Few studies have considered in detail the ethical issues surrounding research in which investigators ask community members to engage in research subject recruitment within their own communities. Peer-driven recruitment and its variants are useful for accessing and including certain populations in research, but also have the potential to undermine the ethical and scientific integrity of community-based research. This paper examines the ethical implications of utilizing community members as recruiters of human subjects in the context of PDR, as well as the (...) authors' experience with a variant of PDR in a research project in South Africa. The importance of situating PDR in a comprehensive community engagement process that is responsive to the constraints of science and local needs and interests is emphasized. The paper will have relevance to bioethicists, health researchers, and research regulators concerned about the appropriate use of peer-driven recruitment strategies in health research. (shrink)

Scholars have debated the role that altruistic considerations play—and should play—in recruitment and decision-making processes for clinical trials. Little empirical data are available to support their various perspectives. We analyzed 140 audiotaped pediatric informed consent sessions, of which 95 (68%) included at least one discussion of how participation in a cancer clinical trial might benefit: 1) the pursuit of scientific knowledge generally; 2) other children with cancer specifically; and 3) “the future” and other vaguely defined recipients. Clinicians initiated most (80%) (...) of these discussions of altruism. The enrollment rate of children in the clinical trial was high (83%) overall, but not higher among children whose parents were involved in an altruism-oriented discussion. These findings suggest that: (1) clinicians invoke a spectrum of altruistic considerations rather than a single monothematic notion of altruism, and (2) the effect of altruistic considerations on subsequent enrollment decisions is marginal. While further research on this topic is warranted, bioethical debate should strive to reflect the diversity of altruistic discourse in clinical research encounters and to place this discourse in the context of other, including nonaltruistic, considerations. (shrink)

The ethics of conducting research in epidemic situations have yet to account fully for differences in the proportion and acuteness of epidemics, among other factors. While epidemics most often arise from infectious diseases, not all infectious diseases are of epidemic proportions, and not all epidemics occur acutely. These and other variations constrain the generalization of ethical decision-making and impose ethical demands on the individual researcher in a way not previously highlighted. This paper discusses a number of such constraints and impositions. (...) It applies the ethical principles enunciated by Emmanuel et al.1 to the controversial Pfizer study in Nigeria in order to highlight the particular ethical concerns of acute epidemic research, and suggest ways of meeting such challenges. The paper recommends that research during epidemics should be partly evaluated on its own merits in order to determine its ethical appropriateness to the specific situation. Snap decisions to conduct research during acute epidemics should be resisted. Community engagement, public notification and good information management are needed to promote the ethics of conducting research during acute epidemics. Individual consent is most at risk of being compromised, and every effort should be made to ensure that it is maintained and valid. Use of data safety management boards should be routine. Acute epidemics also present opportunities to enhance the social value of research and maximize its benefits to communities. Ethical research is possible in acute epidemics, if the potential challenges are thought of ahead of time and appropriate precautions taken. (shrink)

‘Researcher identity’ affects global health research in profound and complex ways. Anthropologists in particular have led the way in portraying the multiple, and sometimes tension-generating, identities that researchers ascribe to themselves, or have ascribed to them, in their places of research. However, the central importance of researcher identity in the ethical conduct of global health research has yet to be fully appreciated. The capacity of researchers to respond effectively to the ethical tensions surrounding their identities is hampered by lack of (...) conceptual clarity, as to the nature and scope of the issues involved. This paper strives to provide some clarification of these ethical tensions by considering researcher identity from the perspective of (1) Guillemin and Heggen's (2009) key distinction between procedural ethics and ethics in practice, and (2) our own distinction between perceptions of identity that are either symmetrical or asymmetrical, with the potential to shift research relationships toward greater or lesser ethical harmony. Discussion of these concepts is supported with ethnographic examples from relevant literature and from our own (United States (US) Government-funded) research in South Africa. A preliminary set of recommendations is provided in an effort to equip researchers with a greater sense of organization and control over the ethics of researcher identity. The paper concludes that the complex construction of researcher identity needs to be central among the ethical concerns of global health researchers, and that the conceptual tools discussed in the paper are a useful starting point for better organizing and acting on these ethical concerns. (shrink)

The hard problem of consciousness is the question how subjective experience arises from brain matter. I suggest that quantum physics may be part of the answer. The simultaneous unity and complexity of subjective experience is very difficult to understand from a classical physics perspective. In contrast, quantum entanglement is naturally both complex and holistic. Building on recent remarkable progress in quantum technology and neuroscience, I propose a concrete hypothesis as a basis for further investigation, namely that subjective experience is related (...) to the dynamics of a complex entangled state of spins, which is continuously generated and updated through the exchange of photons. The proposed hypothesis raises many interesting experimental and theoretical questions in neuroscience, quantum physics, evolutionary biology, psychophysics, and philosophy. (shrink)

Under what circumstances, and with what attitudes, should we make moral evaluations of others? I attempt to answer this question by examining a common vice connected with moral evaluation, judgmentalism (the disposition to derive satisfaction from making negative moral assessment of others because one believes one’s own moral worth is enhanced by the failure of others). A Christian view of judgmentalism is discussed, as well as the vice which is the opposite of judgmentalism, moral cowardice (the disposition to be so (...) adverse to making negative assessments of others that one avoids doing so even when such assessments are appropriate and warranted). (shrink)

This article examines the responsibilities of researchers who conduct exploratory research to provide a service to vulnerable respondents. The term “service” is used to denote the provision of a tangible benefit in relation to the research question that is apart from the altruistic research benefits. This article explores what this “service” could look like, who might be responsible for providing it, and the challenges associated with such a service. The article argues that not providing a tangible benefit to vulnerable research (...) participants is inconsistent with the principle of social justice that undergirds much of the rationale for conducting health disparities research. (shrink)

Many cultural competency efforts in healthcare stress the importance of cultural diversity and difference. This emphasis is necessary and well justified. It has helped sensitize healthcare systems to the differences among people and their health-related attitudes, preferences, and behaviors. However, the emphasis on diversity and difference has, unfortunately, also detracted from serious consideration of the things that cultures have in common and the possibility that socioeconomic differences are today far more important than cultural ones in determining healthcare outcomes.

In "the nature of necessity" alvin plantinga says he does not know whether an individual's essence can be understood in purely qualitative terms. The aim of this article is to show that if essences are suchnesses then plantinga cannot use world-Indexed properties to escape the problems raised for transworld identity by the transitivity of the identity relation. The article concludes that plantinga cannot afford to be in doubt concerning whether essences are primitive.

This paper explores the question of whether there is a conceptual distinction between romantic love and friendship and whether such a distinction would support the normative conclusion that friends should not be lovers. Laurence Thomas has argued that, given an egalitarian conception of romantic love, there is no such distinction between romantic love and friendship. This paper shows that equally egalitarian alternatives to Thomas’s conceptions of love and friendship do suggest that friends should not be lovers. Moreover, the alternative view (...) of romantic love defended in the paper supports a link between romantic love and sexual exclusivity. (shrink)

Background Genomic research is challenging the tradition of informed consent. Genomic researchers in the USA, Canada and parts of Europe are encouraged to use informed consent to address the prospect of disclosing individual research results (IRRs) to study participants. In the USA, no national policy exists to direct this use of informed consent, and it is unclear how local institutional review boards (IRBs) may want researchers to respond. Objective and methods To explore publicly accessible IRB websites for guidance in this (...) area, using summative content analysis. Findings Three types of research results were addressed in 45 informed consent templates and instructions from 20 IRBs based at centres conducting genomic research: (1) IRRs in general, (2) incidental findings (IFs) and (3) a broad and unspecified category of ‘significant new findings’ (SNFs). IRRs were more frequently referenced than IFs or SNFs. Most documents stated that access to IRRs would not be an option for research participants. These non-disclosure statements were found to coexist in some documents with statements that SNFs would be disclosed to participants if related to their willingness to participate in research. The median readability of template language on IRRs, IFs and SNFs exceeded a ninth-grade level. Conclusion IRB guidance may downplay the possibility of IFs and contain conflicting messages on IRR non-disclosure and SNF disclosure. IRBs may need to clarify why separate IRR and SNF language should appear in the same consent document. The extent of these issues, nationally and internationally, needs to be determined. (shrink)

As the perfect companion to introduction to ethics courses, Dell'Olio and Simon's reader includes the most influential ethical theories without overwhelming the beginning student. It contains a variety of readings encompassing contemporary and classic philosophers, male and female perspectives of both western and non-western ethical traditions, and readings in both theoretical and applied ethics as well as a section on 'living the good life.' Useful introduction with thought provoking study questions and suggestions for further readings accompany each chapter which make (...) it easier for students to understand and appreciate their reading. (shrink)

The cultural group selection hypothesis is supported by considerations of short-term and long-term behavioral patterns of group members, and the short-term and long-term consequences of that behavior. The key to understanding cooperation lies in understanding that the effect of an extended behavioral pattern does not equal – and might even be opposite to – the added effects of its parts.

Biography of the paleontologist, priest, writer, and co-discoverer of Peking man who developed a theory claiming to unify cosmic evolution and Christianity.

A biography of the Jewish philosopher and Zionist leader who became noted for his studies of Hasidism, a movement of Jewish mysticism.

Few studies have considered in detail the ethical issues surrounding research in which investigators ask community members to engage in research subject recruitment within their own communities. Peer-driven recruitment and its variants are useful for accessing and including certain populations in research, but also have the potential to undermine the ethical and scientific integrity of community-based research. This paper examines the ethical implications of utilizing community members as recruiters of human subjects in the context of PDR, as well as the (...) authors' experience with a variant of PDR in a research project in South Africa. The importance of situating PDR in a comprehensive community engagement process that is responsive to the constraints of science and local needs and interests is emphasized. The paper will have relevance to bioethicists, health researchers, and research regulators concerned about the appropriate use of peer-driven recruitment strategies in health research. (shrink)

Till We Have Faces is profitably read at three levels: for its surface story, as a crime drama, and as an exploration of the theological mystery of grace. By transposing the myth of Psyche into the mystery genre, Lewis prepares the reader for Orual’s unreliability as a narrator and lures the reader into the novel’s theological depths. Part Two of the novel contains a series of visionary labors which Lewis borrows from Lucius Apuleius but recasts as feats achieved jointly by (...) Orual and Psyche. The theological reading in this article finds textual support for rereading Part One of the novel as depicting Orual, by grace, unknowingly performing Psyche’s labors. Read thusly, the novel is a working out of Lewis’s belief that God can change the past—that grace can reach back into our histories and retell our story. By ascribing to the mutability of the past, Lewis sidesteps the dispute among various branches of Christianity over whether prevenient grace is both irresistible and salvific. An examination of four sources of grace in Orual’s life reveals that what would have been common grace in her life becomes salvific as it leads to her redemption. This exposition also shows the novel’s indebtedness to the many classical Greek sources to which Lewis alludes within it, as well as its affinity with some of the ideas of Simone Weil. (shrink)

This essay describes and critically evaluates a co-operative educational program to train Ugandan health care workers in bioethics. It describes one bottom-up effort, a week-long intensive workshop in bioethics provided by the authors to health care professionals in a developing country—Uganda. We will describe the background and circumstances that led to the organization of the workshop, and review its planning, design, curriculum, and outcome. We will focus especially on measures taken to make the workshop relevant for the audience of Ugandan (...) professionals, and describe lessons learned after two presentations of the workshop. Finally, we will discuss the strengths and weaknesses of such a format, and its potential value in raising bioethical expertise in developing countries. (shrink)

The normative dimensions of Internet use among patients and their families have not been studied in much depth in the field of clinical ethics. This study considers cancer-related Internet use among families and friends of cancer patients, and how that use of the Internet may affect patients and patient care. Interviews were conducted with 120 cancer patients, most of whom (76%) reported that family, friends, and others in their social network used the Internet in some way related to the patient’s (...) cancer. Many patients (73%) did not request this online help from their social networks, yet found it helpful and comforting nonetheless. Other patients were less positive about the helpfulness of the online efforts of friends and relatives. A significant proportion of patients (39%) also felt that the online information they received was prescreened or edited in some way. Very few patients recalled that their clinicians ever discussed these and other issues with them. The study illustrates that indirect Internet use is a central feature of the cancer experience. In contrast to other literature in this area, the study suggests that indirect Internet use may have normatively positive and negative implications for patients. These implications point towards the importance of studying and understanding indirect Internet use—and Internet use in general—in the field of clinical ethics. (shrink)