspirator,” and “secret,” and argue that while conspirators might typically be thought to commit to keeping secrets once their conspiracy is underway, the idea that conspiracies are necessarily secretive to start with is not as obvious as previously thought. (shrink)

Thinking in Translation posits the Hebrew Bible as the fulcrum of the thought of Franz Rosenzweig (1886-1929), underpinning a unique synthesis between systematic thinking and biblical interpretation. Addressing a lacuna in Rosenzweig scholarship, the book offers a critical evaluation of his engagement with the Bible through a comparative study of The Star of Redemption and his Bible translation with Martin Buber. The book opens with Rosenzweig's rejection of German Idealism and fascination with the sources of Judaism. It then analyzes the (...) unique hermeneutic approach he developed to philosophy and scripture as a symbiosis of critique and cross-fertilization, facilitated by translation. An analysis of the Star exposes Rosenzweig's employment of translation in grafting biblical verses unto the philosophical discussion. It is followed by a reading that demonstrates how his Bible translation reflects an attempt to re-valorize the Tanakh as a distinctively Jewish scripture, over and against Christian appropriations. Thinking in Translation recasts Rosenzweig's life's work as a project of melding Judaism and modernity in an attempt to secure their spiritual and intellectual survival. (shrink)

Martin Buber, Franz Rosenzweig and Emmanuel Levinas are three of the most prominent Jewish philosophers of the 20th century. This paper looks at the different understandings each author offers of intersubjectivity and authentic self-hood and questions the extent to which for each author God plays a role in interpersonal relationships.

Martin Buber, Franz Rosenzweig and Emmanuel Levinas are three of the most prominent Jewish philosophers of the 20thcentury. This paper looks at the different understandings each author offers of intersubjectivity and authentic self-hood and questions the extent to which for each author God plays a role in interpersonal relationships.

Cell and tissue-based products, such as autologous adult stem cells, are being prescribed by physicians across the world for diseases and illnesses that they have neither been approved for or been demonstrated as safe and effective in formal clinical trials. These doctors often form part of informal transnational networks that exploit differences and similarities in the regulatory systems across geographical contexts. In this paper, we examine the regulatory infrastructure of five geographically diverse but socio-economically comparable countries with the aim of (...) identifying similarities and differences in how these products are regulated and governed within clinical contexts. We find that while there are many subtle technical differences in how these regulations are implemented, they are sufficiently similar that it is difficult to explain why these practices appear more prevalent in some countries and not in others. We conclude with suggestions for how international governance frameworks might be improved to discourage the exploitation of vulnerable patient populations while enabling innovation in the clinical application of cellular therapies. (shrink)

A long history of extractive industries and activities have shaped the societies of northern Mozambique, and the Cabo Delgado province in particular. For centuries, the growing international demand on local resources had a great impact on the northern micro-societies. The demand for cheap labour and natural resources, ranging from ivory and cotton, to timber, rubies, land, gas and more, involved thousands of local actors in its extraction, reproducing systems of local power. The persistence of poverty, inequality and conflicts, as well (...) as simmering and sometimes grand-scale violence, fits into a long-term trend of extractivism. Through a historical approach and field observations, we focus on the political economy of extracting natural resources. We point out the persisting basic patterns of extractivism that accompanied Mozambique's integration into global markets, and continued or even deepened, in the post-independence period. These activities are oriented towards foreign markets. They are instigated by foreign investment, but invariably carried out in collaboration with a chain of national gatekeepers. In a clientelist system, local elites resort to their proximity to the state to reproduce their power, often at the expense of state expropriation. Weak state institutions have the functional effect of reproducing the elites, also serving the interests of extractivist capital. It is, however, a system with many and profound contradictions, producing conflict and violence, which also recurrently put those interests at risk. (shrink)

Precision medicine is an emerging approach to treatment and disease prevention that relies on linkages between very large datasets of health information that is shared amongst researchers and health professionals. While studies suggest broad support for sharing precision medicine data with researchers at publicly funded institutions, there is reluctance to share health information with private industry for research and development. As the private sector is likely to play an important role in generating public benefits from precision medicine initiatives, it is (...) important to understand what the concerns are and how they might be mitigated. This study reports outcomes of a deliberative method of citizen engagement in Singapore that asked whether sharing precision medicine data with private industry would be permissible, and if so, under what circumstances. Findings from this citizens’ jury suggest sharing with industry would be permissible under certain conditions that are set out in nine recommendations. Implications of the recommendations and their underlying assumptions for policy decision makers are discussed. This study aligns with prior international studies which found conditional acceptance for data sharing with private industry, a public benefit requirement, specific reluctance to share with insurance companies and an emphasis on accountability and transparency to demonstrate trustworthiness. However, our results differ from prior studies in that opt-in consent did not dominate the deliberations as jurors were able to set it aside as an assumed prerequisite for participation in a precision medicine programme. (shrink)

This new edition of Introduction to Lattices and Order presents a radical reorganization and updating, though its primary aim is unchanged. The explosive development of theoretical computer science in recent years has, in particular, influenced the book's evolution: a fresh treatment of fixpoints testifies to this and Galois connections now feature prominently. An early presentation of concept analysis gives both a concrete foundation for the subsequent theory of complete lattices and a glimpse of a methodology for data analysis that is (...) of commercial value in social science. Classroom experience has led to numerous pedagogical improvements and many new exercises have been added. As before, exposure to elementary abstract algebra and the notation of set theory are the only prerequisites, making the book suitable for advanced undergraduates and beginning graduate students. It will also be a valuable resource for anyone who meets ordered structures. (shrink)

Human embryonic stem cell research has generated considerable discussion and debate in bioethics. Bioethical discourse tends to focus on the moral status of the embryo as the central issue, however, and it is unclear how much this reflects broader community values and beliefs related to stem cell research. This paper presents the results of a study which aims to identify and classify the issues and arguments that have arisen in public discourse associated with one prominent policy episode in the United (...) States: the 2004 Californian Stem Cell Research and Cures Initiative. The findings show that public discourse about Proposition 71 is characterised by a broader range of issues than those usually addressed in scholarly publications and public policy documents. While attention to the moral status of the embryo is an important issue in stem cell research, making it the main focus of public discourse has a polarising effect. This also limits opportunities to identify shared values, understand how political alliances are forged, and develop social consensus. Implications for future research and policy are discussed. (shrink)

In 2016, the Office of the State Coroner of New South Wales released its report into the death of an Australian woman, Sheila Drysdale, who had died from complications of an autologous stem cell procedure at a Sydney clinic. In this report, we argue that Mrs Drysdale's death was avoidable, and it was the result of a pernicious global problem of an industry exploiting regulatory systems to sell unproven and unjustified interventions with stem cells.

BL With revised Latin text and English translationBL New historical notes and rewritten Introduction Columba is one of the best-known saints of the early Celtic church; through his foundation of the abbey of Iona he had a far-reaching influence on medieval Christianity. In about 700, a century after his death, the Life of Columba was written by Adomnán, ninth abbot of Iona. It has long been valued as the major primary source on the subject, for the light it throws on (...) early medieval Scotland and Ireland, and as an important work of literature. The 1961 edition of the Life, by Alan and Marjorie Anderson, has long been unavailable. Marjorie Anderson has now revised both the Latin text and the English translation, provided new historical notes, and rewritten the Introduction to take account of recent work in the area. This new edition of a source indispensable for the study of the early medieval church meets a major scholarly need. (shrink)

Regulators around the world are coming under pressure from patients, clinicians, and industry groups to streamline the market approval process for highly novel biomedical technologies, including stem cells and regenerative medicine products. The rationale for streamlining this process centers on the perceived failures of regulatory systems to encourage biomedical innovation and provide patients with timely access to potentially beneficial yet experimental therapies. Critics claim that the process of generating scientific evidence in phased clinical trials is too costly, time-consuming, and poorly (...) suited for stem cell–based products that, unlike bio-pharmaceuticals, are intended to engraft into the body for long... (shrink)

Bioethical, legal, and professional discussions concerning human stem cell science have moved away from the contentious, and possibly irreconcilable, debates about human embryos to other sources of pluripotent stem cells. While there is an array of ethical and legal issues associated with all types of pluripotent stem cells, in recent years complex issues have arisen with regard to the premature use of somatic or "adult" stem cells. Of particular concern is the global emergence of an industry selling products and services (...) marketed as stem cells direct to the consumer, typically over the internet, for a range of serious medical conditions that lack credible evidence of safety and efficacy (Sipp et... (shrink)

Deliberative democratic theory emphasises the importance of informed and reflective discussion and persuasion in political decision-making. The theory has important implications for constitutionalism - and vice versa - as constitutional laws increasingly shape and constrain political decisions. The full range of these implications has not been explored in the political and constitutional literatures to date. This unique Handbook establishes the parameters of the field of deliberative constitutionalism, which bridges deliberative democracy with constitutional theory and practice. Drawing on contributions from world-leading (...) authors, this volume will serve as the international reference point on deliberation as a foundational value in constitutional law, and will be an indispensable resource for scholars, students and practitioners interested in the vital and complex links between democratic deliberation and constitutionalism. (shrink)

Over the last decade, stem cell research has generated an enormous amount of public, political and bioethical debate. These debates have overwhelmingly tended to focus on two moral issues: the moral status of human embryos and the duty to care for the sick and vulnerable. This preoccupation, especially on the question of moral status, has not only dichotomized the debate around two fundamentally incommensurable positions, it has come at the cost of other important issues largely being ignored. In highlighting some (...) of the bioethical and regulatory deficiencies of this fixation, we draw on recent developments in the experimental use of autologous adult stem cells to argue for a more inclusive approach to the ethical issues surrounding stem cell research. (shrink)

A prevailing issue in clinical research is the duty clinicians have to treat or prevent the progression of disease during a study that they are conducting. While all clinical researchers have a duty of care for the patients who participate in clinical research, intervening at the onset or progression of disease may skew results and have a negative impact on the scientific validity of a study. Extreme examples of failures to intervene can be found in the Tuskegee syphilis study and (...) in an attempt to determine if cervical smears were an accurate predictor of cancer, which was uncovered by the Cartwright Inquiry. However, the issue arises in all research where delay in intervention can cause harm. A current study in Singapore is investigating the significance of an ‘ultra-high risk’ state that may constitute the prodromal phase of psychosis. This project called ‘The Longitudinal Youth at Risk Study’ is potentially contentious because it is recruiting young people who are identified as being ‘at risk’ of developing psychosis. In this paper, the decision to offer treatment to all participants as well as a fast track for those who are assessed to have developed serious mental illness into treatment is discussed. It is argued that this approach is ethically justified because of the duty of care that is owed to research participants, and suggests that the principle of equipoise may be used to guide intervention decisions in other clinical research protocols. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics CommentaryTamra Lysaght, Senior Research FellowThe case scenario reflects the dilemmas frequently faced by researchers who discover incidental findings in the course of their studies. Indeed, the literature suggests that the prevalence of incidental findings in neuroimaging research is common,1 and a recent meta-analysis found that such findings increase significantly with age.2 Thus, given the age of the study population and increased likelihood of co-morbidities, it is puzzling that (...) the research team did not anticipate the possibility of finding an anomaly. Even more puzzling is that the reviewing IRB did not detect this omission and require that the team build a plan into the research protocol for managing incidental findings. Following international recommendations,3 such a plan would have likely included protocols for obtaining consent in dealing with an incidental finding, a procedure for evaluating the clinical relevance of the finding, and arranging for suitable follow-up care if necessary.Nevertheless, the research team, not having obtained consent to disclose an incidental finding to the participant, or not, must decide whether to break protocol and contact the participant with information that could have serious health implications for his or her health, especially if the observed lesion turns out to be cancer or some other life-threatening neuropathology. Any decision to break the research protocol should be made in consultation with the approving IRB. The principal investigator, Dr. M, who is ultimately responsible for the ethical conduct of this study, has a number of factors to consider when making this decision. First and foremost, Dr. M will need to weigh up the risks and benefits of disclosing the findings to this 72-year-old [End Page 283] research participant who is presumably already experiencing cognitive impairments, if not early stage symptoms of dementia.Numerous international scholars agree that disclosure of incidental findings should rely on the net beneficence to an individual research participant.4 Specifically, Wolf et al. argue that there should be a strong net benefit for disclosing an incidental finding, such that the information reveals a condition that is likely to be either life-threatening or grave and can be avoided or ameliorated through an intervention. In such instances, the researchers have an ethical obligation to disclose the findings and potentially follow up with clinical care. However, if there is only a net possible benefit, such that the condition is not life-threatening but may be grave or serious and cannot be avoided or ameliorated, then investigators may consider other factors, such as the respect that is owed to research participants and their needs and preferences for information about their health and well-being. Where the condition is not likely to be serious, researchers are not compelled to disclose an incidental finding.In determining the seriousness of an incidental finding, a specialist with expertise in assessing the clinical significance of MRI scans is needed to examine the participants’ images.5 In this instance, Dr. M has a neurologist on the research team who has detected the lesion but is unable to ascertain its clinical relevance without further investigation. The reasons why follow-up information is required is not detailed in the case scenario, but may have arisen because the scans were taken for research purposes and may not be clinically validated for diagnostic purposes — a possibility given the aims of the study (i.e., to elucidate the transition of minimal cognitive impairment to dementia, not brain tumours). For whatever reason, the detected lesion is only a suspected incidental finding that may or may not be life-threatening or grave. Thus, the net benefit to the participant in disclosing this unclear finding is harder to judge.Assuming that the lesion is a serious or life-threatening condition, the team may consider whether it can be avoided or ameliorated with an intervention. The cognitively impaired, although still mentally competent, participant is 72 years old and may respond poorly to a neurosurgical intervention if the diagnosis of a tumour or malignancy is confirmed. The physical and emotional distress of such a procedure may exacerbate the existing cognitive impairments, reducing the net benefit ratio of the disclosure. Indeed, the team should consider the impact that the disclosure... (shrink)

Demands for improved access to innovative therapies have prompted a discourse that claims patients have rights to access treatments that may be of benefit, even if evidence that demonstrates safety and efficacy is lacking. This rights-based discourse is grounded in accounts of autonomy and assertions claiming that the state ought to not interfere with the free choices of patients and clinical decision-making. In this essay, we scrutinise these arguments to defend the ethical and legal permissibility of interference in contexts where (...) the uncertainty of benefit and potential for harm creates vulnerabilities that undermine patient capacity for self-determination. In support of this argument, we draw on two theoretical approaches to explore the limits of autonomy in innovative contexts and analyse the legal bases of the rights-based discourse. We then apply this analysis to the case example of stem cell transplantation as an innovative treatment for multiple sclerosis. (shrink)

Precision medicine (PM) aims to revolutionise healthcare, but little is known about the role religion and spirituality might play in the ethical discourse about PM. This Perspective reports the outcomes of a knowledge exchange fora with religious authorities in Singapore about data sharing for PM. While the exchange did not identify any foundational religious objections to PM, ethical concerns were raised about the possibility for private industry to profiteer from social resources and the potential for genetic discrimination by private health (...) insurers. According to religious authorities in Singapore, sharing PM data with private industry will require a clear public benefit and robust data governance that incorporates principles of transparency, accountability and oversight. (shrink)