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)

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)

Bridging the gap between the world of science and the realm of the spiritual, B. Alan Wallace introduces a natural theory of human consciousness that has its roots in contemporary physics and Buddhism. Wallace's "special theory of ontological relativity" suggests that mental phenomena are _conditioned_ by the brain, but do not _emerge_ from it. Rather, the entire natural world of mind and matter, subjects and objects, arises from a unitary dimension of reality that is more fundamental than these dualities, as (...) proposed by Wolfgang Pauli and Carl Jung. To test his hypothesis, Wallace employs the Buddhist meditative practice of _samatha_, refining one's attention and metacognition, to create a kind of telescope to examine the space of the mind. Drawing on the work of the physicist John Wheeler, he then proposes a more general theory in which the participatory nature of reality is envisioned as a self-excited circuit. In comparing these ideas to the Buddhist theory known as the Middle Way philosophy, Wallace explores further aspects of his "general theory of ontological relativity," which can be investigated by means of _vipasyana_, or insight, meditation. Wallace then focuses on the theme of symmetry in reference to quantum cosmology and the "problem of frozen time," relating these issues to the theory and practices of the Great Perfection school of Tibetan Buddhism. He concludes with a discussion of the general theme of complementarity as it relates to science and religion. The theories of relativity and quantum mechanics were major achievements in the physical sciences, and the theory of evolution has had an equally deep impact on the life sciences. However, rigorous scientific methods do not yet exist to observe mental phenomena, and naturalism has its limits for shedding light on the workings of the mind. A pioneer of modern consciousness research, Wallace offers a practical and revolutionary method for exploring the mind that combines the keenest insights of contemporary physicists and philosophers with the time-honored meditative traditions of Buddhism. (shrink)

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)

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)

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.

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.

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)

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)

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...

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)

Bridging the gap between the world of science and the realm of the spiritual, B. Alan Wallace introduces a natural theory of human consciousness that has its roots in contemporary physics and Buddhism. Wallace's "special theory of ontological relativity" suggests that mental phenomena are _conditioned_ by the brain, but do not _emerge_ from it. Rather, the entire natural world of mind and matter, subjects and objects, arises from a unitary dimension of reality that is more fundamental than these dualities, as (...) proposed by Wolfgang Pauli and Carl Jung. To test his hypothesis, Wallace employs the Buddhist meditative practice of _samatha_, refining one's attention and metacognition, to create a kind of telescope to examine the space of the mind. Drawing on the work of the physicist John Wheeler, he then proposes a more general theory in which the participatory nature of reality is envisioned as a self-excited circuit. In comparing these ideas to the Buddhist theory known as the Middle Way philosophy, Wallace explores further aspects of his "general theory of ontological relativity," which can be investigated by means of _vipasyana_, or insight, meditation. Wallace then focuses on the theme of symmetry in reference to quantum cosmology and the "problem of frozen time," relating these issues to the theory and practices of the Great Perfection school of Tibetan Buddhism. He concludes with a discussion of the general theme of complementarity as it relates to science and religion. The theories of relativity and quantum mechanics were major achievements in the physical sciences, and the theory of evolution has had an equally deep impact on the life sciences. However, rigorous scientific methods do not yet exist to observe mental phenomena, and naturalism has its limits for shedding light on the workings of the mind. A pioneer of modern consciousness research, Wallace offers a practical and revolutionary method for exploring the mind that combines the keenest insights of contemporary physicists and philosophers with the time-honored meditative traditions of Buddhism. (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)

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)

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)

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.

Despite the growing interest in Aristotelian approaches to contemporary philosophy of science, few metaphysicians have engaged directly with the question of how a neo-Aristotelian metaphysics of nature might change the landscape for theological discussion concerning theology and naturalism, the place of human beings within nature, or the problem of divine causality. The chapters in this volume are collected into three thematic sections: Naturalism and Nature, Mind and Nature, and God and Nature. By pushing the current boundaries of neo-Aristotelian metaphysics to (...) recover the traditional notion of substantial forms in physics, reframe the principle of proportionality in biology, and restore the hierarchy of being familiar to ancient philosophy, this book advances a metaphysically unified framework that accommodates both scientific and theological knowledge, enriching the interaction between science, philosophy and theology. Neo-Aristotelian Metaphysics and the Theology of Nature will be of interest to scholars and advanced students working in metaphysics, philosophy of science, natural theology, philosophical theology, and analytic theology. (shrink)

This is the first book to give a collective treatment of philosophical issues relating to tax. Given that the tax system is central to the operation of states and to the ways in which states interact with individual citizens, more interdisciplinary attention to conceptual and normative issues relating to tax is urgently needed.

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)