This article critiques the recent House of Lords decision, R(Purdy) v DPP, and explores the wider debate over the legalization of assisted suicide, with particular focus on assistance in ‘suicide-tourism’. It proceeds in roughly two parts. In the first part, I seek to make the case that it was not legally necessary for the Lords to order that the Director of Public Prosecutions (DPP) clarify his long-standing policy of not prosecuting those who compassionately assist loved ones to travel abroad (...) to die. On the purely legal merits of the case, the Lords’ hands were not ‘tied’, so to speak, and I will attempt to show that a closer analysis of the argumentation leading to the decision will expose its errors in this respect. This conclusion will then open up the normative question of whether clarification of the DPP’s policy is a progressive development. I suggest that in light of the special practical and ethical considerations at stake, the DPP’s previous practice of turning a blind eye to instances of assisted suicide bearing out certain features—whilst not clarifying his policy to this effect—was the most satisfactory one, and that the Lords’ decision was hence a retrograde step. (shrink)

This editorial introduces a revised set of publication requirements for papers, submitted to Homeopathy, that involve animal experimentation. Journals that publish studies involving animal experimentation have a major role to play in the maintenance of ethical standards because researchers are reliant upon them for publication of their findings. With an increasing global trend towards greater transparency and accountability in animal experimentation, many academic journals, such as the British Journal of Pharmacology, 1 and 2 are taking action to improve reporting standards. (...) In recognition of this need, members of Homeopathy's Editorial Board have been working together to examine the scientific rationale and the most relevant ethical guidelines for the use of animals in research. In addition, they have examined existing published studies in homeopathy research and current practice within the broad domain of medical research. Each of these aspects has informed the revised publication policy, whose overarching objectives are to maximise the ethical standards and scientific quality of animal research in homeopathy, and thereby ultimately to avoid any unnecessary suffering of animals used in such research. The following description details the background that was considered, the rationale for this development, and the steps that will be taken. (shrink)

The patient was a woman in her 30s who, until the rapid progression of an ultimately fatal neurologic disease, had been a very successful professional, enjoying athletics and an active social life. In the 6 months of swift deterioration, she had gone from being extremely vibrant and energetic to being totally unable to care for her personal needs. There had been no loss of intellectual capacity. Her sister later recounted to Dr. J., the emergency department physician, that she had found (...) the patient unconscious and unresponsive at home and had immediately called the patient's neurologist in a neighboring city. He directed her to call the paramedics. (shrink)

We read with great interest the commentaries submitted in response to our paper about clinical scientists and the role of ethical preparedness1. The responses raised some important themes that intersect with those discussed in our paper, and we are grateful for the opportunity to expand on them. Pruski2 highlights the importance of ethics education for clinical scientists, noting insufficient provision of such teaching within the clinical science profession. This gap means that scientists completing higher specialist training, who (...) now encounter more complex ethical challenges, are not benefitting from equivalent ethics education standards enjoyed by their counterparts in medical professions. We agree that clinical scientists deserve access to quality education in ethics in order to develop their skills in this area. Alongside a formal element to education, we see ethical preparedness (EP) as advocating for more informal education opportunities. This can be facilitated through the encouragement and creation of space (both physical and metaphorical) to discuss ethical issues as they arise in practice and explore potential scenarios in a supportive and judgement-free environment. Cultivating such an environment plays is crucial to develop professional skills in navigating ethical challenges, promoting a greater sense of collective responsibility and capability to do justice to ethical issues encountered. Van Steijvoort et al 3 draw …. (shrink)

Non‐invasive microanalytical methods have been devised to study the energy metabolism of single human preimplantation embryos. Psyruvate, which is added routinely to all media used to culture human embryos, is consumed throughout the preimplantation period, with glucose assuming an increasing role at embryo compaction and blastocyst formation. All of the glucose consumed may be accounted for by the appearance of lactate in the incubation medium. The enzyme hexokinase my be involved in regulating this aerobic glycolysis. There is cosiderable indirect evidence (...) for the utilisation of endogenous as opposed to exogenous energy substrates, the most likely candidate being protein. Information on early human embryo metabolismis likely to find application in a number of areas: these include the improvement of techniques for assisted human conception, notably in the selection of embryos for transfer following In Vitro Fertilisation; the diagnosis of gentic defects at the preimplantation stage; increased undersding of the causes of implantation failure and miscarriage, and the development of novel post‐coital contraceptives. (shrink)

Consumer concern for “ethical products”, or ethical aspects of the goods which they purchase, is a subject of increasing interest and research,which is here illustrated by an examination of the Fair Trade movement, with special reference to coffee as an indicative commodity. Kate Bird, is currently Lecturer in the Development Administration Group, School of Public Policy, Birmingham University, Birmingham B15 2TT, England, having previously worked abroad and written her MSc dissertation at Wye College on fair trade in coffee products. (...) Dr Hughest holds the Sainsbury Chair in Agribusiness and Food Marketing at Wye College, University of London, Wye, Ashford, Kent TN25 5AH, England (email: [email protected]), where he is also Director of the Food Industry Management Group. He has wide international experience of food management issues. (shrink)

Much has been published about the ethical issues encountered by clinicians in genetics/genomics, but those experienced by clinical laboratory scientists are less well described. Clinical laboratory scientists now frequently face navigating ethical problems in their work, but how they should be best supported to do this is underexplored. This lack of attention is also reflected in the ethics tools available to clinical laboratory scientists such as guidance and deliberative ethics forums, developed primarily to manage issues arising within (...) the clinic.We explore what ethical issues are being experienced by clinical scientists, how they think such issues could be best analysed and managed, and whether their practice might be enhanced by more situated approaches to ethics deliberation and practice such as ethical preparedness. From thematic analysis of cases presented by clinical scientists at a specially convened meeting of the UK Genethics Forum, we derived three main ethical themes: (1) the redistribution of labour and responsibilities resulting from the practice of genomic medicine; (2) the interpretation and certainty of results and (3) the proposal that better standardisation and consistency of ethical approaches (for example, more guidelines and policy) could resolve some of the challenges arising.We argue that although standardisation is important for promoting shared understandings of good (including ethical) practice, supplementary approaches to enhance and sustain ethical preparedness will be important to help clinical scientists and others in the recently expanded genetic/genomic medicine environment foster quality ethical thinking. (shrink)

Consumer concern for “ethical products”, or ethical aspects of the goods which they purchase, is a subject of increasing interest and research,which is here illustrated by an examination of the Fair Trade movement, with special reference to coffee as an indicative commodity. Kate Bird, is currently Lecturer in the Development Administration Group, School of Public Policy, Birmingham University, Birmingham B15 2TT, England, having previously worked abroad and written her MSc dissertation at Wye College on fair trade in coffee products. (...) Dr Hughest holds the Sainsbury Chair in Agribusiness and Food Marketing at Wye College, University of London, Wye, Ashford, Kent TN25 5AH, England (email: [email protected]), where he is also Director of the Food Industry Management Group. He has wide international experience of food management issues. (shrink)

We investigate what distinguishes social entrepreneurial ecosystems (SEEs) from entrepreneurial ecosystems (EEs) through appreciation of the importance of context—the multiplex of intertwined social, spatial, temporal, historical, cultural, and political influences. Community is incorporated as a key variable and hitherto overlooked dimension of the structure and influence of SEEs. We draw on extant literature and examples of a variety of SEEs to support our propositions and demonstrate why considerations of both context and community are critical to advance understanding of SEEs. We (...) contribute to the study of SEEs by presenting a new conceptual framework and theorizing SEE as an evolving composite of interdependent actors who interact and collaborate across multiple levels to collectively generate positive externalities and drive sustainable solutions to social problems. (shrink)

Recruitment processes for clinical trials are governed by guidelines and regulatory systems intended to ensure participation is informed and voluntary. Although the guidelines and systems provide some protection to potential participants, current recruitment processes often result in limited understanding and experiences of inadequate decision support. Many trials also have high drop-out rates among participants, which are ethically troubling because they can be indicative of poor experiences and they limit the usefulness of the knowledge the trials were designed to generate. (...) Drawing on recent social-psychological and philosophical-ethical research on trial recruitment and patient participation in treatment decision-making, this paper identifies possibilities for improving communicative support for both initial decisions and ongoing participation in clinical trials. It highlights the potential of a shift in thinking about ‘voluntariness’, underpinned by relational understandings of autonomy, to encourage more nuanced judgements about the ethics of communication between trial staff and (potential) participants. The paper suggests that the idea of responsively enabling people to consider invitations or requests to participate in particular trials could serve as a general guide to communication. This might help ensure decisions about trial participation are meaningfully informed and voluntary, and that relationships between trial staff and participants contribute to positive experiences of trial participation and ultimately to the generation of the robust knowledge. (shrink)

Interventional research on deceased organ donors and donor organs prior to transplant holds the promise of reducing the number of patients who die waiting for an organ by expanding the pool of transplantable organs and improving transplant outcomes. However, one of the key challenges researchers face is an assumption that someone who receives an organ that was part of an interventional research protocol is always a human subject of that same study. The consequences of this assumption include the need for (...) oversight by an institutional review board and for research-level informed consent from transplant recipients, all within the complex practical realities of the organ donation and transplantation process in the United States. The current national focus on this issue provides an opportunity to think critically about the policy goals of the human subjects regulations and their application to the nascent field of deceased organ donor intervention research. We propose that for donor research where the transplant recipient does not fall under the definition of human subject, the clinical consent model—rather than the consent model used for human research subjects—best facilitates the policy objectives of balancing clinical innovation, transparency, and protection of patients in an ethically responsible and legally compliant manner. (shrink)

Josh is a typical 27-year-old in a career that he enjoys and a successful marriage. Josh begins to exhibit the symptoms of a manic episode. He is soon diagnosed with bipolar disorder. While non-manic, Josh’s preferences are typical. While manic, his preferences change dramatically. He quits his job, cheats on his partner, and squanders his savings. These are behaviors that Josh, when non-manic (euthymic), would never agree to. When Josh returns to a euthymic state, he regrets these decisions. Should those (...) close to Josh have prevented him from making these decisions, or does his competence to decide persist despite his acute mania? In this paper, I examine the connections be-tween bipolar disorder and consent. I defend the view that many (although far from all) individuals with bipolar disorder are competent to consent to a wide variety of things when they are in a manic state. This means that mania should not be presumed to undermine competence in clinical settings. -/- I have several goals in this paper. I want to bring philosophy to bear on the connection between consent and bipolar disorder. Additionally, I intend this paper to contribute to the general debate about the conditions of informed consent. Bipolar disorder presents novel challenges to existing conceptions of competence to consent which require stable core of values for an agent to be competent. For example, Buchanan and Brock endorse such a view. In showing that shifting values do not undermine the competence of a person experiencing acute mania, I show that the aforementioned views of competence are false. Overall, this paper makes substantive contributions to the debate about competence to consent and presents the first sustained philosophical treatment of consent among people with bipolar disorder. (shrink)

Background: Low rates of participation of adolescents and young adults (AYAs) in clinical oncology trials may contribute to poorer outcomes. Factors that influence the decision of AYAs to participate in health research and whether these factors are different from those that affect the participation of parents of children with cancer. Methods: This is a secondary analysis of data from validated questionnaires provided to adolescents (>12 years old) diagnosed with cancer and parents of children with cancer at 3 sites in (...) Canada (Halifax, Vancouver, and Montreal) and 2 in the United States (Atlanta, GA, and Memphis, TN). Respondents reported their own research participation and cited factors that would influence their own decision to participate in, or to provide parental authorization for their child to participate in health research. Results: Completed questionnaire rates for AYAs and parents were 86 (46.5%) of 185 and 409 (65.2%) of 627, respectively. AYAs (n = 86 [67%]) and parents (n = 409 [85%]) cited that they would participate in research because it would help others. AYAs perceived pressure by their family and friends (16%) and their physician (19%). Having too much to think about at the time of accrual was an impediment to both groups (36% AYAs and 47% parents). The main deterrent for AYAs was that research would take up too much time (45%). Nonwhite parents (7 of 56 [12.5%]) were more apt to decline than white parents (12 of 32 [3.7%]; P < .01). Conclusions: AYAs identified time commitment and having too much to think about as significant impediments to research participation. Addressing these barriers by minimizing time requirements and further supporting decision-making may improve informed consent and impact on enrollment in trials. (shrink)

Post-Traumatic Stress Disorder is a mental health condition in which the experience of a traumatic event causes a series of psychiatric and behavioral symptoms such as hypervigilance, insomnia, irritability, aggression, constricted affect, and self-destructive behavior. This paper investigates two case studies to argue that the experience of PTSD is not restricted to humans alone; we have good epistemic reason to hold that some animals can experience genuine PTSD, given our current and best clinical understanding of the disorder in humans. (...) I will use this evidence to argue for two claims. First, because the causal structure of PTSD plausibly requires reference to a traumatic conscious experience in order to explain subsequent behaviors, the fact that animals can have PTSD provides new evidence for animal consciousness. Second, the discovery of PTSD in animals puts pressure on accounts which hold that animal behavior can be fully explained without reference to subjective experience. (shrink)

Homosexual aversion therapy enjoyed two brief but intense periods of clinical experimentation: between 1950 and 1962 in Czechoslovakia, and between 1962 and 1975 in the British Commonwealth. The specific context of its emergence was the geopolitical polarization of the Cold War and a parallel polarization within psychological medicine between Pavlovian and Freudian paradigms. In 1949, the Pavlovian paradigm became the guiding doctrine in the Communist bloc, characterized by a psychophysiological or materialist understanding of mental illness. It was taken up (...) by therapists in Western countries who were critical of psychoanalysis and sought more ‘scientific’ diagnostic and therapeutic methods that focused on empirical evidence and treating actual symptoms. However, their attitude towards homosexuality often played a decisive role in how they used aversion therapy. Whereas Czechoslovakian researchers cautioned readers about low success rates and agitated for homosexual law reform in 1961, most of their anglophone counterparts selectively ignored or misrepresented the results of ‘the Prague experiment’, instead celebrating single-case ‘success’ stories in their effort to correct ‘abnormal’ sexual orientation. In histories of queer sexuality and its pathologization, the behaviourist paradigm remains almost entirely unmapped. This article provides the most detailed study to date of aversion therapy literature from both sides of the East/West border. In doing so, it contributes to the project not only of ‘decentring Western sexualities’, but of decentring Western sexological knowledge. Given its Pavlovian origins, the history of homosexual aversion therapy can be fully understood only in the context of Cold War transnational sexological knowledge exchange. (shrink)

Suppose that a patient is receiving treatment options from her doctor. In one case, the doctor says, “the surgery has a 90% survival rate.” Now, suppose the doctor instead said, “the procedure has a 10% mortality rate.” Predictably, the patient is more likely to consent on the first description and more likely to dissent on the second. This is an example of a framing effect. A framing effect occurs when “the description of [logically-equivalent] options in terms of gains (positive frame) (...) rather than losses (negative frame) elicits systematically different choices.” Framing effects are ubiquitous, but they are particularly troublesome in medicine. Many worry that there is tension between valuing informed consent and using framing effects in clinical settings. In this paper, I answer this question: if an individual is subject to a framing effect when she gives her consent, does this undermine the validity of her consent? I argue that framing effects do not undermine consent in general. (shrink)

A 2009 decision by a Florida state trial court marks a recent addition to the long line of cases authorizing compelled medical treatment of pregnant women for the benefit of their unborn children. Despite recurring judicial and academic consideration of the issues involved, there is no consensus regarding the correct approach to take in cases that pit a woman's right to refuse medical treatment against the state's interest in protecting fetal health. Burton v. Florida, currently under appeal to Florida's First (...) District Court of Appeals, demonstrates the difficulty of emergency decision-making in this area and the need for robust ex ante consideration of the important interests at stake.In March 2009, pursuant to a petition by the State of Florida, the Leon County Circuit Court overrode a pregnant woman's informed refusal to consent to medical treatment, and ordered her to remain a hospital inpatient and submit to medical treatment. (shrink)

In the American medical system, patients do not know the final price of treatment until long after the treatment is given, at which point it is too late to say “no.” I argue that without price disclosure many, perhaps all, tokens of consent in clinical medicine fall below the standard of valid, informed consent. This is a sweeping and broad thesis. The reason for this thesis is surprisingly simple: medical services rarely have prices attached to them that are known (...) to the patient prior to treatment. Yet, for many patients, knowledge of the price is relevant to whether they would give consent. If informed consent requires that patients know all information about their treatment that is relevant to their decision, then consent to a medical intervention in the absence of the price is not informed consent. (shrink)

Through a discussion of Agnès Varda's career from 1954 to 2008 that focuses particularly on La Pointe Courte (1954), L'Opéra-Mouffe (1958), The Gleaners and I (2000), and The Beaches of Agnes (2008), this article considers the connections between Varda's filmmaking and her femaleness. It proposes that two aspects of Varda's cinema—her particularly perceptive portrayal of a set of geographical locations, and her visual and verbal emphasis on female embodiment—make a feminist existential-phenomenological approach to her films particularly fruitful. Drawing both directly (...) on the work of Maurice Merleau-Ponty and on some recent film- and feminist-theoretical texts that have employed his insights, it explores haptic imagery and feminist strategy in The Gleaners and I, the materialization of space characterizing Varda's blurring of fiction and documentary, and the dialectical relationship of people with their environment often observed in her cinema. It concludes that both Varda's female protagonists and the director herself may be said to perform feminist phenomenology in her films, in their actions, movement, and relationship to space, and in the carnality of voice and vision with which Varda's own subjectivity is registered within her film-texts. (shrink)

Creating what sort of professional? Master's level nurse education as a professionalising strategy This paper reports on a detailed analysis of selected findings from a larger study of master's level nurse education. It locates some features of such education within the contemporary situation of nursing as a profession and interprets the role of master's level nurse education as a professionalising strategy. In‐depth interviews were undertaken with a purposive sample of 18 nurse lecturers drawn from eight universities in the United Kingdom. (...) The interview agenda explored participants’ perspectives of the characteristics of master's level performance in practice. Interview transcripts were interpreted by drawing upon hermeneutic methodology.The following themes emerged. (a) The credibility of the master's level nurse was of central importance. In terms of the literature of professionalisation, this may be interpreted as a factor in enhancing the legitimacy of nursing as an occupation. (b) The clinical capability attributed to the nurse is interpreted as leading to an increase in the authority commanded by the expert professional. Thus, the individual capability of the master's level nurse enhances the attribution of autonomous skill to the occupation as a whole. (c) The master's level nurse is seen to exercise influence and leadership and this strengthens the power and status of nursing.Nursing does not have the appearance of a ‘traditional’ profession, neither has it a clear stance as a ‘new profession’. Rather it appears to be especially responsive to the tide of public opinion manifest through government edicts. While nursing is employing rhetoric that espouses both positions, the direction of master's level education is anomalous. (shrink)

In recent years, the government, advocacy organizations, the press, and the public have pressured universities, academic medical centers, and physicianinvestigators to do more to ensure that their financial interests and relationships do not conflict with their duties to conduct high-quality research and protect the safety and welfare of clinical trial participants. A number of factors underlie the increased focus. First, private sector funding of clinical research has grown both in absolute terms and as a proportion of overall funding. (...) In 2008, the pharmaceutical, medical device, and biotechnology industries’ domestic research and development expenditures constituted approximately 60.9% of funding for biomedical research in the United States; the next largest funder, the National Institutes of Health, funded 27.9%. Private industry spent $58.6 billion on research in 2007, up from $40 billion in 2003, an increase of 25% after adjusting for inflation. (shrink)

The article investigates the issue and the mechanisms of censorship and self-censorship in Soviet philosophy. The major forms of censorship are described and analyzed together with their epistemological implications and the peculiar policy of truth. The philosophical problem of defining and describing “facts” and ideological judgments during the “double” technique of reading and re-reading was exposed in the articles of V.F. Asmus and V.V. Bibikhin, thinkers, who experienced the self-censorship and reflected upon this in their texts. Analyzing the complex relation (...) between the “dogmatic” or “critical” foreword and the original word is important, as is reconstructing and deconstructing the way we can reread the ideologically biased foreword, which might be a certain reliquary or protective camouflage, acting as, potentially, either a deactivator or an inhibitor of the reader’s own interpreting efforts. The given case of an attentive reading of V. Asmus’ foreword to the Tractatus Logicus-Philosophicus can itself become an interesting philosophical language game. Interpretation of the foreword may reveal a hidden sense and references and encourage reflection based on the “common sense” assessments and perception of text. These hermeneutical exercises on reading forewords may paradoxically provoke starting the dialogue with the alternative foreword by B. Russell and the text of L. Wittgenstein himself, on one hand, and Marxism-Leninism and its variations in the form of historical materialism and Soviet dialectical materialism, on another. The situation of attentive reading with “a throat, strangled by ideology” is opposed to the power of imaginative “broadening of vocal ranges of the Others” thinking, whereas an inattentive reading of the text leaves a complete disability to object, or reply, to the censorship. (shrink)

Clinical ethicists move in different environments and interface with a variety of stakeholders, and are therefore uniquely positioned to answer the call for equity and anti-racism. We describe why a clinical ethicist should contribute to anti-racism efforts and describe general approaches for addressing racism across institutional contexts, including: (1) addressing racism as a bedside clinical ethics consultant, (2) addressing a wider lens of anti-racism work across multiple ethics consults over time, and (3) addressing racism at the organizational (...) level. (shrink)

Bioethics has begun to see the revaluation of affects in medical practice, but not all of them, and not necessarily in the sense of affects as we know them. Empathy has been accepted as important for good medical practice, but only in a way that strips it of its affectivity and thus prevents other affects, like sympathy, from being accepted. As part of a larger project that aims at revaluing the importance of affectivity in medical practice, the purpose of this (...) paper is to develop a clinical sympathy that can serve as a trainable skill for medical professionals. While everyday sympathy may be problematic as a professional skill for physicians, this does not imply that sympathy should be entirely rejected. As a natural part of our moral psychology, sympathy is an intersubjective affect that aids in our interactions with others and our decision-making abilities. I present here a theory of clinical sympathy as an affective response to patients, in which physicians are both attuned to their affective response and understand how their affects are influencing their beliefs and judgments. In this way, clinical sympathy serves as a trainable skill that can aid physicians in their interactions with their patients. (shrink)

This paper articulates a dilemma posed by philosophical counseling literature that presupposes diagnostic recognition. In addition, guests often bring self-ascribed mental health diagnoses from their previous experience, and requests the philosophical counselor to de-diagnose or otherwise reinterpret their problems. Although philosophical counselors can do this, we cannot skirt philosophical diagnosis. The paper’s thesis is that it behooves philosophical counselors to differentiate these types of diagnosis and to know when we are doing one or the other, including the utilization of diagnostic (...) recognition. Anecdotes from the author’s philosophical counseling sessions are included to illustrate the discussion. The paper concludes that the space of philosophical diagnosis is neither incommensurate with, nor incompatible with clinical diagnosis. On the contrary, the space of philosophical diagnosis ought to harbor the possibility of clinical diagnostic recognition. The philosophical counselor’s repertoire of diagnostic intuitions should cultivate the intuitive recognition of clinical prototypes. (shrink)

Philosophical counseling offers a depathologizing practice that can benefit both the practitioner and the client. Philosopher Michel Foucault’s account of biopower is a useful analytic of the psychopathologization of everyday life, and can show the social signif­icance of philosophical practice. This essay critiques the conflation, by some philosophical practitioners, of the medical disease model and all psychotherapeutic methods. Foucault’s conflation of human normativity and normalization is also critiqued. Historian of science Georges Canguilhem’s alternative account of human normativity within the medical (...) disease model is offered as an antidote to the conflations by these philosophical practitioners and Foucault. Philosophical practitioners ought to give up objectivist claims to value neutrality and acknowledge that the interventions of philosophical counseling in clinical diagnostic discourses are normative, theory-laden, and politically significant. (shrink)

Janet Malek (91–102, 2019) argues that a “clinical ethics consultant’s religious worldview has no place in developing ethical recommendations or communicating about them with patients, surrogates, and clinicians.” She offers five types of arguments in support of this thesis: arguments from consensus, clarity, availability, consistency, and autonomy. This essay shows that there are serious problems for each of Malek’s arguments. None of them is sufficient to motivate her thesis. Thus, if it is true that the religious worldview of (...) class='Hi'>clinical ethics consultants should play no role whatsoever in their work as consultants, this claim will need to be defended on some other ground. (shrink)

Ryle (1949, Chapter V) discusses a range of predicates which in different ways exemplify a property I shall call quasi-duality - they appear to report two actions or events in one predicate. Quasi-duality is the key property of predicates Ryle classed as achievements. Ryle's criteria for classification were not temporal or aspectual, and Vendler's subsequent adoption of the term achievement for the aktionsart of momentary events changes the term - Rylean achievements and Vendlerian achievements are in principle different classes. Nevertheless, (...) I shall argue in this paper that certain kinds of quasi-duality do have aspectual significance. This paper examines a number of quasi-dual predicates which are not generally discussed in the aktionsart literature, including break a promise, miscount, and cure the patient. Two types of quasi-dual predicates are identified and dubbed criterion predicates and causative upshot predicates. It is shown that both types of quasi-dual predicate lack process progressives, despite being durative, and it is argued that the lack of process progressives identifies these predicates as (aspectual) achievements. They are termed durative achievements to distinguish them from canonical, momentary achievements. It is argued that these predicates lack process progressives, and hence are achievements, because they express individual-level predicates on the event argument. A process progressive is stage-level for the event, and hence is incompatible with a predicate which is lexically individual-level for the event. (shrink)

In the latest reform of the National Health Service great emphasis has been placed on the achievement and maintenance of quality. Mechanisms for ensuring this are being set up under the general title of “clinical governance”. What is the meaning of this term? The metaphor behind the phrase is of navigation through stormy seas, but who guides the helmsman? Clinical ethics committees could have a part to play in these changes, provided their role is properly understood. Clinical (...) governance is concerned with management according to an agreed set of aims. The task of ethics committees is Socratic rather than managerial. They should ask fundamental questions about the ethical norms of the services provided and give critical appraisal of the moral character of institutional policies. If these tasks are carried out then governance may become a watchword rather than just another buzzword. (shrink)

A 2009 decision by a Florida state trial court marks a recent addition to the long line of cases authorizing compelled medical treatment of pregnant women for the benefit of their unborn children. Despite recurring judicial and academic consideration of the issues involved, there is no consensus regarding the correct approach to take in cases that pit a woman's right to refuse medical treatment against the state's interest in protecting fetal health. Burton v. Florida, currently under appeal to Florida's First (...) District Court of Appeals, demonstrates the difficulty of emergency decision-making in this area and the need for robust ex ante consideration of the important interests at stake.In March 2009, pursuant to a petition by the State of Florida, the Leon County Circuit Court overrode a pregnant woman's informed refusal to consent to medical treatment, and ordered her to remain a hospital inpatient and submit to medical treatment. (shrink)

Clinical ethics consultants (CECs) are not moral authorities. Standardization of CECs’ professional role does not confer upon them moral authority. Certification of particular CECs does not confer upon them moral authority (nor does it reflect such authority). Or, so we will argue. This article offers a distinctly Orthodox Christian response to those who claim that CECs—or any other academically trained bioethicist—retain moral authority (i.e., an authority to know and recommend the right course of action). This article proceeds in three (...) parts. First, we discuss recent movements toward the certification of CECs in the United States, focusing primarily on proposals and programs put forth by the American Society for Humanities and Bioethics (ASBH). Second, we outline two secular reasons to be concerned about the relevant trends toward certification. For one thing, certification is currently being advanced via political dominance, rather than gaining authority by reliance on rigorous philosophical argument or reason. For another, the trends operate on the assumption that there exists a secular, content-full, canonical, morality. There is no such morality. Next, we argue that Orthodox Christians should resist the current trends toward certification of CECs. Specifically, we unpack ways in which the ASBH’s certification program (and those like it) conflict with Orthodox claims about moral authority and the moral life more generally. We conclude that Orthodox Christians should resist the current certification trends. (shrink)

Snake venoms are recognized here as a grossly under‐explored resource in pharmacological prospecting. Discoveries in snake systematics demonstrate that former taxonomic bias in research has led to the neglect of thousands of species of potential medical use. Recent discoveries reveal an unexpectedly vast degree of variation in venom composition among snakes, from different species down to litter mates. The molecular mechanisms underlying this diversity are only beginning to be understood. However, the enormous potential that this resource represents for pharmacological prospecting (...) is clear. New high‐throughput screening systems offer greatly increased speed and efficiency in identifying and extracting therapeutically useful molecules. At the same time a global biodiversity crisis is threatening the very snake populations on which hopes for new venom‐derived medications depend. Biomedical researchers, pharmacologists, clinicians, herpetologists, and conservation biologists must combine their efforts if the full potential of snake venom‐derived medications is to be realized. (shrink)

Legal judgment writing mobilises a process of story-telling, drawing on existing judicial discourses, precedents and practices to create a narrative relevant to the specific case that is articulated by the presiding judge. In the Feminist Judgments projects feminist scholars and activists have sought to challenge and reinterpret legal judgments that have disadvantaged, discriminated against or denied women’s experiences. This paper reflects on the process of writing as a feminist judge in the Australian Project, in an intimate homicide case, R v (...) Middendorp. Drawing on the work of Judith Butler on intelligibility, iterability and the communality of violence and vulnerability, this article argues that feminist judgments necessarily require some uncomfortable compromises with unjust gendered institutions. While ‘donning the robes’ may be an uncomfortable process, a feminist re-articulation of the law’s carceral power serves to unsettle and challenge some aspects of gendered oppression, even though it cannot unsettle the operation of the institution. The article concludes that effective feminist interventions by members of the judiciary may require donning robes that are not entirely comfortable in order to persuade and advocate for change. (shrink)

Principles of ethics -- Medical research and clinical trials -- Treatment decision making -- Palliative and end-of-life care -- Patient advocacy -- Communication and ethics -- Genetics and genomics -- The impact of ethical conflict and dilemmas on nurses -- Ethics consultation and education.

Medical professionals seem to interpret their uses of humor very differently from those outside the medical profession. Nurses and physicians argue that humor is necessary for them to do their jobs well. Many (potential) patients are horrified that they could one day be the butt of their physician’s jokes. The purpose of this paper is to encourage the respectful use of humor in clinical prac-tice, so as to support its importance in medical practice, while simultaneously protecting against its potential (...) abuse. I begin by examining two extremes of supporting or chastising the use of medical humor. I look at these views through the lenses of popular theories of humor to help explain their theoretical bases. In this second section, I explain the emotional aspect of humor as an embodied and embedded transformation of the world. This clarifies the role that humor plays in our daily lives, as well as why the ethical or unethical nature of its use is dependent on context. Third, I address the potential problems in the relationship between humor and clinical sympathy, and how this further affects the relationship between medical professionals and their patients. I conclude by arguing that humor can conflict with clinical sympathy, but this need not be the case. If medical professionals actively engage with clinical sympathy and focus on using humor in a way that is respectful towards their patients, then humor can continue to be a positive force in their lives while still providing the best care for their patients. (shrink)

In Brazil, every study involving human beings is required to produce an informed consent form that must be signed by study participants: this is stated in Resolution 196/96. 1 Consent must be obtained through a specific structured process. Objective: To present the opinions of women regarding how the process of obtaining informed consent should be conducted when women are invited to participate in studies on contraceptive methods. Subjects and Methods: Eight focus groups were conducted, involving a total of 51 women (...) living in the metropolitan region of Campinas. The women involved in the study were either participating in a clinical trial in the area of women's health or had participated in such a trial in the previous 12 months. A thematic guide was used to conduct the focus group discussions; the discussions were recorded, transcribed and a thematic analysis performed. Results: In general, the person who invites a woman to participate in a study should be a member of the research team but not the principal investigator. Information relating to the study should be given orally and in writing, both individually and in the group setting. Study volunteers should be informed about, among other things, the risks, possible side effects and discomforts, including long-term effects. The use of audiovisual aids to provide information was suggested. Conclusion: The process for obtaining informed consent was seen as a means of establishing a relationship between the volunteers and the investigator/research team. The information that the study participants expected to be given coincides with the requirements established under Resolution 196/96. The use of audiovisual aids would improve understanding of the information provided. (shrink)

Empathy has been shown to improve patient care and physician well-being. However, the emotional labor involved in expressing empathy might interfere with experiencing calm, equally important to clinicians’ well-being. This article offers examples of how clinical environments can bolster both empathy and calm and suggests that empathy can be expressed socially, not just individually, to build solidarity and make space for calm.

L'analyse d'une cinétique de croissance y est conduite à partir du modèle logistique généralisé de Richards-Nelder. On distingue 2 types de processus dits mono- et multi-logistique. Dans le cas mono-logistique, le phénomène est correctement décrit par une seule fonction logistique. La cinétique de croissance est alors caractérisée par lea propriétés de chacune des phases G 1 à G 4, délimitées par les points singuliers Γmax, V max et Γmin. On appelle structure de croissance la contribution relative de ces différentes phases (...) à l'expression de la croissance totale. Cette distribution temporelle de l'activité de croissance est une représentation discrétisée de la trajectoire y 0 → y max. On appelle processus multi-logistique toute cinétique de croissance correspondant à une somme de 2 ou plusieurs logistiques généralisées. II existe alors un plus grand nombre de points singuliers et donc un plus grand nombre de phases G i que dans le cas monologistique. La structure de croissance définit avec précision la cinetique du phénomène, ainsi que l'importance relative des différentes composantes logistiques au cours du temps. Une application en est donnée avec le grandissement des cellules pleuridiophores de l'Algue Antithamnion plumula. L'allongement de ces cellules est toujours de type bi-logistique. Les caractéristiques de la structure de croissance permettent une discrimination nette du sporophyte et des gametophytes mâle et femelle. Tandis que la composante 1 est pen différente, la composante 2 varie fortement selon la ploïdie du thalle. En revanche, il y a pen de différences entre les deux gamétophytes. Cette notion de structure de croissance est ainsi susceptible d'apporter des résultats originaux. Audelà de cet example, cette approche est proposée comme une méthode de caractérisation simple mais précise de toute cinétique de croissance basée sur lea variations temporelles de l'activité de croissance [couple ]. (shrink)

OBJECTIVES: To investigate the need for hospital clinical ethics committees by studying the frequency with which ethical dilemmas arose, the perceived adequacy of the process of their resolution, and the teaching and training of staff in medical ethics. DESIGN: Interviews with individuals and three multidisciplinary teams; questionnaire to randomly selected individuals. SETTING: Two major London children's hospitals. RESULTS: Ethical dilemmas arose frequently but were resolved in a relatively unstructured fashion. Ethical concerns included: the validity of consent for investigations and (...) treatment; lack of children's involvement in consent; initiation of heroic or futile treatments; resource allocation. Staff expressed the need for a forum which would provide consultation on ethical issues, develop guidelines for good ethical practice, undertake teaching and training, and provide ethical reflection outside the acute clinical setting. CONCLUSION: Multidisciplinary, accountable and audited clinical ethics committees with predominantly advisory, practice development and educational roles could provide a valuable contribution to UK clinical practice and perhaps in other countries that have not developed hospital clinical ethics committees. (shrink)

Exploring nursing expertise: nurses talk nursing It has become increasingly important for practitioners to articulate their expertise in modern healthcare settings that demand high levels of accountability and evidence‐based practice. The material presented within this article has been interpreted drawing from discourse analysis1 to help explore the discourses that shape and influence understandings of nursing practice. What we present are extracts from four of the 35 participant nurses who applied to take part in the Royal College of Nursing Institute's Expertise (...) in Practice (pilot) Project (EPP). The material presented is used to provide a starting point for exploring how nurses talk about and construct expertise in nursing practice. The four nurse participants’ clinical practice areas cover palliative care, mental health, intensive care and fertility care. The material reveals high levels of intensity in the nurse–patient relationship, ‘maverick’ nursing practices and ongoing reflexivity. All of these aspects appear to capitalize on expertise as a ‘catalyst’ that alters treatment pathways and maximizes patient‐centred outcomes. Exploring a discourse of nursing expertise exposes the tacit situated nature of professional practice that is heterogeneous and most difficult to articulate and explain. It is proposed that expertise tends to be understood from traditional and dominant discourses of medicine, management and technology. Explaining expertise in practice exposes non‐conventional practice that in itself can be isolating and challenging to the status quo of contemporary health‐care. (shrink)

Inadequate diet is the leading risk factor for morbidity and mortality worldwide. However, approaches to identifying inadequate diets in clinical practice remain inconsistent, and dietary interventions frequently focus on facilitating ‘healthy choices’, with limited emphasis on structural constraints. We examine the ethical implications of introducing a routine question in the medical history about ability to access food. Not collecting data on food security means that clinicians are unable to identify people who may benefit from support on an individual level, (...) unable to consider relevant dietary risk factors for disease and disease progression and unable to monitor population trends and inequalities in dietary access in order to design effective policy interventions. We argue that the current lack of routine screening for food insecurity is inconsistent with our approach to other health behaviours, as well as with doctors’ frequent informal role as gatekeepers to the food aid system, and recent calls for governmental action on food insecurity and health inequalities from individual clinicians and professional bodies. Potential ethical barriers to asking patients about food security are addressed, including concerns about stigma, limiting autonomy, fair resource allocation, unclear professional remits and clinicians’ ability to offer effective interventions. We suggest that there is an ethical imperative for doctors to ask patients about their ability to access healthy food. Gathering this data provides a valuable first step in re-framing the social determinants of health as modifiable risks, rather than inevitable inequities. No data are available. (shrink)