During the last two decades, national bioethics committees have been established in many countries all over the world. They vary with respect to their structure, composition, and working methods, but the main functions are similar. They are supposed to facilitate public debate on controversial bioethical issues and produce opinions and recommendations that can help inform the public and policy‐makers. The dialogue among national bioethics committees is also increasingly important in the globalized world, where biomedical technologies raise ethical dilemmas that traverse (...) national borders. It is not surprising, therefore, that the committees are established and active in the technologically advanced countries. There have also been a few international capacity‐building initiatives in bioethics that have had a dual task: networking among existing national bioethics committees and helping establish such committees in those countries that still lack them. The problem is that, due to a lack of information, it is not clear what problems and challenges committees face in the transitioning societies often characterized as low‐ and middle‐income countries. (shrink)

ABSTRACT:Global multi-stakeholder initiatives are important instruments that have the potential to improve the social and environmental sustainability of global supply chains. However, they often fail to comprehensively address the needs and interests of various supply-chain participants. While voluntary in nature, MSIs have most often been implemented through coercive approaches, resulting in friction among their participants and in systemic problems with decoupling. Additionally, in those cases in which deliberation was constrained between and amongst participants, collaborative approaches have often failed to materialize. (...) Our framework focuses on two key aspects of these breakdowns: assumptions about the orientation of MSI participants, and the deliberation processes that participants use to engage with each other to create these initiatives and sustain them over time. Drawing from stakeholder and deliberation theories, we revisit the concept of MSIs and show how their deliberative capacity may be enhanced in order to encourage participants to collaborate voluntarily. (shrink)

As an international IRB collaboration project, we set out to develop an approach to enhance the understanding of issues related to the conduct of human research with an international partner. While the larger project included two specific aims, the activities supporting the first aim are addressed in this paper—specifically, human research protection program capacity strengthening in Cali, Colombia, through the development of an infrastructure that supports the conduct of human research with appropriate protection of subjects and access to new resources (...) at the international site. (shrink)

Multi-stakeholder initiatives (MSIs)—private governance mechanisms involving firms, civil society organizations, and other actors deliberating to set rules, such as standards or codes of conduct, with which firms comply voluntarily—have become important tools for governing global business activities and the social and environmental consequences of these activities. Yet, this growth is paralleled with concerns about MSIs’ deliberative capacity, including the limited inclusion of some marginalized stakeholders, bias toward corporate interests, and, ultimately, ineffectiveness in their role as regulators. In this article, we (...) conceptualize MSIs as deliberative systems to open the black box of the different elements that make up the MSI polity and better understand how their deliberative capacity hinges on problems in different elements. On the basis of this conceptualization, we examine how deliberative mini-publics—forums in which a randomly selected group of individuals from a particular population engage in learning and facilitated deliberations about a topic—can improve the deliberative capacity of MSIs. (shrink)

Health research initiatives worldwide are growing in scope and complexity, particularly as they move into the developing world. Expanding health research activity in low- and middle-income countries has resulted in a commensurate rise in the need for sound ethical review structures and functions in the form of Research Ethics Committees (RECs). Yet these seem to be lagging behind as a result of the enormous challenges facing these countries, including poor resource availability and lack of capacity. There is thus an urgent (...) need for ongoing capacity and resource development in these regions in general, and in Africa in particular. Similarly, there is a need for research and initiatives that can identify existing capacity and funding and indicate the areas where this needs to be developed.This discussion paper argues that the Mapping African Research Ethics Capacity (MARC) project is a timely initiative aimed at identifying existing capacity. MARC provides a platform and tool on the Council on Health Research for Development's (COHRED) Health Research website (HRWeb), which can be used by RECs and key stakeholders in health research in Africa to identify capacity, constraints and development needs. MARC intends to provide the first comprehensive interactive database of RECs in Africa, which will allow for the identification of key relationships and analyses of capacity. The potential of MARC lies in the mapping of current ethical review activity onto capacity needs. This paper serves as a starting point by providing a descriptive illustration of the current state of RECs in Africa. (shrink)

The notion of a capacity in the sense of a power to bring about or undergo change plays a key role in Aristotle’s theories about the natural world. However, in Metaphysics Θ Aristotle also extends ‘ capacity ’, and the corresponding concept of ‘activity’, to cases where we want to say that something is in capacity, or in activity, such and such but not, or not directly, in virtue of being capable of initiating or undergoing change. This paper seeks to (...) clarify and confirm a certain view of how Aristotle wishes us to see the relationship between the two uses of ‘ capacity ’ and ‘activity’. To that end, I consider also Aristotle’s employment of the terms in the De Anima, which sheds light on the key examples which direct the discussion in Metaph. Θ. (shrink)

A needs assessment survey of ethics review committees (ERCs) across Africa was conducted in order to establish their major needs and areas of weaknesses in terms of ethical review capacity. The response rate was 84% (31 of 37 targeted committees), and committees surveyed were located in 18 African countries. The majority of the responding committees (61%) have been in existence between 5 and 10 years; approximately 74% of the respondents were institutional committees, with the remainder being either national (6/31) or (...) regional (2/31). In terms of the ethical review process, nine of the 31 committees that responded did not have standard operating procedures (SOPs), and seven of the 22 that did have SOPs had never revised them after their initial development (an average period of three years). Of the 31 committees, 10 operated without any ethical guidelines. Many of the committees (13/30) met once per month, and the number of proposals reviewed annually varied, ranging from five to over 100. All respondents relied on paper-based data management and archiving systems. Overall, the survey identified the major constraints on ERCs as lack of office equipment, outdated or lack of SOPs, lack of electronic data management systems, inadequate resources, lack of or insufficient expertise on the committees, and poor recognition of the importance of the role of the committees. Consequently, the authors are addressing the identified needs and weaknesses through the Bill and Melinda Gates Foundation-funded capacity building project. The impact of the intervention project will be assessed during and at the end of the four-year longitudinal project. (shrink)

We ordinarily suppose that there is a difference between having and failing to exercise a rational capacity on the one hand, and lacking a rational capacity altogether on the other. This is crucial for our allocations of responsibility. Someone who has but fails to exercise a capacity is responsible for their failure to exercise their capacity, whereas someone who lacks a capacity altogether is not. However, as Gary Watson pointed out in his seminal essay ’Skepticism about Weakness of Will’, the (...) idea of an unexercised capacity is much more difficult to make sense of than it initially appears. The aim of ’Rational Capacities’ is to provide the needed explication of this idea. (shrink)

Background. The increased number of clinical trials taking place in developing countries and the complexity of trial protocols mandate that local ethics review committees reviewing them have the capacity to ensure that they are conducted to the highest ethical standards.Methods. The Kenya AIDS Vaccine Initiative Institute of Clinical Research and the Kenyan National Council for Science and Technology embarked on an exercise to enhance the capacity of ERCs in Kenya to review such protocols. This process involved conducting an audit of (...) all ERCs in the country, and performing training needs assessments to identify knowledge and capacity gaps. Information obtained was used to develop training materials for ERC members at workshops conducted in different parts of the country.Results. Five accredited and 13 non-accredited ERCs were identified. Four of the accredited ERCs were located in the capital city of Kenya, Nairobi. The most common challenges cited by participants during the needs assessments were excess workload, and a lack of co-ordination and/or communication between the ERCs. Subsequently, 140 ERC members from 17 institutions across the country were trained as follows: 36 from institutions in the western part of Kenya, 38 from institutions in the south-eastern coastal region, 38 from the eastern region and 44 from Nairobi.Conclusion. The KAVI-ICR and the NCST have developed training modules for training ERC members in Kenya and are in the process of developing a manual to train members. The Kenyan experience may be used to enhance the capacity of ERCs in the East African region. (shrink)

With developed country governments and high resource institutions engaging in research in low- and middle-income countries, we argue that these entities have a moral obligation to help build and strengthen research infrastructure and capacity so local scientists and institutions can adequately conduct studies to understand and resolve the health burdens in low and middle income countries. We explore the moral justifications and motivations behind engaging in research capacity strengthening in the health sector in LMIC at multiple levels. In highlighting these (...) issues, this paper aims to initiate a global discourse around why capacity development in LMIC has a moral basis at the individual, institutional and system levels. (shrink)

This article examines capacity development for collective action and institutional change through the implementation of Corporate Social Responsibility initiatives. We integrate Hargrave and Van de Ven's, 864-888) Collective Action Model with capacity development literature to develop a framework that can be used to clarify the nature of CSR involvement in capacity development, help identify alternative CSR response options, consider expected impacts of these options on stakeholders, and highlight trade-offs across alternative CSR investments. Our framework encompasses CSR program investments in the (...) capacities of individuals, organizations, and collaborations, as also their impact on the larger enabling environment. We then use this framework to provide descriptive evidence of two implementations: The PhD Project, whose mission is to increase the diversity of corporate America by increasing the diversity of business school faculty, and Involve, the community involvement program at KPMG, one of the Big Four Accounting firms. We discuss implications of our framework for managerial practice and future research. (shrink)

BackgroundEvaluation of decision-making capacity to consent to medical treatment has proved to be difficult in patients with dementia. Studies showed that physicians are often insufficiently trained in the evaluation of decision-making capacity. In this study, we present findings from a secondary analysis of a qualitative interviews with physicians. These interviews were initially used to assess usability of an instrument for the evaluation of decision-making capacity. By looking at difficult cases of decision-making capacity evaluation in patients with dementia, we provide recommendations (...) for such evaluations in clinical practice.MethodsWe used thematic coding to analyse physicians’ narratives of problematic decision-making capacity evaluations in patients with dementia to uncover challenging issues of decision-making capacity evaluation.ResultsIn this study, decision-making capacity evaluations in patients with dementia were mainly perceived as challenging when they pertained to treatment refusals and treatment unrelated circumstances, such as psychiatric consultation, advance directives, and new living arrangements. Furthermore, the physicians reported training needs regarding situation-independent challenges with decision-making capacity evaluation.ConclusionsUpon further examining self-reported training needs and challenging cases, we have developed recommendations to improve decision-making capacity evaluations in clinical practice. In these recommendations, we argue that being able to evaluate decision-making capacity is an integral part of the informed consent process. (shrink)

In this paper I take up John Searle's account of ?Background capacities? to render intelligible the presupposed and hidden aspects of the background conditions that enable the performance of skilled movement. The paper begins with a review of Searle's initial account of Background capacities and how this picture can be applied to account for skilled movement in sport. Then an objection to this picture is addressed, claiming that Searle's initial picture might ?overrepresentationalise? background conditions. Moreover, this (...) objection prompts how Searle has modified his initial picture of background conditions in accordance with his more recent ?connection principle?. Searle's recent account of background conditions is then elaborated and discussed in the second half of the paper. The discussion emphasises three distinct levels of analysis in Searle's framework necessary to a full understanding of his background conditions: (i) the neurophysiological level; (ii) the descriptive higher-order practical skill level; and (iii) the logical level of integration. It is argued that Searle's logical framework is found plausible, but that more work is needed to better understand the background conditions of skilled movement in terms of neurophysiological capacities and practical skills from both scientific and philosophical perspectives. (shrink)

The Farmers Market Nutrition Program (FMNP) is a federal-state partnership designed to provide fresh, locally grown produce to low-income participants at nutritional risk and expand consumer awareness and use of local produce sold at farmers markets. This paper describes the results of a collaboration initiative based on the typology of a “comprehensive, multisectorial collaboration” to support the FMNP. We report the outcomes of the partnerships that developed over three years, including increased outreach to FMNP participants and strategies to decrease barriers (...) to participation. Those partnerships that reached higher degrees of coordination or collaboration are now addressing market accessibility and market quality in new ways. Those partnerships that exhibited the highest degree of collaboration are contributing to community capacity building beyond FMNP issues per se and to larger issues affecting the agriculture community and the food security of residents. (shrink)

This article focuses on the current trends and initiatives in human capacity building in Africa. It takes as it starting point that human capacity development is essential for Africa to become an information and know-ledge society and therefore an equal partner in the global sharing of knowledge. Four knowledge areas are identified and discussed. These are education, research and development, brain drain and information and documentation drain. The paper concludes that there is a clear understanding in Africa that its future (...) lies with education and that most African leaders have a strong political will to invest in human capacity building on the continent. It is also clear that much has been done, particularly primary education. Africa will most defi-nitely benefit from this in the long run. Problem areas remain however. These are in the needed growth of research and development and how to address the brain and information drain phenomena. (shrink)

This article examines capacity development for collective action and institutional change through the implementation of Corporate Social Responsibility (CSR) initiatives. We integrate Hargrave and Van de Ven’s (2006, Academy of Management Review31(4), 864–888) Collective Action Model with capacity development literature to develop a framework that can be used to clarify the nature of CSR involvement in capacity development, help identify alternative CSR response options, consider expected impacts of these options on stakeholders, and highlight trade-offs across alternative CSR investments. Our framework (...) encompasses CSR program investments in the capacities of individuals, organizations, and collaborations, as also their impact on the larger enabling environment. We then use this framework to provide descriptive evidence of two implementations: (1) The PhD Project, whose mission is to increase the diversity of corporate America by increasing the diversity of business school faculty, and (2) Involve, the community involvement program at KPMG, one of the Big Four Accounting firms. We discuss implications of our framework for managerial practice and future research. (shrink)

There is growing interest in developing co-operation between adult literacy researchers and practitioners to further research skills and approaches. Canada’s National Literacy Secretariat has recently initiated a series of policy debates that suggested several possibilities: targeted research grants, research internships for practitioners, practical sabbaticals for researchers, support for networking between literacy researchers and practitioners, and joint seminars and workshops between researchers and practitioners. A common theme throughout these discussions is the need to develop critical thinking about both collaborative research and (...) adult literacy. In this paper we discuss two collaborative initiatives between university-based researchers and adult literacy groups in the provinces of British Columbia and Ontario. Each project was based on the notion of “research circles” and specifically designed to enhance research capacity and critical thinking about literacy research. (shrink)

The increase in the volume of research conducted in Low and Middle Income Countries (LMIC), has brought a renewed international focus on processes for ethical conduct of research. Several programs have been initiated to strengthen the capacity for research ethics in LMIC. However, most such programs focus on individual training or development of ethics review committees. The objective of this paper is to present an approach to institutional capacity assessment in research ethics and application of this approach in the form (...) of a case study from an institution in Africa. (shrink)

This article examines how international institutions serve to diffuse human rights norms and create judicial capacity building in post-conflict societies. Specifically, we examine how the International Criminal Tribunal for the former Yugoslavia (ICTY) and the Office of the High Representative have influenced the reform of domestic courts in Bosnia and Herzegovina (BiH). We place these reforms within the broader debate over restructuring the complex system of government in BiH. Since 2005, domestic courts in BiH have had jurisdiction over the following: (...) (1) Cases which were initially under the jurisdiction of the domestic courts but remanded to the ICTY and recently returned to BiH. (2) Cases which originated at the ICTY and have been transferred to the State Court, and (3) new cases which originated and remained in the domestic court system. We find that while human rights norms have been incorporated into the new legal code, the diffusion of these human rights norms has been inadequate because of the lack of judicial capacity building. While some courts in the capital enjoy significant resources, the vast majority of cases will be tried at provincial courts which are under-funded and unable to prosecute the significant number of cases. Moreover, the government structure of BiH has had a decidedly negative impact on the prosecution of these cases. Ultimately, the rule of law requires consistency of approach and funding to protect human rights throughout the state. (shrink)

This study introduces visual cognition into Lithium-ion battery capacity estimation. The proposed method consists of four steps. First, the acquired charging current or discharge voltage data in each cycle are arranged to form a two-dimensional image. Second, the generated image is decomposed into multiple spatial-frequency channels with a set of orientation subbands by using non-subsampled contourlet transform. NSCT imitates the multichannel characteristic of the human visual system that provides multiresolution, localization, directionality, and shift invariance. Third, several time-domain indicators of the (...) NSCT coefficients are extracted to form an initial high-dimensional feature vector. Similarly, inspired by the HVS manifold sensing characteristic, the Laplacian eigenmap manifold learning method, which is considered to reveal the evolutionary law of battery performance degradation within a low-dimensional intrinsic manifold, is used to further obtain a low-dimensional feature vector. Finally, battery capacity degradation is estimated using the geodesic distance on the manifold between the initial and the most recent features. Verification experiments were conducted using data obtained under different operating and aging conditions. Results suggest that the proposed visual cognition approach provides a highly accurate means of estimating battery capacity and thus offers a promising method derived from the emerging field of cognitive computing. (shrink)

There is growing interest in developing co-operation between adult literacy researchers and practitioners to further research skills and approaches. Canada’s National Literacy Secretariat has recently initiated a series of policy debates that suggested several possibilities: targeted research grants, research internships for practitioners, practical sabbaticals for researchers, support for networking between literacy researchers and practitioners, and joint seminars and workshops between researchers and practitioners. A common theme throughout these discussions is the need to develop critical thinking about both collaborative research and (...) adult literacy. In this paper we discuss two collaborative initiatives between university-based researchers and adult literacy groups in the provinces of British Columbia and Ontario. Each project was based on the notion of “research circles” and specifically designed to enhance research capacity and critical thinking about literacy research. (shrink)

A depth of ethical knowledge and understanding are essential for the enactment of ethical decisions and actions. Ethics is the foundational core for democratic teaching, learning and educational leadership. It is imperative that the development of ethical insight and the formation of an ethical stance become fundamental elements of both initial and continuing teacher education. Educators must be adept at cultivating ethical cultures within schools and districts. They need to know how to effectively foster the collective ethical capacity of (...) all those with whom they are called to serve. To ensure the highest level of ethical professional practice and action, the collective ethical knowledge, sensitivity, awareness, and efficacy of the teaching profession must continue to evolve. The ongoing ethical formation of the teaching profession is essential for the public’s continued trust and confidence in the ethical actions and practices of the educational community. Educative processes designed to enhance the collective ethical capacity of the teaching profession are explored in this inquiry. Critical reflection and various dialogic processes focusing on the lived ethical experiences encountered within teaching were used for fostering the ethical leadership and decision making of educators. (shrink)

Stereotype threat is a possible reason for difficulties faced by girls and women in the fields of science, technology, engineering, and mathematics. The threat experienced due to gender can cause elevated worry during performance situations. That is, if the stereotype that women are not as good as men in math becomes salient, this stereotype activation draws women’s attention to task-irrelevant worry caused by the fear of conforming to the negative stereotype. Increased worry can reduce cognitive resources, potentially leading to performance (...) decrements. We argue that such worry is more pronounced immediately after an unrelated self-control demand, which is assumed to temporarily decrease people’s self-control exertion over their attention and stream of thought. This prediction was examined in an experiment conducted with 102 participating university students enrolled in courses in which math plays a crucial role. After the manipulation of self-control capacity, stereotype threat was induced for the female students, but not the male students. Then, the students were asked to report their thoughts during a math performance situation three times. Multiple-group autoregressive path models revealed that when self-control capacity was relatively low, female compared with male students reported more intense worry in the initial two thought protocols. In contrast, in the relatively high self-control capacity condition, female and male students did not differ significantly in their reported worry at any time. These results expand on previous findings, suggesting that threat effects depend on definable situational self-control conditions. (shrink)

The intensification of cross-sector collaboration phenomena has occurred in multiple fields of action. Organizations in the private, public, and social sectors are working together to tackle society’s most wicked problems. Some success has resulted in a generalized belief that cross-sector collaborations represent the new paradigm to manage complex problems. Yet, important knowledge gaps remain about how cross-sector alliances generate value for society, particularly to its beneficiaries. This paper answers the question: How cross-sector collaborations lead to systemic change? It uses a (...) qualitative embedded case study design. I use two general cases of alliance-based interventions in the developing country Colombia. Embedded cases within each general case identify evidence of collective action capacity of the beneficiaries. Findings identify and explain alliances’ contributions to beneficiaries’ capacity building: brokering trust and creating spaces where beneficiaries develop an emergent collective action capacity. Alliances also enable beneficiaries to enact that capacity by building bridges, circulating capitals, and buffering relationships to protect people’s initiatives. Alliances and empowered collectives of beneficiaries produce systemic change using five mechanisms: brokering trust, creating spaces, building bridges, circulating capitals, and buffering relationships. Beneficiaries increased capacity for collective action is an outcome that becomes an alliance input, leading overtime to further benefits involving systemic change. (shrink)

BackgroundThe assessment of patients’ decision-making capacity is ubiquitous in contemporary healthcare. This paper examines the ethics of undisclosed probing of capacity by psychiatrists. The discussion will refer to the law in England and Wales, though the highlighted issues are likely to be relevant in similar jurisdictions.Main textDecision-making capacity is a private attribute, and patients may not necessarily be aware that one of their personal abilities is being explored. Routine exploration of capacity has not historically been a part of psychiatric examination, (...) but it is now difficult to avoid during psychiatric interview.Ethical practice and shared decision-making require patients to be aware that their decision-making may be evaluated by the doctor at some point, and the potential implications of an objective professional conclusion of incapacity. Case law directs that patients should be informed about any assessment of their decision-making ability, though the extent to which this has translated into practice is unclear. However, explanation about the assessment may cause a patient to react negatively, which may impede therapeutic engagement and constitute an ethical dilemma. It is argued that in the absence of systemic measures, professionals should retain the discretion to decide whether a particular patient should be informed about the impending probe into their decision-making ability, or not. In the latter instance, concealment of information about the assessment or its purpose should be subject to the caveats and safeguards associated with any recourse to therapeutic exception.ConclusionThe necessity to mandatorily inform patients about assessment of their capacity introduces a novel ethical dilemma for psychiatrists. The negotiation of this dilemma should not be the prerogative of the clinician, and requires systemic initiatives to ensure universal awareness of patients about the possibility of their capacity being assessed during their journeys through healthcare systems. (shrink)

Recent scholarship has considered what, if anything, rich people owe to poor people to achieve justice in global health and the implications of this for international research. Yet this work has primarily focused on international clinical research. Health systems research is increasingly being performed in low and middle income countries and is essential to reducing global health disparities. This paper provides an initial description of the ethical issues related to priority setting, capacity-building, and the provision of post-study benefits that (...) arise during the conduct of such research. It presents a selection of issues discussed in the health systems research literature and argues that they constitute ethical concerns based on their being inconsistent with a particular theory of global justice (the health capability paradigm). Issues identified include the fact that priority setting for health systems research at the global level is often not driven by national priorities and that capacity-building efforts frequently utilize one-size-fits-all approaches. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Finding PartnershipThe Benefit of Sharing and the Capacity for ComplexityMichaela Amering (bio)Keywordsrecovery, empowerment, trialog, user involvement, schizophreniaIs There Ignorance and Arrogance? In Psychiatry? In Medicine?Adding insight to injury' is the paraphrase psychiatrist Pat McGorry (1992) coined for his reproach of 'pushing for "insight" or "acceptance of diagnosis"' without carefully taking into account the complexities of the individual situation, context, and needs. That must be about the kind of behavior (...) Marga Reimer has in mind in her paper on treatment adherence in the absence of insight, which depicts mental health professionals characterized by arrogance against the common sense of motivating compliance by perceived or anticipated benefits on different everyday life levels, but instead trying to get people to believe in a mental illness such as schizophrenia and wishing them to want treatment for that in the form of medication.In addition, Reimer presents examples from general medicine to make her point that adherence follows perceived or anticipated benefits instead of being a result of insight into a medical model of illness and McGorry (1992) also suggests that disregard for the active role that patients may play as reflected in psychiatry in terms such as 'case management' and 'compliance' "is a failing which extends to mainstream medicine and probably to most systems of human service delivery." On the other hand, Bill Anthony (2006), one of the most eminent experts on psychiatric rehabilitation and recovery in a personal report on his own medical illness, multiple sclerosis—MS, and the assistance he has been receiving in connection with it, describes the 'MS-Community' as exemplary with respect to instilling courage and hope, continually providing information and opportunities for exchange, and for never questioning a person's ultimate freedom of choice. In contrary, in mental health care he does not experience the medical profession as acting with full respect and support for its patients and suggests a great deal more work and transformation—especially concerning coercive treatments—ahead to follow this example. Similarly, it has been suggested that psychiatry should be better integrated into medicine to overcome stigma and discrimination of psychiatric health problems and interventions. A pertinent example of an initiative in this direction is the proposal of a fusion of mental health and incapacity legislation to arrive at ethically consistent legal situations with regard to involuntary [End Page 77] treatment across medicine (Dawson and Szmukler 2006).Is There Something Called Schizophrenia? and How Much Longer?Reimer's main example—schizophrenia—is the diagnosis that poses some of the greatest problems to the field and to the recognition of psychiatry as a scientific medical discipline. The current concept as well as the term 'schizophrenia' will probably not be around much longer; 'a century of schizophrenia is enough' (Kelly and Murray 2002). Suggested solutions for the problems of the diagnosis of schizophrenia concern the urgent complement of the categorical with a dimensional approach (Allardyce et al. 2007), a change also put forward as one of the essential remedies to undermine the stigma of mental illness that is often exacerbated by clinical diagnosis (Corrigan 2007). Such a move would also clearly help against the still prevalent experiences of users of services and their families and friends, whose hopes and dreams have been crushed and whose resilience has been undermined by clinical situations, which in times of psychotic crises, not only forced diagnoses but also prognoses—often scientifically unfounded—on them (Amering and Schmolke 2009).Is There a Solution? Can We Use Our Talents? And Those of People With a Lived Experience of Mental Health Problems and Care?Clinicians as well as scientists know that health, illness, and recovery occur in complex ways and contexts. People faced with mental health problems clearly realize the complexities of their situation and are especially motivated to appreciate the variety of factors and interactions that need to be integrated to arrive at a valid assessment. Ideally, the therapeutic relationship—essentially a partnership—holds a formidable chance of sharing efforts and creating the wisdom for finding and facing the truths necessary to develop solutions that can uphold and work in line with the complexities of human life.I would argue that psychiatric professionals are certainly part... (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)

The article elucidates the pivotal role of philosophical knowledge in nurturing students’ capacity for scientific creativity. Grounded in D.B. Bogoyavlenskaya’s typology of cognition levels (stimulus-productive, heuristic, and creative), the authors illustrate that authentic creativity is not merely tied to the acquisition of subject-specific knowledge but is deeply rooted in personal engagement with science and the primacy of cognitive motivation. The decisive factor in sculpting a scientist’s creative potential lies in their immersion in the culture of philosophical thought, characterized by its (...) pursuit of the universal, critical reflection on the foundations of cognition, and problematization of the apparent. Drawing from the experience of teaching philosophy to students in the natural sciences, the article showcases the significance of philosophical practices and pedagogical approaches that inspire students to creatively grapple with scientific quandaries within the context of cultural universals. Firstly, it emphasizes the cultivation of a culture of understanding as a process of grasping the essence of the phenomena under study. The importance of hermeneutic approaches and engaging with philosophical texts to deepen understanding is accentuated. Secondly, it highlights the refinement of communication skills and the experience of collective discourse as a mechanism for objectifying individual ideas and insights. Thirdly, it stresses the nurturing of independence and initiative in thinking, as well as personal investment in the research process, which constitute the bedrock of genuine scientific creativity. The culmination should be the emergence of a personality imbued with a culture of seeking the universal within the particular, equipped with sophisticated skills in categorical thinking, and enriched by the experience of philosophical reflection on the boundaries of entrenched paradigms of perceiving reality. The challenges and prospects of implementing the proposed model of philosophical engagement are examined, taking into account the social challenges of the information society and the psychological idiosyncrasies of the current generation of students. The authors arrive at the conclusion that philosophy, as the methodological nucleus of university education, ensures the integrity and openness of scientific knowledge, establishing the foundational value orientations and guiding principles for the creative endeavors of a future scientist. (shrink)

When the energy-harvesting embedded system is running, its available energy seems to be sufficient overall. However, in the process of EHES task execution, an energy shortage may occur in the busy period such that system tasks cannot be scheduled. We call this issue the energy deception of the EHES. Aiming to address the ED issue, we design an appropriate initial energy level of the battery. In this paper, we propose three algorithms to judge the feasibility of the task set (...) and calculate the appropriate initial energy level of the battery. The holistic energy evaluation algorithm makes a preliminary judgment of the task set feasibility according to available energy and consumption energy. A worst-case response time-based initial energy level of the battery algorithm and an accurate cycle-initial energy level of the battery algorithm can calculate the proper initial battery capacity. We use the YARTISS tool to simulate the above three algorithms. We conducted 250 experiments on As Late As Possible and As Soon As Possible scheduling with the maximum battery capacities of 50, 100, 200, 300, and 400. The experimental results show that setting a reasonable initial energy level of the battery can effectively improve the feasibility of the task set. Among the 250 task sets, the HEE algorithm filtered 2.8% of them as infeasible task sets. When the battery capacity is set to 400, the WCRT-BIEL algorithm increases the success rates of the ALAP and ASAP by 17.2% and 26.8%, respectively. The AC-BIEL algorithm increases the success rates of the ALAP and ASAP by 18% and 26.8%, respectively. (shrink)

Abortion bans premised on fetal pain capacity are this decade's “partial‐birth abortion”: a medically suspect anti‐choice initiative that can be politically difficult to oppose. No one is “pro–fetal pain.” But rhetorically, the concept of “fetal pain” works to conflate the capacity for pain with the experience of pain. If pain justified banning medical procedures, all surgery would be illegal. Pain is a routine side effect of medical practice. What's unethical is unnecessary pain, and that's why the standard medical response to (...) pain is palliation. (shrink)

BackgroundInstitutional Review Boards (IRBs) play a vital role in safeguarding the rights and interests of both research participants and researchers. However, China initiated the establishment of its own IRB system relatively late in comparison to international standards. Despite commendable progress, there is a pressing need to strengthen the organizational capacity building of Chinese IRBs. Hence, this study aims to analyze the key factors driving the enhancement of organizational capacity within these committees.MethodThe cross-sectional survey for this research was conducted from July (...) 2020 to January 2022. Following the statistical grouping based on the "2020 China Health Statistical Yearbook", a systematic investigation of IRBs in various provinces of China was carried out. In-depth interviews and questionnaire surveys were conducted with the chairpersons and administrative executives (or secretaries) of highly cooperative IRBs. Subsequently, data were collected from 107 IRBs. Qualitative Comparative Analysis (QCA) was employed as the method to analyze the factors influencing the organizational capacity of medical ethics committees and explore the diverse combinations of these factors.ResultsThrough a singular necessary condition analysis, the variable "protection of rights and interests" emerges as a critical factor contributing to the robust construction of Institutional Review Boards Institutional Review Boards (IRBs). Conversely, the variables of "lack of member ability, absence of review process, and deficiency in the supervision mechanism" collectively constitute a sufficient condition leading to weaker IRB construction. The state analysis uncovers three interpretation modes: member ability-oriented (M1), system process-oriented mode (M2), and resource system-oriented mode (M3).ConclusionsThe results of this study are effectively explicable using the "Triangular Force" model proposed for the hypothesis of IRBs' organizational capacity, which provides a solid foundation for the development of organizational capabilities in IRBs. To enhance the organizational capacity of IRBs in China, it is imperative to elevate the competence of committee members and strengthen team development. This can be achieved by establishing a comprehensive regulatory framework and refining procedural protocols. Moreover, clarifying the organizational structure and optimizing resource allocation are essential steps in bolstering the overall organizational capabilities of these committees. (shrink)

Depletion of mitochondrial endo/exonuclease G‐like (EXOG) in cultured neonatal cardiomyocytes stimulates mitochondrial oxygen consumption rate (OCR) and induces hypertrophy via reactive oxygen species (ROS). Here, we show that neurohormonal stress triggers cell death in endo/exonuclease G‐like‐depleted cells, and this is marked by a decrease in mitochondrial reserve capacity. Neurohormonal stimulation with phenylephrine (PE) did not have an additive effect on the hypertrophic response induced by endo/exonuclease G‐like depletion. Interestingly, PE‐induced atrial natriuretic peptide (ANP) gene expression was completely abolished in endo/exonuclease (...) G‐like‐depleted cells, suggesting a reverse signaling function of endo/exonuclease G‐like. Endo/exonuclease G‐like depletion initially resulted in increased mitochondrial OCR, but this declined upon PE stimulation. In particular, the reserve capacity of the mitochondrial respiratory chain and maximal respiration were the first indicators of perturbations in mitochondrial respiration, and these marked the subsequent decline in mitochondrial function. Although pathological stimulation accelerated these processes, prolonged EXOG depletion also resulted in a decline in mitochondrial function. At early stages of endo/exonuclease G‐like depletion, mitochondrial ROS production was increased, but this did not affect mitochondrial DNA (mtDNA) integrity. After prolonged depletion, ROS levels returned to control values, despite hyperpolarization of the mitochondrial membrane. The mitochondrial dysfunction finally resulted in cell death, which appears to be mainly a form of necrosis. In conclusion, endo/exonuclease G‐like plays an essential role in cardiomyocyte physiology. Loss of endo/exonuclease G‐like results in diminished adaptation to pathological stress. The decline in maximal respiration and reserve capacity is the first sign of mitochondrial dysfunction that determines subsequent cell death. (shrink)

This book examines how Shanghai aims to improve public service provision by accelerating the use of artificial intelligence (AI) in the public sector. After clarifying the technical and social factors that shape the use of AI in this area, the book delves into the AI policy environment and AI ecosystem of Shanghai to gauge the city’s capacity to implement public sector AI applications. Then it examines how this capacity translates into real-world policy initiatives through the investigation of case studies. It (...) highlights the analytical, operational and political capabilities that determine the strengths and limitations of such initiatives in deploying AI in the public sector, and it assesses their impacts on public service provision in Shanghai. By using the findings on Shanghai to gain a deeper understanding of key topics in public sector AI research, this book also contributes new knowledge about the use of AI to improve the provision of public services. (shrink)

In this article, we describe a project in which philosophy, in combination with methods drawn from mental modeling, was used to structure dialogue among stakeholders in a region-scale climate adaptation process. The case study we discuss synthesizes the Toolbox dialogue method, a philosophically grounded approach to enhancing communication and collaboration in complex research and practice, with a mental modeling approach rooted in risk analysis, assessment, and communication to structure conversations among non-academic stakeholders who have a common interest in planning for (...) a sustainable future. We begin by describing the background of this project, including details about climate resiliency efforts in West Michigan and the Toolbox dialogue method, which was extended in this project from academic research into community organization involving the West Michigan Climate Resiliency Framework Initiative. This extension involved application of several methods, which are the focus of the Methods section. We then present and discuss preliminary results that suggest the potential for philosophical dialogue to enhance mutual understanding in complex community initiatives that focus on sustainable responses to climate change. Overall, the article supplies a detailed, instructive example of how philosophy can support policy-relevant decision-making processes at the community level. (shrink)

Despite decades of struggle against the industrial food system, academics still question the impact of the alternative food movement. We consider what food movement leaders themselves say about their motivation to act and their capacity to scale up their impact. Based on semi-structured interviews with 27 food movement leaders in Michigan, our findings complicate the established academic narratives that revolve around notions of prefigurative and oppositional politics, and suggest pragmatic strategies that could scale up the pace and scope of food (...) movement impacts. In contrast to the apolitical perspective some scholars see guiding alternative food movements, local leaders we interviewed see the food system from a structural-political lens. Though some see strength in fragmentation, most are not under the illusion that they can work alone and aspire to build their collective strength further. Concerns about organizational survival and conflicting views about the goals of the food movement, however, present ongoing challenges. Ultimately, we argue that there is a middle ground food movement leaders can walk between prefigurative and oppositional politics, one that still attempts to intentionally change the state, while also maintaining the inventiveness that can come from autonomous, grassroots initiatives. Specifically, interviewees suggested that increased strategic capacity around policy advocacy, critical food systems education, and negotiation could help them extend cross-movement networks and mainstream more equitable food policies, while continuing to experiment with customized solutions. (shrink)

This paper is motivated by the observation that Southern governments start to take responsibility for a more sustainable production of agricultural commodities as a response to earlier private initiatives by businesses and non-governmental organizations. Indonesia is one of the leading countries in this respect, with new public sustainability regulations on coffee, cocoa and palm oil. Based on the concept of governance capacity, the paper develops an evaluation tool to answer the question whether the new public regulation on sustainable palm oil (...) may become a viable alternative to private regulation. ISPO embraces a tremendous governance challenge as thousands of companies and millions of smallholder farmers are expected to participate. It is concluded that, although ISPO has initiated a process of change, it has not yet developed its full potential. The main reason regards ISPO’s rather loose problem definition, weak authority of the implementing organization, and the fact that the reliability of ISPO is still too low to convince of the global market. ISPO may therefore face difficulties in meeting its own targets and solving palm-oil related problems, such as deforestation, biodiversity loss, greenhouse gas emissions, and social conflicts between big plantations and local communities. The main governance challenge regards combining a more authoritative implementation mechanism with a convincing balance between sustainability objectives and economic interests of the sector. (shrink)

BackgroundHealthcare professionals and surrogate decision-makers often face the difficult decision of whether to initiate or withhold antibiotics from people with dementia who have developed a life-threatening infection after losing decisional capacity.MethodsWe conducted a vignette-based survey among 1050 Quebec stakeholders (senior citizens, family caregivers, nurses and physicians; response rate 49.4%) to (1) assess their attitudes toward withholding antibiotics from people with dementia lacking decisional capacity; (2) compare attitudes between dementia stages and stakeholder groups; and (3) investigate other correlates of attitudes, including (...) support for continuous deep sedation (CDS) and medical assistance in dying (MAID). The vignettes feature a woman moving along the dementia trajectory, who has refused in writing all life-prolonging interventions and explicitly requested that a doctor end her life when she no longer recognizes her loved ones. Two stages were considered after she had lost capacity: the advanced stage, where she likely has several more years to live, and the terminal stage, where she is close to death.ResultsSupport for withholding antibiotics ranged from 75% among seniors and caregivers at the advanced stage, to 98% among physicians at the terminal stage. Using the generalized estimating equation approach, we found stakeholder group, religiosity, and support for CDS and MAID, to be associated with attitudes toward antibiotics.ConclusionsFindings underscore the importance for healthcare professionals of discussing underlying values and treatment goals with people at an early stage of dementia and their relatives, to help them anticipate future care decisions and better prepare surrogates for their role. Findings also have implications for the scope of MAID laws, in particular in Canada where the extension of MAID to persons lacking decisional capacity is currently being considered. (shrink)

The Deprivation of Liberty Safeguards (DOLS) were recently introduced into the Mental Capacity Act (MCA) via an amendment to mental health legislation in England and Wales. As Shah (2011) discusses, the rationale behind creating these protocols was to close what is commonly referred to as the ‘Bournewood gap’; a legislative loophole that allowed a severely autistic man (H.L.) who did not initially dissent to admission to be detained in a hospital and deprived of his liberty in his ‘best interests’ as (...) judged by his clinical team. Before the implementation of the DOLS, patients who lacked the capacity to consent to admission or treatment but who were nonetheless compliant could be admitted informally and treated as .. (shrink)

This article explores refusal of medical treatment by adult patients from ethical and legal perspectives. Initially, consequentialist and deontological ethical theory are outlined. The concepts of autonomy, paternalism and competence are described and an overview of Beauchamp and Childress’s principle-based approach to moral reasoning is given. Relevant common law is discussed and the provisions of the Mental Capacity Act 2005 in assessing competence is evaluated. In order to demonstrate the consideration of moral issues in clinical practice, ethical theory is applied (...) to two well-known incidents: the case of Re MB, where doubt over decision-making capacity led to a paternalistic act to override a patient’s choice; and the death of Emma Gough, a situation where respect for autonomy prevailed when healthcare staff acted lawfully in following a patient’s refusal of life-saving treatment. Finally, guidance from regulatory bodies on the roles and responsibilities of health professionals in relation to this topic are considered. (shrink)

The World Health Organization has in the last decade identified mental health as a priority for global health promotion and international development, to be targeted through promulgation of evidence-based medical practices, health systems reform, and respect for human rights. Yet these overlapping strategies are marked by tensions as the historical primacy of expert-led initiatives is increasingly subject to challenge by new social movements — in particular, disabled persons’ organizations. These tensions come into focus upon situating the WHO’s contributions to the (...) analysis of global mental health in light of the negotiation and early stages of implementation of the Convention on the Rights of Persons with Disabilities, particularly as it applies to persons with mental disabilities. (shrink)

There is a wealth of data on the perceptual and cognitive capacities of infants strongly supporting early nativistic influences on development. Without considering these initial determinants, constructivist models of development are at best incomplete.

In recent studies of primates, the question has been raised whether competitive regimes are species-specific or should rather be considered as sex-specific. To study this problem we use an individual-oriented model called DomWorld in which artificial agents are equipped merely to group and compete. In former studies of this model, dominance style appeared to be strongly influenced by the intensity of aggression: by increasing only this intensity of aggression, a great number of the characteristics of an egalitarian society switched to (...) those of a despotic one. Here, we investigate, using DomWorld, a competitive regime of artificial males and females that differ exclusively in their fighting capacity; males having a higher intensity of aggression and a higher initial capacity of winning, such as may be due to a male-biased sexual dimorphism. Unexpectedly it appears that, in the model, even if the intensity of aggression of males is greater than that of females, their hierarchy is still significantly weaker and thus their society less differentiated and more egalitarian than that of females. The explanation is that, due to the higher initial dominance of males, single events of victory and defeat lead to less differentiation than among females. The greater the sexual difference in initial dominance between the sexes is the more egalitarian the males behave among themselves compared to the behaviour of the females among themselves. These effects are already visible during the initial phases of the hierarchical development. These results resemble findings among primates; in real primates their degree of sexual dimorphism may influence the competitive regime of each sex. (shrink)

The chief executive of the Law Society proposes that the Mental Capacity Bill is a progressive initiative enhancing personal autonomy. Laing replies to this by showing that the Bill, for from enhancinging personal autonomy explodes it by inviting homicide by unaccountable third parties, allowing non-therapeutic research and organ-removal without consent and creating a secret and unaccountable court with a lethal power over the vulnerable incapacitated.

My initial scope will be limited: starting from a neurobiological standpoint, I will analyse how actions are possibly represented and understood. The main aim of my arguments will be to show that, far from being exclusively dependent upon mentalistic/linguistic abilities, the capacity for understanding others as intentional agents is deeply grounded in the relational nature of action. Action is relational, and the relation holds both between the agent and the object target of the action , as between the agent (...) of the action and his/her observer . Agency constitutes a key issue for the understanding of intersubjectivity and for explaining how individuals can interpret their social world. This account of intersubjectivity, founded on the empirical findings of neuroscientific investigation, will be discussed and put in relation with a classical tenet of phenomenology: empathy. I will provide an 'enlarged' account of empathy that will be defined by means of a new conceptual tool: the shared manifold of intersubjectivity. (shrink)

Capacity of conscious agents to perform genuine choices among future alternatives is a prerequisite for moral responsibility. Determinism that pervades classical physics, however, forbids free will, undermines the foundations of ethics, and precludes meaningful quantification of personal biases. To resolve that impasse, we utilize the characteristic indeterminism of quantum physics and derive a quantitative measure for the amount of free will manifested by the brain cortical network. The interaction between the central nervous system and the surrounding environment is shown to (...) perform a quantum measurement upon the neural constituents, which actualize a single measurement outcome selected from the resulting quantum probability distribution. Inherent biases in the quantum propensities for alternative physical outcomes provide varying amounts of free will, which can be quantified with the expected information gain from learning the actual course of action chosen by the nervous system. For example, neuronal electric spikes evoke deterministic synaptic vesicle release in the synapses of sensory or somatomotor pathways, with no free will manifested. In cortical synapses, however, vesicle release is triggered indeterministically with probability of 0.35 per spike. This grants the brain cortex, with its over 100 trillion synapses, an amount of free will exceeding 96 terabytes per second. Although reliable deterministic transmission of sensory or somatomotor information ensures robust adaptation of animals to their physical environment, unpredictability of behavioral responses initiated by decisions made by the brain cortex is evolutionary advantageous for avoiding predators. Thus, free will may have a survival value and could be optimized through natural selection. (shrink)

The initial relationships between organisms leading to endosymbiosis and the first eukaryote are currently a topic of hot debate. Here, I present a theory that offers a gradual scenario in which the origins of phagocytosis and mitochondria are intertwined in such a way that the evolution of one would not be possible without the other. In this scenario, the premitochondrial bacterial symbiont became initially associated with a protophagocytic host on the basis of cooperation to kill prey with symbiont‐produced toxins (...) and reactive oxygen species (ROS). Subsequently, the cooperation was focused on the digestion stage, through the acidification of the protophagocytic cavities via exportation of protons produced by the aerobic respiration of the symbiont. The host gained an improved phagocytic capacity and the symbiont received organic compounds from prey. As the host gradually lost its membrane energetics to develop lysosomal digestion, respiration was centralized in the premitochondrial symbiont for energy production for the consortium. (shrink)

Unesco initiated the Ethics Education Programme in 2004 at the request of member states to reinforce and increase the capacities in the area of ethics teaching. The programme is focused on providing detailed information about existing teaching programmes. It also develops and promotes teaching through proposals for core curricula, through a training course for ethics teachers and by distributing educational resources to support programmes.