Some political philosophers have judged that it is absurd to think that there can be unintentional consent. In this paper, I present an example of unintentional consent, which I refer to as the adapted boardroom example. I consider reasons for denying that this is an example of unintentional consent, but find that these reasons are unconvincing.

Ethical codes help guide the methods of research that involves samples gathered from ?at-risk? populations. The current article reviews general as well as specific ethical principles related to gathering informed consent from partner violent offenders mandated to outpatient treatment, a group that may be at increased risk of unintentional coercion in behavioral sciences research due to court mandates that require outpatient treatment without the ethical protections imbued upon prison populations. Recommendations are advanced to improve the process of informed (...) consent within this special population and data supporting the utility of the recommendations in a sample 70 partner violent offenders are provided. Data demonstrate that participants were capable of comprehending all essential elements of consent. (shrink)

Case 1 reminds us that patients have duties too, while case 2 presents an instance of justified withholding of informationHow refreshing to read these two cases! No conjoined twins, fantastical chimeras, or other incredible scenarios at the fringes of medical reality. Each case highlights the practical and theoretical difficulties that doctors face in their everyday practice.Case 1: In case 1, the patient, who had declined an HIV test, changed his mind and requested an HIV test on the request form without (...) informing the doctor. The pathologist performed the tests and returned the results to the unsuspecting doctor, who duly investigated the matter. The doctor’s anxiety at the situation, as well as the worries of the entire practice and pathology laboratory, must have been deeply unpleasant. Thus the patient, no doubt unintentionally, caused much distress by requesting the HIV test. He was, at the very least, guilty of a lack of foresight and consideration. As a minimum, he should have informed the doctor of his last minute alteration. This would have enabled the doctor to discuss the implications of the test, to organise appropriate counselling, and, most importantly, to receive the results in full knowledge of the situation.As Dr Fraser points out, the experience of case 1 reinforces the importance of taking good medical notes. Even if the patient’s refusal had been documented in the notes, however, this would not have prevented him from requesting the HIV test, and indeed other tests, on the blood form. Pharmacists may still occasionally be faced with situations when they are unsure whether the doctor prescribed 10 capsules of a drug, or 110 capsules, as the patient may have added a “1” in front of the doctor’s original prescription. Similarly, how …. (shrink)

Aggressive techniques within casual sex encounters, such as taking sexual liberties without permission or ignoring rejection, can, perhaps unintentionally, complicate consent. Passive recipients may acquiesce out of fear, which aggressors may not realize. Some philosophers argue that social norms are sufficiently well known to make this misunderstanding unlikely. However, the chance of aggression leading to non-consensual sex, even if not great, is high enough that aggressors should work diligently to avoid this potentially grave result. I consider how this problem (...) plays out in the common mating ritual of hooking up. I argue that aggressive hook ups can only be permissible if they are modeled on BDSM encounters: the participants must obtain prior consent and prepare safe words for voiding that consent during the hook up. While this solution removes the spontaneity of aggressive sex, I argue that spontaneously aggressive hook ups with strangers cannot be permissible. (shrink)

This book investigates silence as a normal, ubiquitous and indispensable element of political thinking, theory, and language. It explores the diverse dimensions in which silences mould the different core features of the political-by summoning-up finality, by contributing to rendering support for communities or withholding it, by processing consent or dissent, by the manner in which it secures continuities or generates ruptures, and by its role in shaping national time, public memory and collective identity. Not least, silence is a highly (...) flexible power resource, both enabling and constraining major social practices, traditions, and currents. The emphasis of this study is primarily on the concealed, unintentional, and unrecognized ways through which silence pervades socio-political life, departing from the typical focus on intentional silencing and the dominance of logos. Instead, silence adopts the guises of the unspeakable, the ineffable, the inarticulable, and the unconceptualizable. En route, silence is juxtaposed with stillness, absence contrasted with lack, agency set against undetected conventions, and the veiled paired with the wondrous. Drawing extensively from historical, philosophical, anthropological, psychoanalytical, theological, linguistic, and literary viewpoints, the book demonstrates the common threads that connect silences to those different disciplines, alongside the features that pull them asunder. In extracting and decoding their political implications, it explores both academic literature and colloquial, everyday discourse. Selected case-studies elaborating the overall analysis include topics such as Buddhist nondualism, Locke's tacit consent, the submerging of historical narratives, state neutrality, Pinter's miscommunications and menace, and the separate ways ideologies integrate silence into their beliefs. (shrink)

Background Equitable care is a fundamental value in the nursing profession. Healthcare workers have both a moral and professional duty to ensure that they do not discriminate. Aim This study aimed to explore how patients perceive equitable nursing care. Research design, participants, and research context This descriptive phenomenological qualitative research study used purposeful sampling to select 17 patients from various departments of a general hospital in southern Iran. The participants were then interviewed using a semi-structured in-depth interview format, which aimed (...) to delve into their experiences with equitable nursing care. The collected data were analyzed using Colaizzi's seven-step method and MAXQDA20 software. Ethical considerations Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Ethics Committee of Jiroft University of Medical Sciences. Findings The data analysis of the study identified three main themes and six subthemes that were related to the experiences of patients with equitable nursing care. The first theme, equitable care, encompassed subthemes such as nurses’ dedicated efforts to facilitate patient recovery and adherence to ethical behavior. The second theme, unconscious causes of inequitable nursing care, included subthemes such as unintentional discrimination stemming from organizational constraints and unconscious biases resulting from a lack of knowledge and skills. The third theme, discriminatory care, comprised subthemes such as deliberate discrimination based on personal traits and selective discrimination. Conclusion The study findings indicate that achieving equitable nursing care requires a multifaceted approach. This includes effective hospital management, organizational reforms, and regulatory enhancements. Additionally, it is crucial to pay close attention to the needs of patients, enhance nurses’ theoretical and practical skills in providing equitable care, fostering a culture of equality within healthcare settings, and consider the personality dimensions and moral characteristics of nurses. (shrink)

In Islamic theological writings, under the heading of sustenance, the focus is generally on issues such as who is the provider of sustenance, whether haram is considered sustenance, and whether Allah’s consent exists for haram sustenance. Another issue that can be found between the lines of the subject of sustenance is whether it is haram for a person to work for sustenance or not. In fact, the pursuit of means of livelihood in order to sustain one’s life is, according (...) to the general and predominant acceptance of Muslim scholars, permissible and, in cases of necessity, wajib. According to a record in Uṣūl al-niḥal, during the formative period of itizālī thought, there were Mu‘tazilite sufis (ṣūfiyyat al-Muʿtazila) such as Bishr b. al-Mu‘tamir’s disciple Abū Imrān Mūsā b. al-Raqqāshī, al-Naẓẓām’s apostate disciple Fadl al-Hadathī, and Husayn al-Kūfī, about whom no information is available. These names, who seem to have earned their livelihood through almsgiving, defended the forbiddenness (taḥrīm al-makāsib) of all kinds of endeavour for sustenance, contrary to the acceptance of Muslim thinkers. However, it should be noted that for them, the forbiddenness in making an effort for sustenance does not cover the definition of sustenance, which is ‘all the benefits’, but only the effort in obtaining sustenance through means such as trade and agriculture. It is interesting to find such an extreme tendency among the Mu‘tazilites, who came to the fore with their rationalist discourses. “How could a Mu‘tazilite defend tahrīm al-makāsib?”, the issue of abandonment of striving for sustenance (tark al-makāsib), from which the idea of tahrīm al-makāsib is thought to have evolved, is mentioned, and then the Mu‘tazilite sufis views on tahrīm al-makāsib are tried to be based mainly on Mu‘tazilite sources and the criticisms of Mu‘tazilite authors against them are included. It has been determined that Mu‘tazilite sufis justifications for defending tahrīm al-makāsib concentrate on three points: (i) the absence of a just order due to the absence of a just imam and the possibility of supporting the oppressors (rulers) intentionally or unintentionally, and as a result of this, some of them describe the land of Islam as dār al-kufr, (ii) again in relation to the issue of imamate, in an environment where there is no justice, i.e. legal/moral order, the halāl and harām are so intertwined that they cannot be separated from each other, and in order to protect oneself from harām, the things that are subject to sustenance can only be purified through charity and become halāl, and (iii) the fact that trust in Allah is obligatory and any effort to pursue sustenance is contrary to tawakkul. The Mu‘tazilite authors criticised the proponents of tahrīm al-makāsib on the grounds that it is permissible to trade while maintaining a rational and ethical attitude, that one’s intention and interest in trade are important, and that tawakkul cannot be built on the right ground. As a result, the proponents of tahrīm al-makāsib disappeared because they could not gain a foothold in the Mu‘tazilite intellectual climate due to their erroneous reasoning. (shrink)

BackgroundDiscrimination in health care is an international challenge and a serious obstacle to justice and equality in health.Research objectiveThe purpose of this study was to design a grounded theory of discrimination in health care based on the experiences and perceptions of Iranian healthcare providers and patients.Research designThis qualitative study was conducted using by the grounded theory method.Participants and research contextData were collected through semi-structured interviews with 18 healthcare providers including 11 nurses, two physicians, two nurse’s assistants, and three patients in (...) two general hospitals in Tehran, Iran. Participants were selected through purposeful sampling and analyzed simultaneously using the Corbin and Strauss (2015) approach.Ethical considerationsThe study was approved by the Research Ethics Committee of the University of Social Welfare and Rehabilitation Sciences (Ethics code: IR.USWR.REC.1398.023). Also, after explaining the objectives of the study, all the participants completed and signed the written consent form.FindingsThe “culture of discrimination” was the study’s core category, reflecting the nature of discrimination in health care. The theory of “culture of discrimination in health care” is the result of five main categories: “individual social stimuli,” “culture of discrimination,” “unintentional discrimination,” “conflict with discrimination,” and “dissatisfaction with discriminatory behavior.” These categories cover the underlying factors, strategies, and outcomes of the discrimination process in health care.DiscussionThe results of the study showed that nurses and other health care providers experience unintentional discrimination. Unintentional discrimination refers to discriminatory behaviors and practices of health care providers.ConclusionThe theory of culture of discrimination in health care can be used as a practical guide to describe and understand the role of health care providers, especially nurses. Further studies with a quantitative approach to applying this theory in medical settings are recommended. (shrink)

In light of the recent focus in bioethics on questions of deliberate moral enhancement through the use of psychoactive drugs, Levy et al. (2014) argue that the more pressing issue may be the incidental effect that prescription drugs could already be having on moral agency. Although concerns have focused on the possibility of altering moral psychology through direct effects on brain function, the authors point out that this may already be a reality, albeit an unintentional one. They conclude from (...) their survey of prescription drugs already in use, that we should urgently investigate the ways they may be “influencing the shape of our societies” (2014, 123). The question of how we ought to respond to this possibility, I believe, must be considered in the broader context of existing attitudes and policy in response to substances with similar effects; and the relative significance of these drug effects compared with other factors, in particular social factors that shape society through their developmental influence on moral psychology. -/- First, it is important to consider the drugs described by the authors alongside widely used drugs with known, comparable effects. For example, alcohol has profound effects on features of cognition that seem relevant to moral agency, in altering risk assessment and increasing aggression (Bushman and Cooper 1990; George et al. 2005). Its impairing of inhibitory control arguably undermines the reflective processes that are often considered central to moral agency (Craigie 2011; Field et al. 2010). However, by and large the current policy adopted in liberal democratic societies is to educate people about these dangers but leave it up to adults to choose whether they use alcohol. Exceptions to this position are grounded in reasons of public protection, for example, in the case of blood alcohol limits for drivers in order to protect people against injury or death as a result of drunk driving. Restrictions are also sometimes placed on inebriation in the context of particular public roles, for example, serving on a jury, although the issue remains controversial (Law Reform Commission 2010, s. 8.21, 8.26, 8.27). This approach to alcohol regulation offers an established model for responding to the kinds of drugs in question. Broadly, it suggests that concerns about the effect of a drug on moral agency are only considered serious enough to warrant restricting its use when this puts others at risk of serious harms, or when a person is fulfilling a public role where sound decision making is of great importance (e.g., in maintaining trust in institutions such as the criminal justice system). Although at first it may be an alarming thought that pharmaceuticals [End Page 127] could be influencing individual moral psychology, the example of alcohol suggests that this this is a familiar experience, and something for which states already have a policy framework. -/- Caffeine is another commonly used drug with psychoactive properties that seem likely to affect moral agency. Along with potentially morally relevant effects on attention and aggression (Einöther and Giesbrecht 2013; Kuhns et al. 2010), research suggests a connection between cortisol—a hormone that is elevated by caffeine—and the processing of social cues relating to threat (Montoya et al. 2012; Putman et al. 2007). There are little in the way of restrictions on the use of caffeine. Nonetheless, one might be concerned about the possible effects of caffeine on moral agency and society, particularly if the effects are less obvious than in the case of alcohol (Kuhns et al. 2010). The same concern might apply to the pharmaceuticals in question. Perhaps there is a need to investigate these effects on thought and behavior because they are not easy to detect. The greater danger might be in the fact that people do not recognize how these drugs change their appraisals and decisions, rather than in the effects themselves. It seems a reasonable suggestion that if a drug has significant enough effects on interpersonal relationships, then this information should be made available as a part of an informed consent procedure. (shrink)

The Ethics of Hooking Up: Casual Sex and Moral Philosophy on Campus provides a systematic moral analysis of hooking up, or sexual activity between people who barely know each other, frequently while intoxicated, and with little or no verbal interaction. It explores the moral quandaries resulting from this potent combination of sex, alcohol, near-anonymity, and limited communication, focusing in particular on issues involving consent and respect. After delineating common practices involving casual sex on college campuses and exploring the difficulty (...) of reaching mutual consent, author James Rocha argues that respect, kindness, sensitivity, and honest communication are also necessary conditions for morally permissible casual sex. Key Features Provides a rare, systematic examination of the ethics of the hook up practice, which is the dominant mating practice for young people today. Analyzes the moral concepts of consent and respect in the context of hooking up, which provides significant moral challenges that highlight how we should obtain consent and show respect to one another. Argues for a moral paradigm shift in how young people hook up, emphasizing ways to avoid unintentionally committing grave moral wrongs. Situates the philosophy of casual sex in real life hook up practice, enabling us to rethink overly abstracted moral views on casual sex. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Bonaventure, the Body, and the Aesthetics of Salvation by Rachel DaviesRobin LandrithRachel Davies, Bonaventure, the Body, and the Aesthetics of Salvation. Cambridge, UK: Cambridge University Press, 2020. Pp. Xii + 187. $105.00. ISBN: 9781108485371. Rachel Davies's Bonaventure, the Body, and the Aesthetics of Salvation finds in Bonaventure a resource for contemporary theological efforts to read embodied experience as a primary text. She argues that Bonaventure supports these efforts (...) by affirming the body as an aid to the soul in the whole self's sanctification. In her effort to read Bonaventure's account of the body in aesthetic terms, Davies argues that Bonaventure sees the suffering body as the site of the revelation of God's beauty. Distinguishing her reading from that of Hans Urs von Balthasar, however, Davies avoids suggesting that bodily suffering is beautiful per se (19–21), emphasizing instead the need to seek the beauty unique to bodily suffering "through" that suffering, looking toward its redemption (25). The beauty of suffering is beauty in potency—beautiful only insofar as it is grafted onto Christ's suffering, and, like Christ's suffering, only revealed as beautiful when it appears in the resurrected body. For Davies, the "deep logic" (32) by which Christ's suffering and resurrection transform human suffering permits hope that suffering can be made meaningful, but that same logic also refuses premature attempts to say how it will be made meaningful. Davies's argument is most persuasive when read as a mystical meditation on the beauty unique to human suffering—that is, as a theo-logical text in the formal sense. There is a pastoral sensitivity motivating her scholarly contribution. The book attempts to address "a common human struggle: the experience of bodily diminishment, which threatens to turn corporeality into a noetic obstacle rather than the communicative medium it was intended to be" (170). In some ways, Davies shows Bonaventure to be a useful resource in pursuit of this aim. At the same time, Bonaventure's works and milieu create conditions within which Davies's scholarly and pastoral theses occasionally work against each other. Davies first intends to highlight Bonaventure's (occasionally) favorable view [End Page 245] of the body—a view which stands apart from less-favorable assessments frequent in medieval theology (32). In doing so, Davies recovers an important, surprisingly tender, instance of medieval sensitivity to the soul's abandonment of the body in sin alongside medieval references to the body's rebellion against the soul. As a scholarly contribution, Davies's work draws attention to these existing, if at times undeveloped, intuitions within Bonaventure's account of the role of the body in the process of sanctification. Still, it is difficult to see an obvious pastoral application for the claim that the soul abandons the body when we consider cases of involuntary chronic or terminal suffering. Davies does not try to offer one, but neither does she address the fact that shifting the accent to the guilt of the soul in abandoning the body risks shifting the blame for suffering—even chronic suffering—to the sufferer herself. Davies by no means thinks the blame lies here. She is attentive to the challenges that such suffering presents to the sufferer. Indeed, it is to alleviate some of these challenges that Davies emphasizes the mystical, rather than imitative, aspect of Bonaventure's account of the effect of Christ's suffering on other instances of human suffering (109). She observes that Christ's "victory is a victory for the entire Church," which means that "those who cannot begin to imagine the transfiguration of their own sufferings, or direct their feelings toward any sort of fruitfulness, can at least consent to be carried along passively in Christ's return to the Father" (108). This "requires nothing but blind trust, and does not ask people to find meaning in their own suffering, or even to be at peace with it" (108). I am convinced by the pastoral merit of this point, and of the capacity of Bonaventure's mystical soteriology to sustain it. But the notion of an unconscious or unintentional transfiguration of suffering raises two further questions regarding attempts to apply Davies's... (shrink)

Background: The factors influencing parents’ willingness to enroll their children in biobanks are poorly understood. This study sought to assess parents’ willingness to enroll their children, and their perceived benefits, concerns, and information needs under different consent and data-sharing scenarios, and to identify factors associated with willingness. Methods: This large, experimental survey of patients at the 11 eMERGE Network sites used a disproportionate stratified sampling scheme to enrich the sample with historically underrepresented groups. Participants were randomized to receive one (...) of three consent and data-sharing scenarios. Results: In total, 90,000 surveys were mailed and 13,000 individuals responded (15.8% response rate). 5737 respondents were parents of minor children. Overall, 55% (95% confidence interval 50–59%) of parents were willing to enroll their youngest minor child in a hypothetical biobank; willingness did not differ between consent and data-sharing scenarios. Lower educational attainment, higher religiosity, lower trust, worries about privacy, and attitudes about benefits, concerns, and information needs were independently associated with less willingness to allow their child to participate. Of parents who were willing to participate themselves, 25% were not willing to allow their child to participate. Being willing to participate but not willing to allow one’s child to participate was independently associated with multiple factors, including race, lower educational attainment, lower annual household income, public health care insurance, and higher religiosity. Conclusions: Fifty-five percent of parents were willing to allow their youngest minor child to participate in a hypothetical biobank. Building trust, protecting privacy, and addressing attitudes may increase enrollment and diversity in pediatric biobanks. (shrink)

Research ethics committees and institutional review boards spend considerable time developing, scrutinising, and revising specific consent processes and materials for survey-based studies conducted on crowdsourcing and online recruitment platforms such as MTurk and Prolific. However, there is evidence to suggest that many users of ICT services do not read the information provided as part of the consent process and they habitually provide or refuse their consent without adequate reflection. In principle, these practices call into question the validity (...) of their consent. In this paper we argue that although the ‘no read problem’ and the routinisation of consent may apply to research participants’ consent practices for studies on crowdsourcing platforms, this is not a serious problem. Furthermore, given that the informational requirements for informed consent in these contexts are minimal, we argue that these participants are, nevertheless, sufficiently informed to give valid consent. We conclude that research ethics committees and institutional review boards should only agonise over the precise details of the informed consent process and materials in those rare cases where appreciable risks to research participants need to be managed. (shrink)

Most regulations and guidelines require that potential research participants be told a great deal of information during the consent process. Many of these documents, and most of the scholars who consider the consent process, assume that all this information must be disclosed because it must all be understood. However, a wide range of studies surveying apparently competent participants in clinical trials around the world show that many do not understand key aspects of what they have been told. The (...) standard view of the conditions for valid consent therefore implies that these people have failed to give valid consent to research participation. In this paper we argue that the standard view is false. The primary function of the requirement that researchers disclose information about a study is the avoidance of illegitimate control over someone’s consent decision, which is a form of fraud.We derive the content and manner of appropriate disclosure by analysing the ways in which the manipulation of information can invalidate consent. Our analysis shows that the informational requirements for valid consent are conceptually distinct and thus unlikely to have identical contents. This implies that consent can be valid when not everything that ought to be disclosed by the person asking for consent is understood by the person who proffers it. (shrink)

Most regulations and guidelines require that potential research participants be told a great deal of information during the consent process. Many of these documents, and most of the scholars who consider the consent process, assume that all this information must be disclosed because it must all be understood. However, a wide range of studies surveying apparently competent participants in clinical trials around the world show that many do not understand key aspects of what they have been told. The (...) standard view of the conditions for valid consent therefore implies that these people have failed to give valid consent to research participation. In this paper we argue that the standard view is false. The primary function of the requirement that researchers disclose information about a study is the avoidance of illegitimate control over someone’s consent decision, which is a form of fraud.We derive the content and manner of appropriate disclosure by analysing the ways in which the manipulation of information can invalidate consent. Our analysis shows that the informational requirements for valid consent are conceptually distinct and thus unlikely to have identical contents. This implies that consent can be valid when not everything that ought to be disclosed by the person asking for consent is understood by the person who proffers it. (shrink)

ABSTRACT:The notion of “democracy” has become a much-debated concept in scholarship on business ethics, management, and organization studies. The strategy of this paper is to distinguish between a principle of organization that fosters participation (type I democracy) and a principle of legitimation that draws on consent (type II democracy). Based on this distinction, we highlight conceptual shortcomings of the literature on stakeholder democracy. We demonstrate that parts of the literature tend to confound ends with means. Many approaches employ type (...) I democracy notions of participation and often take for granted that this also improves type II democratic legitimation. We hold this to be a mistake. We provide examples of the ambiguity of organizational procedures and show that under some circumstances a decrease in the degree of participation may actually increase legitimation because a governance structure that results in higher productivity can provide higher benefits for all parties involved, serve their interests and therefore meet their agreement. Less type I democracy may mean more type II democracy. We believe this to be an important insight for judging (and further improving) the legitimacy of both capitalistic firms and competitive markets. (shrink)

Patients belonging to ethnic, racial, and religious minorities have been all but excluded from the legal academy’s ongoing conversation about informed consent. Perhaps this is just as well, since the conversation appears to have concluded that the doctrine has failed to serve as a meaningful regulation of clinical relationships. Informed consent does not operate in practice the way it was intended in theory. More than a decade ago, Peter Schuck noted the “informed consent gap” that distinguishes the (...) “proper” law of informed consent “on the books” from the actual consent law in action, and called for a more contextualized approach to informed consent. Susan Wolf later called for a systemic approach to informed consent in order to accommodate multiple decision points in the managed care setting. Some reformers have sought enhancements to expand the doctrine. (shrink)

Sex and dementia is becoming an increasingly important topic in applied ethics. By the year 2030, more than 74.7 million people are expected to be diagnosed with dementia worldwide; many of these people may want to engage in sex. The question of how to manage cases of sex and dementia is occurring more frequently in practical cases because of our aging population. The primary reason that sex and dementia is ethically complex is because sexual consent is both legally and (...) morally significant, yet many people with dementia may be unable to consent in accordance with current standards. In this dissertation, I introduce three frameworks that could be used to approach cases of sex and dementia. The first framework is that of relational autonomy and supported decision-making; this framework tries to enable people with dementia to make autonomous sexual decisions with support. The next approach is a framework of advance sexual consent, which considers the relevance of prior autonomous sexual decisions. The third framework focuses on prioritizing well-being above a person’s capacity to make autonomous decisions and to consent to sex. I assess each framework and consider their positive and negative nuances. The overall goal is to balance the right to sexuality while at the same time protecting people with dementia from undue harm. Ultimately, this dissertation shows that cases of sex and dementia ought to be managed on a case-by-case basis; one framework will not work for every context. In order to approach situations on a case-by-case basis, I contend that a process of weighing and balancing norms and principles is necessary. I use Beauchamp and Childress’s method of weighing and balancing to propose a systematic procedure. This process takes various factors into account in order to determine how to proceed in an ethically defensible manner. According to an approach of weighing and balancing, sexual acts would not be immediately barred based on a person’s inability to consent; rather, a person’s present convictions, the sexual activity to which they want to participate, the possibility of experiencing undue harm, their prior wishes and values, their capacity to make autonomous decisions with support, etc. would all be considered. Overall, this dissertation contributes to the complex topic of sex and dementia and offers a starting point for further discussion on how to approach these cases in practice. (shrink)

The use of placebo in clinical practice has been the topic of extensive debate in the bioethics literature, with much scholarship focusing on concerns regarding deception. While considerations of placebo without deception have largely centred on open-label placebo, this paper considers a different kind of ethical quandary regarding placebo without an intent to deceive—one where the provider believes a treatment is effective due to a direct physiological mechanism, even though that belief may not be supported by rigorous scientific evidence. This (...) is often the case with complementary and alternative medicine (CAM) techniques and also with some mainstream therapies that have not proven to be better than sham. Using one such CAM technique as a case study—electroencephalography (EEG) neurofeedback for attention-deficit/hyperactivity disorder (ADHD)—this paper explores the ethics of providing therapies that may have some beneficial effect, although one that is likely due to placebo effect. First, we provide background on EEG neurofeedback for ADHD and its evidence base, showing how it has proven to be equivalent to—but not better than—sham neurofeedback. Subsequently, we explore whether offering therapies that are claimed to work via specific physical pathways, but may actually work due to the placebo effect, constitute deception. We suggest that this practice may constitute unintentional deception regarding mechanism of action. Ultimately, we argue that providers have increased information provision obligations when offering treatments that diverge from standard of care and we make recommendations for mitigating unintentional deception. (shrink)

Proper procedures for informed consent are widely recognized as an ethical requirement for biomedical research involving human beings, in particular as a means to respect the autonomy and personal integrity of potential and actual research participants.

Surgical Informed Consent has long been recognized as an important component of modern medicine. The ultimate goals of SIC are to improve clients’ understanding of the intended procedure, increase client satisfaction, maintain trust between clients and health providers, and ultimately minimize litigation issues related to surgical procedures. The purpose of the current study is to assess the comprehensiveness of the SIC process for women undergoing obstetric and gynecologic surgeries. A hospital-based cross-sectional study was undertaken at Hawassa University Comprehensive Specialized (...) Hospital in November and December, 2016. A total of 230 women who underwent obstetric and/or gynecologic surgeries were interviewed immediately after their hospital discharge to assess their experience of the SIC process. Thirteen components of SIC were used based on international recommendations, including the Royal College of Surgeon’s standards of informed consent practices for surgical procedures. Descriptive summaries are presented in tables and figures. Forty percent of respondents were aged between 25 and 29 years. Nearly a quarter had no formal education. More than half of respondents had undergone an emergency surgical procedure. Only 18.4% of respondents reported that the surgeon performing the operation had offered SIC, while 36.6% of respondents could not recall who had offered SIC. All except one respondent provided written consent to undergo a surgical procedure. However, 8.3% of respondents received SIC service while already on the operation table for their procedure. Only 73.9% of respondents were informed about the availability of alternative treatment options. Additionally, a majority of respondents were not informed about the type of anesthesia to be used and related complications. Only 54.2% of respondents reported that they had been offered at least six of the 13 SIC components used by the investigators. There is gap in the provision of comprehensive and standardized pre-operative counseling for obstetric and gynecologic surgeries in the study hospital. This has a detrimental effect on the overall quality of care clients receive, specifically in terms of client expectations and information needs. (shrink)

The COVID-19 global pandemic has shone a light on several important ethical questions, ranging from fairness in resource allocation to the ethical justification of government mandates. In addition to these institutional issues, there are also several ethical questions that arise at the interpersonal level. This essay focuses on several of these issues. In particular, I argue that, despite the insistence in public health messaging that avoiding infecting others constitutes ‘saving lives’, virus transmission that results in death constitutes an act of (...) killing. Whether this killing is wrongful depends on several factors. I consider one intuitively plausible view—namely, that in many cases, killing via unintentional transmission is not wrongful, because the parties in question have implicitly waived their rights against this harm, often via reciprocal risk imposition. I argue that this view is mistaken, but that its central insight can be better captured by identifying the appropriate standards of blame that we ought to apply during a pandemic. I conclude by showing how these conclusions can be fruitfully applied to certain institutional questions, such as helping to justify restricting government mandates. (shrink)

Retractions solicited by authors following the discovery of an unintentional error—what we henceforth call a “self-retraction”—are a new phenomenon of growing importance, about which very little is known. Here we present results of a small qualitative study aimed at gaining preliminary insights about circumstances, motivations and beliefs that accompanied the experience of a self-retraction. We identified retraction notes that unambiguously reported an honest error and that had been published between the years 2010 and 2015. We limited our sample to (...) retractions with at least one co-author based in the Netherlands, Belgium, United Kingdom, Germany or a Scandinavian country, and we invited these authors to a semi-structured interview. Fourteen authors accepted our invitation. Contrary to our initial assumptions, most of our interviewees had not originally intended to retract their paper. They had contacted the journal to request a correction and the decision to retract had been made by journal editors. All interviewees reported that having to retract their own publication made them concerned for their scientific reputation and career, often causing considerable stress and anxiety. Interviewees also encountered difficulties in communicating with the journal and recalled other procedural issues that had unnecessarily slowed down the process of self-retraction. Intriguingly, however, all interviewees reported how, contrary to their own expectations, the self-retraction had brought no damage to their reputation and in some cases had actually improved it. We also examined the ethical motivations that interviewees ascribed, retrospectively, to their actions and found that such motivations included a combination of moral and prudential considerations. These preliminary results suggest that scientists would welcome innovations to facilitate the process of self-retraction. (shrink)

Background: Informed consent for genetic tests is a well-established practice. It should be based on good quality information and in keeping with the patient’s values. Existing informed consent assessment tools assess knowledge and values. Nevertheless, there is no consensus on what specific elements need to be discussed or considered in the consent process for genetic tests.Methods: We performed a systematic review to identify all factors involved in the decision-making and consent process about genetic testing, from the (...) perspective of patients. Through public databases, we identified studies reporting factors that influence the decision to accept or decline genetic testing. Studies were included if they reported the perspective of patients or at-risk individuals. All articles were thematically coded.Results: 1989 articles were reviewed: 70 met inclusion criteria and 12 additional articles were identified through the references of included studies. Coding of the 82 articles led to the identification of 45 factors involved in decision-making and consent, which were initially divided into three domains: in favor of, against or with an undetermined influence on genetic testing. Each factor was also divided into three subdomains relating to the informed choice concept: knowledge, values or other. The factors in the “other” subdomain were all related to the context of testing (e.g. timing, cost, influence of family members, etc), and were present in all three domains.Conclusions: We describe the network of factors contributing to decision-making and consent process and identify the context of genetic testing as a third component to influence this process. Future studies should consider the evaluation of contextual factors as an important and relevant component of the consent and decision-making process about genetic tests. Based on these results, we plan to develop and test a more comprehensive tool to assess informed consent for genetic testing. (shrink)

In this paper I assess the labour ward admission policies introduced by some National Health Service trusts during the COVID-19 pandemic, arguing that these intersected with other policies in a manner which may have coerced birthing people into consenting to vaginal examinations they might have otherwise refused. In order to fully understand the potential severity of these policies, I situate this critique in the historical and contemporary context of the problematic relationship between consent and vaginal examinations. Identifying the legal (...) wrongs associated with performing coerced vaginal examinations, I highlight that the law is inadequately equipped to provide appropriate redress. Further, I illustrate that the issue explored in this paper reflects broader problems which exist with regard to the focus of, and the investment in, the maternity services. (shrink)

Despite the fact that the requirement to obtain informed consent for medical procedures is deeply enshrined in both U.S. moral and legal doctrine, empirical studies and anecdotal accounts show that women's rights to informed consent and refusal of treatment are routinely undermined and ignored during childbirth. For example, citing the most recent Listening to Mothers survey, Marianne Nieuwenhuijze and Lisa Kane Low state that "a significant number of women said they felt pressure from a caregiver to agree to (...) having an intervention that they did not want during birth". Specifically, Nieuwenhuijze and Low cite that "19% of women who did not have epidural analgesia felt... (shrink)

ABSTRACT The use of broad consent for genomics research raises important ethical questions for the conduct of genomics research, including relating to its acceptability to research participants and comprehension of difficult scientific concepts. To explore these and other challenges, we conducted a study using qualitative methods with participants enrolled in an H3Africa Rheumatic Heart Disease genomics study (the RHDGen network) in Zambia to explore their views on broad consent, sample and data sharing and secondary use. In-depth interviews were (...) conducted with RHDGen participants (n = 18), study staff (n = 5) and with individuals who refused to participate (n = 3). In general, broad consent was seen to be reasonable if reasons for storing the samples for future research use were disclosed. Some felt that broad consent should be restricted by specifying planned future studies and that secondary research should ideally relate to original disease for which samples were collected. A few participants felt that broad consent would delay the return of research results to participants. This study echoes findings in other similar studies in other parts of the continent that suggested that broad consent could be an acceptable consent model in Africa if careful thought is given to restrictions on re-use. (shrink)

Data platforms represent a new paradigm for carrying out health research. In the platform model, datasets are pooled for remote access and analysis, so novel insights for developing better stratified and/or personalised medicine approaches can be derived from their integration. If the integration of diverse datasets enables development of more accurate risk indicators, prognostic factors, or better treatments and interventions, this obviates the need for the sharing and reuse of data; and a platform-based approach is an appropriate model for facilitating (...) this. Platform-based approaches thus require new thinking about consent. Here we defend an approach to meeting this challenge within the data platform model, grounded in: the notion of ‘reasonable expectations’ for the reuse of data; Waldron’s account of ‘integrity’ as a heuristic for managing disagreement about the ethical permissibility of the approach; and the element of the social contract that emphasises the importance of public engagement in embedding new norms of research consistent with changing technological realities. While a social contract approach may sound appealing, however, it is incoherent in the context at hand. We defend a way forward guided by that part of the social contract which requires public approval for the proposal and argue that we have moral reasons to endorse a wider presumption of data reuse. However, we show that the relationship in question is not recognisably contractual and that the social contract approach is therefore misleading in this context. We conclude stating four requirements on which the legitimacy of our proposal rests. (shrink)

Disease radically changes the life of many people and satisfies formal criteria for being a transformative experience. According to the influential philosophy of Paul, transformative experiences undermine traditional criteria for rational decision-making. Thus, the transformative experience of disease can challenge basic principles and rules in medical ethics, such as patient autonomy and informed consent. This article applies Paul’s theory of transformative experience and its expansion by Carel and Kidd to investigate the implications for medical ethics. It leads to the (...) very uncomfortable conclusion that disease involves transformative experiences in ways that can reduce people’s rational decision-making ability and undermine the basic principle of respect for autonomy and the moral rule of informed consent. While such cases are limited, they are crucial for medical ethics and health policy and deserve more attention and further scrutiny. (shrink)

Carol Gould argues that democratic institutions can serve as mechanisms of informed consent or could at least facilitate creating regulations and other structures which facilitate informed consent in bioethics, medicine, and elsewhere. I am sceptical. I argue that democracies cannot serve as vehicles of consent, let alone informed consent. Further, the problems of democratic ignorance and irrationality created significant barriers to democratic deliberation helping to produce better regulations or conditions for informed consent. Democracy is not (...) a good surrogate for consent. (shrink)

This book supports the emerging field of vascularized composite allotransplantation for face and upper-limb transplants by providing a revised, ethically appropriate consent model which takes into account what is actually required of facial and upper extremity transplant recipients. In place of consent as permission-giving, waiver, or autonomous authorization, this book imagines consent as an ongoing mutual commitment, i.e. as covenant consent. The covenant consent model highlights the need for a durable personal relationship between the patient/subject (...) and the care provider/researcher. Such a relationship is crucial given the recovery period of 5 years or more for VCA recipients. The case for covenant consent is made by first examining the field of vascularized composite allotransplantation, the history and present understandings of consent in health care, and the history and use of the covenant concept from its origins through its applications to health care ethics today. This book explains how standard approaches to consent are inadequate in light of the particular features of facial and upper limb transplantation. In contrast, use of the covenant concept creates a consent model that is more appropriate ethically for these very complex surgeries and long-term recoveries. (shrink)

Informed consent is recognized as a primary ethical requirement to conduct research involving humans. In the investigations with the use of human biological material, informed consent (IC) assumes a differentiated condition on account of the many future possibilities. This work presents suitable alternatives for IC regarding the storage and use of human biological material in research, according to new Brazilian regulations. Both norms – Resolution 441/11 of the National Health Council, approved on 12 May 2011, and Ordinance 2.201 (...) (NATIONAL GUIDELINES FOR BIOREPOSITORIES AND BIOBANKS OF HUMAN BIOLOGICAL MATERIAL FOR RESEARCH PURPOSE) of the Brazil Ministry of Health, approved on 14 September 2011 – state that the consent of subjects for the collection, storage and use of samples stored in Biobanks is necessarily established by means of a Free and Informed Consent Form (ICF). In order to obtain individual and formal statements, this form should contain the following two mutually exclusive options: an explanation about the use of the stored material in each research study, and the need for new consent or the waiver thereof when the material is used for a new study. On the other hand, ICF suitable for Biorepositories must be exclusive and related to specific research. Although Brazilian and international regulations identify the main aspects to be included in the IC, efforts are still necessary to improve the consent process, so that the document will become a bond of trust between subject and researcher. (shrink)

Volume 20, Issue 6, June 2020, Page 25-27.

For more than sixty years, surgeons have used bioethical strategies to promote patient self‐determination, many of these now collectively described as “informed consent.” Yet the core framework—understanding, risks, benefits, and alternatives—fails to support patients in deliberation about treatment. We find that surgeons translate this framework into an overly complicated technical explanation of disease and treatment and an overly simplified narrative that surgery will “fix” the problem. They omit critical information about the goals and downsides of surgery and present untenable (...) options as a matter of patient choice. We propose a novel framework called “better conversations.” Herein, surgeons provide context about clinical norms, establish the goals of surgery, and comprehensively delineate the downsides of surgery to generate a deliberative space for patients to consider whether surgery is right for them. This paradigm shift meets the standards for informed consent, supports deliberation, and allows patients to anticipate and prepare for the experience of treatment. (shrink)

It is widely believed that informed consent must be obtained from a patient for it to be morally permissible to administer to him/her a medical intervention. The same has been argued for the use of neurointerventions administered to criminal offenders. Arguments in favour of a consent requirement for neurointerventions can take two forms. First, according to absolutist views, neurointerventions shouldneverbe administered without an offender’s informed consent. However, I argue that these views are ultimately unpersuasive. The second, and (...) more plausible, form defences of the consent requirement may take are more moderate in that they accept the use of neurointerventions in some cases, but not in others. Based on common rationales for consent in medical interventions, I discuss whether four moderate approaches in defence of the informed consent requirement for medical interventions succeed in establishing that informed consent must be obtained from offenders prior to administering neurointerventions to them. I offer novel critical perspectives on approaches that have already received some attention in the literature, and I critically discuss other approaches to defending informed consent in a medical context that have not yet received due attention. Ultimately, I argue that it is not obvious that any of these considerations support a requirement of offenders’ informed consent to neurointerventions. Lastly, however, I suggest that there is at least one overlooked fact as regards how courts currently employ mandatory neurointerventions, which may support such a requirement. (shrink)

Laura Odwazny and Benjamin Berkman have raised several challenges regarding the new reasonable person standard in the revised Common Rule, which states that in‐ formed consent requires potential research subjects be provided with information a reasonable person would want to know to make an informed decision on whether to participate in a study. Our aim is to offer a response to the challenges Odwazny and Berkman raise, which include the need for a reasonable person standard that can be applied (...) consistently across institutional review boards and that does not stigmatize marginal groups. In response, we argue that the standard ought to be based in an ordinary rather than ideal person conception of reasonable person and that the standard ought to employ what we call a liberal constraint: the reasonability standard must be malleable enough such that a wide variety of individuals with different, unique value systems would endorse it. We conclude by suggesting some of the likely consequences our view would have, if adopted. (shrink)

Decisions concerning children in the health care setting have engendered significant controversy and sparked ethics policies and statements, legal action, and guidelines regarding who ought to make decisions involving children and how such decisions ought to be made. Traditionally, parents have been the default decision-makers for children not only with regard to health care but with regard to other matters, such as religious practice and education. In recent decades, there has been a steady trend away from the view that parents (...) are in authority over their children and toward the view that children are rights-bearers who should be granted greater authority over themselves. The mature minor doctrine refers to the decision to grant mature minors the authority to make decisions traditionally reserved for their parents. This essay (1) documents the trend towards expanding the understanding of some minors as “mature” and hence as having the right and authority to give informed consent, (2) examines the reasons for which some commentators have a special interest in expanding the mature minor doctrine to the research setting and allowing minors to enroll in research without parental permission, and (3) defends the view that the mature minor doctrine, regardless of its application to clinical health care decisions, ought to be set aside in the research setting in favor of greater parental involvement. (shrink)

Informed consent is a vital part of ethical research. In emergency health care research environments such as ambulance services and emergency departments, it is sometimes necessary to conduct trial interventions or observations without patient consent. At times where treatment is time critical, it may be impossible or inappropriate to seek consent from next of kin. Emergency medicine is one of the few areas where the process of informed consent can be waived to allow research to proceed (...) without patient consent. This article will explore the ethics of informed consent in the prehospital emergency research context. This will include an overview of current Australian guidelines for ethical research, and recent changes in law internationally which have affected the conduct of international emergency health research. An overview of the ethical reasoning behind the waiver of informed consent in emergency research is presented, also addressing issues relating to emergency health research such as proxy consent, unconscious patients, and patient decision making capacity. The unusual circumstances encountered in the prehospital ambulance environment will also be discussed, including the dependent and coercive relationship between patients and ambulance professionals, and a lack of alternatives for care and transport for patients who refuse consent. The conflict arising from differences in medical culture and values between patients and health care professionals will also briefly be discussed. It will be argued that, while emergency care research should not require informed consent due to the restrictions of time and dependent nature of the relationship between patient and health professional, emergency health researchers still have a responsibility to consider the patients’ perspective when considering the ethical issues of an emergency research project, particularly in the prehospital environment. (shrink)

There are a number of dispositionalist solutions to the free will problem based on freedom consisting in the agent's exercise of a power. But if a subject a is free when they exercise their power P, there is an objection to be overcome from the possibility of power implantation. A brainwasher, rather than directly manipulating a subject's movements, can instead implant in them a desire, to be understood as a disposition to act, and allow the subject to exercise such a (...) power. It seems that, according to the dispositionalist theory of freedom, such an agent would still count as acting freely. There is a strong non-consent intuition that a is not free in such a case because they did not consent to having the power P—the desire in question. Filling out this intuition is not straightforward. But it can be done in terms of the exercise of P being regulated by higher-order powers of self-reflection. Such regulation is what allows an agent to either take ownership of a power or to reject it. (shrink)

In conducting research on humans, respect for human dignity requires investigators to obtain informed consent. Institutional pressures, however, often reduce the informed consent form to a signature on a document. Unfortunately, people often do not read or understand these documents. In the present effort, we argue that the key problem here arises because investigators often do not take into account the psychology of participants. Based on 3 articles, we argue that informed consent requires investigators to help participants (...) “make sense” of a study, and its implications, for both themselves and others. Informed consent procedures that might encourage participant sensemaking are discussed. (shrink)

Ethical medical care of pregnant women in Australia should include the real provision of information regarding the risks and benefits of vaginal birth. Routinely obtaining consent for the different ways in which childbirth is commonly intervened on and the assistance involved (such as midwife-led care or a planned caesarean section) and providing sufficient information for women to evaluate the harms and benefits of the care on offer, would not only enable the empowerment of women but would align with the (...) current standard of care as established by Rogers v Whittaker. (shrink)

The use of decision-making capacity assessments in clinical medicine is an underdeveloped yet quickly growing practice. Despite the ethical and clinical importance of these assessments as a means of protecting patient autonomy, clinicians, philosophers, and ethicists have identified a number of practical and theoretical hurdles which remain unresolved. One ethically important yet largely unaddressed issue is whether, and to what extent physicians ought to inform and obtain consent from patients prior to initiating a capacity assessment. In what follows, I (...) address the following question: Must, or should, physicians obtain consent for capacity assessments? I argue that physicians have an ethical obligation to obtain express patient consent for capacity assessments, and in doing so, I challenge the predominant view which requires physicians to merely inform patients without obtaining consent. I then identify an underlying philosophical paradox that complicates the clinician's duty to obtain consent: in short, consent is needed for an assessment of one's ability to consent. Finally, I recommend a practical solution to this paradox of consent for capacity assessments by proposing a model of double consent from both the patient and health care representative. (shrink)