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 in Zambia to explore their views on broad consent, sample and data sharing and secondary use. In-depth interviews were conducted with RHDGen participants, study staff (...) and with individuals who refused to participate. 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)

Advances in genetic and genomic research have introduced challenges in obtaining informed consent for research in low and middle-income settings. However, there are only few studies that have explored challenges in obtaining informed consent in genetic and genomic research in Africa and none in South Africa. To start filling this gap, we conducted an empirical study to investigate the efficacy of informed consent procedures for an H3Africa genomic study on Rheumatic Heart Disease at the University of Cape Town in South (...) Africa. The main aim of the study was to understand ethical challenges in obtaining informed consent in the RHDGen study. We used a qualitative study methodology involving in-depth interviews and participant observations. Our study participants were RHDGen cases, healthy controls and research staff involved in the recruitment of RHDGen cases and controls. In total, we conducted 32 in-depth interviews with RHDGen cases and controls, 2 in-depth interviews with research staff and 57 direct observations of the consent procedures of RHDGen cases and controls. The interviews were conducted in English, audio-recorded and transcribed verbatim. Data were analyzed using thematic content analysis. The study was conducted in 3 sites within Cape Town, South Africa. Most healthy controls joined the RHDGen study in order to be screened for rheumatic heart disease. A majority of RHDGen cases decided to join the RHDGen study because of therapeutic misconception. The ethical challenges that impacted on obtaining informed consent in the RHDGen study were complex. In this study, the main challenges were diagnostic misconception among RHDGen controls and therapeutic misconception among RHDGen cases. (shrink)

The requirement of gauge invariance for the Schwinger-DeWitt equations, interpreted as a manifestly covariant quantum theory for the evolution of a system in spacetime, implies the existence of a five-dimensional pre-Maxwell field on the manifold of spacetime and “proper time” τ. The Maxwell theory is contained in this theory; integration of the field equations over τ restores the Maxwell equations with the usual interpretation of the sources. Following Schwinger's techniques, we study the Green's functions for the five-dimensional hyperbolic field equations (...) for both signatures ± [corresponding to O(4, 1) or O(3, 2) symmetry of the field equations] of the proper time derivative. The classification of the Green's functions follows that of the four-dimensional theory for “massive” fields, for which the “mass” squared may be positive or negative, respectively. The Green's functions for the five-dimensional field are then given by the Fourier transform over the “mass” parameter. We derive the Green's functions corresponding to the principal part ΔP and the homogeneous function Δ 1 ; all of the Green's functions can be expressed in terms of these, as for the usual field equations with definite mass. In the O(3, 2) case, the principal part function has support for x2⩾τ2, corresponding to spacelike propagation, as well as along the light cone x2=0 (for τ=0). There can be no transmission ofinformation in spacelike directions, with this propagator, since the Maxwell field, obtained by integration over τ, does not contain this component of the support. Measurements are characterized by such an integration. The spacelike field therefore can dynamically establish spacelike correlations. (shrink)

Objective: Little empirical evidence exists to support either side of the ongoing debate over whether legalising physician aid in dying would undermine patient trust.Design: A random national sample of 1117 US adults were asked about their level of agreement with a statement that they would trust their doctor less if “euthanasia were legal [and] doctors were allowed to help patients die”.Results: There was disagreement by 58% of the participants, and agreement by only 20% that legalising euthanasia would cause them to (...) trust their personal physician less. The remainder were neutral. These attitudes were the same in men and women, but older people and black people had more agreement that euthanasia would lower trust. However, overall, only 27% of elderly people and 32% of black people thought that physician aid in dying would lower trust. These views differed with physical and mental health, and also with education and income, with those having more of these attributes tending to view physician aid in dying somewhat more favourably. Again, however, overall views in most of these subgroups were positive. Views about the effect of physician aid in dying on trust were significantly correlated with participants’ underlying trust in their physicians and their satisfaction with care. In a multivariate regression model, trust, satisfaction, age, and white/black race remained independently significant.Conclusion: Despite the widespread concern that legalising physician aid in dying would seriously threaten or undermine trust in physicians, the weight of the evidence in the USA is to the contrary, although views vary significantly. (shrink)

In Roper v. Simmons (2005) the United States Supreme Court announced a paradigm shift in jurisprudence. Drawing specifically on mounting scientific evidence that adolescents are qualitatively different from adults in their decision-making capacities, the Supreme Court recognized that adolescents are not adults in all but age. The Court concluded that the overwhelming weight of the psychological and neurophysiological data regarding brain maturation supports the conclusion that adolescents are qualitatively different types of agents than adult persons. The Supreme Court further solidified (...) its position regarding adolescents as less than fully mature and responsible decisionmakers in Graham v. Florida (2010) and Miller v. Alabama (2012). In each case, the Court concluded that the scientific evidence does not support the conclusion that children under 18 years of age possess adult capacities for personal agency, rationality, and mature choice. This study explores the implications of the Supreme Court decisions in Roper v. Simmons, Graham v. Florida, and Miller v. Alabama for the “mature minor” standard for medical decision making. It argues that the Supreme Court’s holdings in Roper, Graham, and Miller require no less than a radical reassessment of how healthcare institutions, courts of law, and public policy are obliged to regard minors as medical decisionmakers. The “mature minor” standard for medical decision making must be abandoned. (shrink)

The community representative plays a very important role in an institutional review board but there is sparse data about their understanding of their role in an IRB. This study was conducted to assess perceptions of community members serving on IRBs of one region in India. A validated questionnaire was administered to community members of IRBs in a prospective cross-sectional study. The questions related to demography, perceptions of their role in the IRB, experiences while serving on the IRBs, difficulties faced by (...) them, and suggestions to improve their contributions. Of the 56 IRBs contacted, all 15 of the public institutions shared details of their community members, while only 26 of the 41 IRBs of private institutions responded. When questioned about why they joined the IRB, one third of the respondents said either that there was “no specific reason” for joining or that they accepted the invitation to serve on the insistence of other members of the IRBs or the head of their institution. All except one felt that community members were needed for optimal functioning. Six participants said that they did not review informed consent documents, and 10 were unaware that their presence was vital for quorum to be met. Twenty-eight said they participated actively in meetings and did not feel intimidated by the presence of clinicians. Twelve reported difficulties in understanding medical terminologies in ICDs. Although the majority of participants were aware about their role in an IRB, some did not review important documents such as ICDs. Restricted participation by private hospital IRBs was a striking observation in our study. There is a need to define eligibility criteria and develop targeted training modules for community members to ensure their effective contribution to effective oversight of clinical research. (shrink)

This article offers a critique of the recently revised BMA guidance on routine neonatal male circumcision and seeks to challenge the assumptions underpinning the guidance which construe this procedure as a matter of parental choice. Our aim is to problematise continued professional willingness to tolerate the non-therapeutic, non-consensual excision of healthy tissue, arguing that in this context both professional guidance and law are uncharacteristically tolerant of risks inflicted on young children, given the absence of clear medical benefits. By interrogating historical (...) medical explanations for this practice, which continue to surface in contemporary justifications of non-consensual male circumcision, we demonstrate how circumcision has long existed as a procedure in need of a justification. We conclude that it is ethically inappropriate to subject children—male or female—to the acknowledged risks of circumcision and contend that there is no compelling legal authority for the common view that male circumcision is lawful. (shrink)

Book Information Knowledge in a Social World. By Alvin I. Goldman. Clarendon Press. Oxford. 1999. Pp. xiii + 407. Paperback, £16.99.

M. F. Burnyeat taught for 14 years in the Philosophy Department of University College London, then for 18 years in the Classics Faculty at Cambridge, 12 of them as the Laurence Professor of Ancient Philosophy, before migrating to Oxford in 1996 to become a Senior Research Fellow in Philosophy at All Souls College. The studies, articles and reviews collected in these two volumes of Explorations in Ancient and Modern Philosophy were all written, and all but two published, before that decisive (...) change. Whether designed for a scholarly audience or for a wider public, they range from the Presocratics to Augustine, from Descartes and Bishop Berkeley to Wittgenstein and G. E. Moore. Their subject-matter falls under four main headings: 'Logic and Dialectic' and 'Scepticism Ancient and Modern', which make up the first volume, with 'Knowledge' and 'Philosophy and the Good Life' contained in this, the second volume. The title 'Explorations' well expresses Burnyeat's ability to discover new aspects of familiar texts, new ways of solving old problems. In his hands the history of philosophy becomes itself a philosophical activity. (shrink)

In this paper we first give a survey of reductive cut-elimination methods in classical logic. In particular we describe the methods of Gentzen and Schütte-Tait from the abstract point of view of proof reduction. We also present the method CERES which we classify as a semi-semantic method. In a further section we describe the so-called semantic methods. In the second part of the paper we carry the proof analysis further by generalizing the CERES method to CERESD . In the generalized (...) version CERESD we admit general elimination rules which are based on the mere semantical truth of sentences. We construct complete cut-free LK-derivations originating from derivations potentially containing unproven lemmas. Finally we give a comparison of reductive methods and CERESD by presenting a general simulation result. (shrink)

The authors refute Harris’s criticism of the work of NICE and in turn criticise his description of the institute’s positionHarris’s recent editorial,1It’s not NICE to discriminate, is long on both polemic and invective but short on scholarship. He offers nothing to illuminate the debate about allocating health care in circumstances of finite resources; he has no understanding of the quality adjusted life year and its use in health economic evaluation; and he makes ill researched, unsubstantiated charges against the institute and (...) its advisory bodies.ALLOCATING HEALTHCARE RESOURCESThe British National Health Service , like every other healthcare system in the world, has finite resources. How the NHS’s budget should be most appropriately allocated is a very specific example of the more general problem of distributive justice.2The NHS, with its requirement3 to provide all care that is “necessary and appropriate”, was founded with an egalitarian purpose. Yet despite its laudable emphasis on fairness, the implementation of the NHS’s egalitarian approach remains uncertain. What is necessary? What is appropriate? How should the tensions between the service’s egalitarian aspirations, and the need to provide health care from finite resources, be resolved? On what principles should these allocative decisions be made?Utilitarianism, with its goal to maximise overall good, is another approach. Yet experience with the original Oregon plan demonstrated that, when rigidly applied, it can yield solutions that most find unacceptable—for example, tooth capping taking precedence over emergency appendectomy.4 Moreover, some versions of utilitarianism can allow the interests of minorities to be overridden by the majority; and it has next to nothing to offer in eradicating health inequalities.There is no single, broadly accepted, theory of distributive justice …. (shrink)

The medieval Islamic philosophers held a certain conception of the divine unity that assumes the necessary existent to be both one and simple. The oneness of the necessary existent meant that it is the only necessary existent and its simplicity meant that it admits no composition whatsoever – it is pure essence and its essence is necessary existence. In The Incoherence of the Philosophers al-Ġazālī presents, with elaboration, an exposition of the philosophers' conception of the divine unity, several arguments for (...) its two components, and his critique of these arguments. In this paper I focus on six of the arguments attributed to the philosophers. Following the textual evidence, I reconstruct these arguments and offer two possible interpretations of them. The first interpretation, which I call the many-argument interpretation, sees one of the arguments as employing the simplicity of the necessary existent to establish its oneness and the other five arguments as invoking oneness to establish simplicity. The second interpretation, which I call the one-argument interpretation, doesn't offer a new reading for the first argument but sees the other five arguments as defending the simplicity of the necessary existent based on its basic concept. I argue for the superiority of the one-argument interpretation. Résumé Les philosophes de l'Islam classique ont une doctrine de l'unité divine selon laquelle l'existant nécessaire est à la fois unique et simple. Son unicité signifie qu'il est le seul existant nécessaire, sa simplicité qu'il n'admet aucune sorte de composition; il est pure essence et son essence est existence nécessaire. Dans la Destruction des Philosophes, al-Ġazālī présente avec force détails un exposé de la doctrine de l'unité divine des philosophes, plusieurs arguments en faveur de ses deux composantes, ainsi que sa critique de ces arguments. Je me concentre ici sur six des arguments qu'il attribue aux philosophes. En suivant les données textuelles, je reconstruis ces arguments et en propose deux interprétations possibles. La première, que j'appelle l'interprétation “à arguments multiples”, identifie l'un des arguments comme s'appuyant sur la simplicité de l'existant nécessaire pour établir son unicité, et les cinq autres comme s'appuyant sur son unicité pour établir sa simplicité. La seconde, que j'appelle l'interprétation “à argument unique”, conserve la première lecture du premier argument mais voit dans les cinq autres une défense de la simplicité de l'existant nécessaire fondée sur sa notion fondamentale. J'argumente en faveur de la supériorité de l'interprétation “à argument unique”. (shrink)

Next SectionCultural differences in end-of-life care and the moral disagreements these sometimes give rise to have been well documented. Even so, cultural considerations relevant to end-of-life care remain poorly understood, poorly guided, and poorly resourced in health care domains. Although there has been a strong emphasis in recent years on making policy commitments to patient-centred care and respecting patient choices, persons whose minority cultural worldviews do not fit with the worldviews supported by the conventional principles of western bioethics face a (...) perpetual struggle in getting their care needs met in a meaningful, safe, and healing way. In this essay, attention is given to exploring why cultural differences exist, why they matter, and how health care providers should treat them in order to reduce the incidence and impact of otherwise preventable harmful moral outcomes in end-of-life care. In addressing these questions, a novel application of the renowned terror management theory will be made. (shrink)

Dissociative style is mostly studied as a risk factor for dissociative pathology, but it may also reflect a fundamental characteristic of healthy information processing. Due to the close link between attention and working memory and the previous finding of enhanced attentional abilities with a high dissociative style, a positive relationship was also expected between dissociative style and verbal working memory span. In a sample of 119 psychology students, it was found that the verbal span of the high-dissociative group was about (...) half a word larger than of the medium and low-dissociative groups. It is suggested that dissociative style may be one of only very few individual differences that is directly relevant to consciousness research. (shrink)

There is an ancient and ambiguous philosophical doctrine that perception is passive. This can mean that the mind contributes nothing to the content of our sensory experience: its power of perception is a mere receptivity. In this sense the principle has often been questioned, and is indeed doubtful on empirical grounds, given one reasonable interpretation of what it would be for the mind to make such a contribution.

Television medical dramas sometimes depict medical professionalism and bioethical issues, but their nature and extent are unclear. The authors systematically analysed the bioethical and professionalism content of one season each of Grey's Anatomy and House M.D., two of the most popular current television medical dramas. The results indicate that these programmes are rife with powerful portrayals of bioethical issues and egregious deviations from the norms of professionalism and contain exemplary depictions of professionalism to a much lesser degree.

Several of the treatises and lectures that make up the Hippocratic corpus begin with more or less extended statements about the physical composition and operation of the world at large, and approach the study of human physiology from this angle. We see this, for example, in De Natwra Hominis, De Flatibus, De Carnibus, De Victu; it was the approach of Alcmaeon of Croton, Diogenes of Apollonia, and according to Plato of Hippocrates himself. The work known as De Hebdomadibus would appear (...) to be a prime example of the type. The first twelve chapters are cosmological. They are dominated by two ideas: that everything in nature is arranged in groups of seven, and that the human body is constructed on the same pattern as the whole world. In the later part of the book we pass to the subject of fevers, their causation and treatment. But as Roscher observed, the cosmology and the pathology do not belong together. (shrink)

The passing on of information to GPs by genito-urinary doctors is to be encouraged but is not always possible and ultimately the patient's wishes and confidentiality must be respected if sexually transmitted diseases and HIV infection are to be controlled. Infected health-care workers should seek counselling and medical support and clear guidelines from professional organisations which are in existence. However, they will only do so if strict confidentiality is maintained and assurance about future employment can be given.