Lifestyle diseases constitute an increasing proportion of health problems and this trend is likely to continue. A better understanding of the responsibility argument is important for the assessment of policies aimed at meeting this challenge. Holding individuals accountable for their choices in the context of health care is, however, controversial. There are powerful arguments both for and against such policies. In this article the main arguments for and the traditional arguments against the use of individual responsibility as a criterion for (...) the distribution of scarce health resources will be briefly outlined. It is argued that one of the most prominent contemporary normative traditions, liberal egalitarianism, presents a way of holding individuals accountable for their choices that avoids most of the problems pointed out by the critics. The aim of the article is to propose a plausible interpretation of liberal egalitarianism with respect to responsibility and health care and assess it against reasonable counter-arguments. (shrink)

Using relevant encyclicals issued over the last 100 years, the author extracts those principles that constitute the underpinnings of Catholic Social Teaching about the employment relationship and contemplates implications of their incorporation into human resource policy. Respect for worker dignity, for his or her family's economic security, and for the common good of society clearly emerge as the primary guidelines for responsible human resource management. Dovetailing these three Church mandates with the economic objectives of the firm could, in essence, alter (...) the firm's nature because profit motivations would be constrained by consideration for worker and societal welfare. Integration of Church teaching with current corporate goals should therefore impact greatly on a variety of human resource policies. (shrink)

It is argued here that cognitive science currently neglects an important source of insight into the human mind: the effects created by magicians. Over the centuries, magicians have learned how to perform acts that are perceived as defying the laws of nature, and that induce a strong sense of wonder. This article argues that the time has come to examine the scientific bases behind such phenomena, and to create a science of magic linked to relevant areas of cognitive science. Concrete (...) examples are taken from three areas of magic: the ability to control attention, to distort perception, and to influence choice. It is shown how such knowledge can help develop new tools and indicate new avenues of research into human perception and cognition. (shrink)

Objectives: Evidence based patient choice seems based on a strong liberal individualist interpretation of patient autonomy; however, not all patients are in favour of such an interpretation. The authors wished to assess whether ideals of autonomy in clinical practice are more in accordance with alternative concepts of autonomy from the ethics literature. This paper describes the development of a questionnaire to assess such concepts of autonomy.Methods: A questionnaire, based on six moral concepts from the ethics literature, was sent to aneurysm (...) patients and their surgeons. The structure of the questionnaire was assessed by factor analysis, and item reduction was based on reliability.Results: Ninety six patients and 58 surgeons participated. The questionnaire consisted of four scales. Two of the scales reflected the paternalistic and consumerist poles of the liberal individualist model, one scale reflected concepts of Socratic autonomy and of procedural independence, and the fourth scale reflected ideals of risk disclosure.Discussion: The Ideal Patient Autonomy Scale is a 14 item normative instrument. It is clearly distinct from the generally used psychological preference questionnaires that assess preferences for physician-patient roles. (shrink)

Objective: To explore the experiences of people with a “terminal illness”, focusing on the patients’ perspective of euthanasia and assisted suicide.Method: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a “terminal” illness, malignant or non-malignant.Results: That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly (...) by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse.Conclusion: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death. (shrink)

Tobacco consumption is believed to be one of the world’s greatest preventable health problems. According to the World Health Organisation, 1.1 billion people worldwide are addicted to nicotine with tobacco causing an estimated four million premature deaths every year. The development of a nicotine conjugate vaccine suggests that immunisation may hold promise as a future therapeutic and preventive strategy for tobacco smoking and nicotine addiction. Allowing parents to immunise their children against smoking could be an infringement of children’s right to (...) an open future, however, and is not ethically unproblematic. (shrink)

Background: Only data of published study results are available to the scientific community for further use such as informing future research and synthesis of available evidence. If study results are reported selectively, reporting bias and distortion of summarised estimates of effect or harm of treatments can occur. The publication and citation of results of clinical research conducted in Germany was studied.Methods: The protocols of clinical research projects submitted to the research ethics committee of the University of Freiburg in 2000 were (...) analysed. Published full articles in several databases were searched and investigators contacted. Data on study and publication characteristics were extracted from protocols and corresponding publications.Results: 299 study protocols were included. The most frequent study design was randomised controlled trial , followed by uncontrolled studies , laboratory studies and non-randomised studies . 182 were multicentre studies including 97 international collaborations. 152 of 299 had commercial funding and 46 non-commercial funding. 109 of the 225 completed protocols corresponded to at least one full publication ; the publication rate was 48%. 168 of 210 identified publications were cited in articles indexed in the ISI Web of Science. The median was 11 citations per publication .Conclusions: Results of German clinical research projects conducted are largely underreported. Barriers to successful publication need to be identified and appropriate measures taken. Close monitoring of projects until publication and adequate support provided to investigators may help remedy the prevailing underreporting of research. (shrink)

From the diverse work and often competing insights of women's human rights activists, Brooke Ackerly has written a feminist and a universal theory of human rights that bridges the relativists' concerns about universalizing from particulars and the activists' commitment to justice. Unlike universal theories that rely on shared commitments to divine authority or to an 'enlightened' way of reasoning, Ackerly's theory relies on rigorous methodological attention to difference and disagreement. She sets out human rights as at once a research ethic, (...) a tool for criticism of injustice and a call to recognize our obligations to promote justice through our actions. This book will be of great interest to political theorists, feminist and gender studies scholars and researchers of social movements. (shrink)

This paper addresses problems related to transferring market concepts to non-market domains. More specifically it is about fallacies following from the use of the commodity concept in environmental valuation studies. First of all, the standard practice tends to misconstrue the ethical aspects related to environmental choices by forcing them into becoming ordinary trade-off problems. Second, the commodity perspective ignores important technical interdependencies within the environment and the relational character of environmental goods. These are all properties that have made many such (...) goods escape the commoditisation pressure of markets in the first place. Further, it is shown that these interdependencies are the source of some of the ethical dilemmas observed. Finally, inherent characteristics of the environment tend to make the concept of the margin, so indispensable to economic calculus, either difficult or irrelevant to define. The commodity 'fiction' twists the perception of the environment from systems preservation to items use or transformation. This is a problem of increased importance as we approach potential systems perturbations. (shrink)

Moral education through service learning at post-secondary level is an important but under-researched field. Most existing studies center on its learning outcomes like academic progress, personal development, communication, and leadership skills, with only a few evaluating the moral development of college students participating in service-learning projects. The lack of study on moral development in service learning indicates a need for clarification of the theoretical underpinnings of service learning, John Dewey's ideas on moral growth, in particular his model of moral imagination (...) and the implications thereof, for current service-learning research and practice. We argue that Dewey's work here can help strengthen .. (shrink)

Because metaphysics aims for absolute generality, its primary job is to tell us what are the fundamental particulars, of which one may say that is ultimately all there is, and yet be assured of an unabridged version of reality. It should be clear that such a search for the fundamental particulars is totally different from the enterprise of determining which particulars are basic from the point of view of particular-identification, which though it has recently been labeled "metaphysics," albeit "descriptive metaphysics," (...) might less confusingly be called "descriptive epistemology.". (shrink)

The Report of the Ad Hoc Adivisory Group on the Operation of NHS Research Ethics Committees has resulted in a strange mixture of the timid, the revolutionary, and the bizarre.The Report of the Ad Hoc Advisory Group on the Operation of NHS Research Ethics Committees is a curious document.1 The remit of the review was focused on the workings and effectiveness of NHS research ethics committees and the multicentre committees ). The Group was primarily set up in response to a (...) series of complaints from medical researchers about the new research governance regime in the UK as a result of the Clinical Trials Directive2 and the Governance Arrangements for NHS Research Ethics Committees.3 The opportunity was also taken to consider the role of research ethics committees in a wider context, and take account of recent developments in relation to the ethics review of social care research,4 student projects,5 as well as recent legislation such as the Human Tissue Act,6 and the Mental Capacity Act.7 However, the resulting report is a strange mixture of the timid, the revolutionary, and the bizarre.A good example of the report’s timidity is its reluctance to propose fundamental change to the process of review or seriously limit the type of research that requires REC review. To its credit AHAG does suggest that some research ‘especially surveys and many studies on NHS staff, could normally be conducted safely without a requirement for REC review’ .1 This is, of course, to be welcomed. However, the report ultimately seems dismissive of the general complaint from researchers that the current process is inappropriately uniform. For example, in section 3.2, it is argued that the ‘common perception that the NHS REC system is dominated …. (shrink)

A group of activist clinicians have offered to volunteer for clinical trials of live attenuated HIV vaccines. This has provided an important conceptual challenge to medical ethics, and to work on the development of HIV vaccines. In exploring these issues, this article highlights how the HIV field has altered the content as well as the tone of ethical discourse. The balance of expertise and authority between research subjects and triallists is profoundly changed, raising questions about the limits of voluntarism and (...) differing perspectives on risk-benefit analysis. Care is needed to ensure that the novelty of the situation does not confuse the central ethical and scientific issues. (shrink)

As is well known, some paradoxes arise through inadequate analysis of the meanings of terms in a language, an adequate analysis showing that the paradoxes arise through a lack of separation of an object theory and a metatheory. Under such an adequate analysis in which parts of the metatheory are modelled in the object theory, the paradoxes give way to remarkable theorems establishing limitations of the object theory.Such a modelling is often accomplished by a Gödel numbering. Here we shall use (...) a somewhat different technique in axiomatic set theory, from which we shall reap a few results having the effect of comparing the strength of various axiom schema of comprehension for sets and classes. Similar results were obtained by A. Mostowski [7] using Gödel numbering. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Bad, the Ugly, and the Need for a Position by PsychiatryLloyd A. Wells (bio)Keywordsvice, psychiatric education, psychiatry-law interface, medicalizationSadler’s paper is thought provoking and will resonate with many psychiatrists who deal with the interface of vice and psychiatric syndromes. This interface and the dilemmas it poses are perhaps most discussed by residents, who are dealing with the issue for the first time and who often debate what is (...) “psychiatric” about these cases. Many residents have their own informal systems of classifying vice, often with a divide between the criminal population and those perceived as avoiding work and responsibility. These unofficial classifications are usually judgmental and often pejorative, but the residents rarely get much help from faculty in this area. Indeed, many of the faculty have equally judgmental and pejorative views, which are neither systematized nor subject to systematic analysis.By clarifying the importance of the issue of the vice–mental disorder relationship (VMDR) to psychiatry, Sadler may move this topic to one that receives Socratic discourse in our training programs and serious consideration in the training of psychiatrists rather than an idiosyncratic lumping of these patients into the broad category of “patients I don’t like.”Sadler asks for comments in several categories: historical intractability, goals of psychiatry, taxonomy, implications for the criminal justice system, implications for the law, and ethical/political implications.Issues of historical intractability are long standing. In A Tour of the Whole Island of Great Britain, written in the early eighteenth century, Daniel Defoe (1724–1727) describes many asylums, often with the comment, “as it is a madhouse, so is it also a house of correction.” Some of the great public hospitals of the seventeenth and eighteenth centuries were built at least as much to get antisocial and homeless people off the streets as to provide care for the mentally ill. The moral treatment of France and Great Britain, which added much to the practice of psychiatry, clearly had punitive “treatments” for patients with vice-laden behaviors, and this was very explicit in the American moral model of treatment of the late nineteenth century with its obsessive need to prevent patients from masturbating. In the nineteenth and early twentieth centuries, there was great debate about the inclusion of Pritchard’s “moral insanity”—now sanitized into “personality disorders”—into the psychiatric domain, and Kraepelin referred to this group as “enemies of society.”Sadler next asks us to consider the goals of psychiatry in regard to “a proper VMDR.” He wonders [End Page 43] whether a strict medicalization account can be defended. I think it is clear from a large literature and from clinical experience that it cannot be defended —now. But it may become defensible in this century, which will pose enormous challenges to psychiatry, lawmakers, and the courts (vide infra). A strict moralization model is defended by many in society, including some psychiatrists, but has severe limitations and seems illogical. It is hard to make a case (though juries have done so) that, for example, a very delusional young woman with postpartum psychosis who murders her children because of the belief that far worse things than death will happen to them imminently if they live, fits the moralization approach. The Dahmer case is especially instructive. Although there was enormous “vice” (and perhaps “evil”), it is hard to make a case that a sane man would make temples out of the body parts of victims and would attempt to commune with the dead through them.He wonders whether a “mixed” version of medicalization/moralization can be developed and defended. I would argue for both a mixed approach and a “shared” approach. A middle adolescent with bipolar disorder burned his house to the ground. (Fortunately, he and family members were injured but not killed.) He was wildly manic at the time and set the fire because he wanted to prove that he was immortal and totally impervious to flames. He was delusional, extraordinarily impulsive, and completely without judgment, and it would be extraordinarily difficult to exclude the medical frame in any consideration of the vice involved. The vice, indeed, may be more involved in his decision while euthymic to stop taking... (shrink)

Research on positive psychology demonstrates that specific individual dispositions are associated with more desirable outcomes. The relationship of positive psychological constructs, however, has not been applied to the areas of business ethics and social responsibility. Using four constructs in two independent studies (hope and gratitude in Study 1, spirituality and generativity in Study 2), the relationship of these constructs to sensitivity to corporate social performance (CSCSP) were assessed. Results indicate that all four constructs significantly predicted CSCSP, though only hope and (...) gratitude interacted to impact CSCSP. Discussion focuses upon these findings, limitations of the study, and future avenues for research. (shrink)