Community engagement is increasingly emphasized in biomedical research, as a right in itself, and to strengthen ethical practice. We draw on interviews and observations to consider the practical and ethical implications of involving Community Health Workers (CHWs) as part of a community engagement strategy for a vaccine trial on the Kenyan Coast. CHWs were initially engaged as an important network to be informed about the trial. However over time, and in response to community advice, they became involved in trial information (...) sharing and identifying potential participants; thereby taking on roles that overlapped with those of employed fieldworkers (FWs). While CHWs involvement was generally perceived as positive and appreciated, there were challenges in their relations with FWs and other community members, partly related to levels and forms of remuneration. Specifically, payment of CHWs was not as high as for FWs and was based on ‘performance’. This extrinsic motivation had the potential to crowd out CHWs intrinsic motivation to perform their pre-existing community roles. CHWs remuneration potentially also contributed to CHWs distorting trial information to encourage community members to participate; and to researchers encouraging CHWs to utilize their social connections and status to increase the numbers of people who attended information giving sessions. Individual consent processes were protected in this trial through final information sharing and consent being conducted by trained clinical staff who were not embedded in study communities. However, our experiences suggest that roles and remuneration of all front line staff and volunteers involved in trials need careful consideration from the outset, and monitoring and discussion over time. (shrink)

Moral and social arguments weigh heavily against performing medical procedures solely for purposes of sex selection. The medical profession has a responsibility to abandon its posture of ethical neutrality and take a firm stand now against sex selection.

The ArgumentA survey of 2901 genetics professionals in 36 nations suggests that eugenic thought underlies their perceptions of the goals of genetics and that directiveness in counseling after prenatal diagnosis leads to individual decisions based on pessimistically biaed information, especially in developing nations of Asia and Eastern Europe. The “non-directive counseling” found in English-speaking nations is an aberration from the rest of the world. Most geneticists, except in China, rejected government involvement in premarital testing or sterilization, but most also held (...) a pessimistic view of persons with genetic disabilities. Individual, but not state-coerced, eugenics survives in much modern genetic practice. (shrink)

We surveyed the approaches of 661 geneticists in 18 nations to 14 clinical cases and asked them to give their ethical reasons for choosing these approaches. Patient autonomy was the dominant value in clinical decision-making, with 59% of responses, followed by non-maleficence (20%), beneficence (11%) and justice (5%). In all, 39% described the consequences of their actions, 26% mentioned conflicts of interest between different parties and 72% placed patient welfare above the welfare of others. The U.S., Canada, Sweden, and U.K. (...) led in responses favoring autonomy. There were substantial international differences in moral reasoning. Gender differences in responses reflected women's greater attention to relationships and supported feminist ethical theories. (shrink)

The bibliography covers the years from january 1916 through february 1976. it lists, in philosophy, 14 books written or co-authored by charles hartshorne, six peirce volumes edited, with paul weiss, and 358 papers published in journals (approximately 100 different journals), symposia, anthologies, and "festschriften", including approximately 100 book reviews. in ornithology it includes one book and 12 papers published in ten different journals. the total number of items is 384.

Contributors to this volume demonstrate how the ethics of care factors into a variety of social policies and institutions, and can indeed be useful in thinking about a number of different social problems. Divided into two sections, the first looks at care as a model for an evaluative framework that rethinks social institutions, liberal society, and citizenship at a basic conceptual level. The second explores care values in the context of specific social practices or settings, as a framework that should (...) guide thinking. (shrink)

Concept and theory formation in the social sciences, by A. Schutz.--Is it a science? by S. Morgenbesser.--Knowledge and interest, by J. Habermas.--Sociological explanation, by T. Burns.--Methodological individualism reconsidered, by S. Lukes.--The problem of rationality in the social world, by A. Schutz.--Concepts and society, by E. Gellner.--Symbols in Ndembu ritual, by V. Turner.--Telstar and the Aborigines or La pensée sauvage, by E. Leach.--Groote Eylandt totemism and Le totémisme aujourd'hui, by P. Worsley.--Bibliography (p. 225-228).

Background Protecting a person’s right to privacy and confidentiality is important in healthcare services. As future health professionals, nursing students should bear the same responsibility as qualified health professionals in protecting patient privacy. Objectives To investigate nursing students’ practices of patient privacy protection and to identify factors associated with their practices. Research design A cross-sectional study design was adopted. A two-part survey was used to collect two types of data on nursing students: (1) personal characteristics, including demographics, clinical experience and (...) use of information and communication technology and social media and (2) practice of patient privacy protection, collected using the Patient Privacy Scale. Participants and research context: A total of 319 nursing students aged 18 or above, studying pre-registration nursing programmes and who had attended at least one block of clinical placement, were recruited from a university in Hong Kong. Ethical considerations The study received ethical approval from the Survey and Behavioural Research Ethics Committee of the Chinese University of Hong Kong. The participants were informed of the study aim and written consent was obtained before completing the survey. Findings: The mean total score on the Patient Privacy Scale was 119.7 out of 135. Nursing students who were regular users of Instagram and those who had never taken photographs with patients and hence did not need to obtain patient consent were associated with better practices of patient privacy protection (higher total scores on the Patient Privacy Scale). Conclusions The findings improve our understanding of nursing students’ practice of patient privacy protection and the associated factors. This will inform the development and revision of current strategies to enhance nursing students’ practice of patient privacy protection, especially their use of social media. (shrink)

Fieldworkers (FWs) are community members employed by research teams to support access to participants, address language barriers, and advise on culturally appropriate research conduct. The critical role that FWs play in studies, and the range of practical and ethical dilemmas associated with their involvement, is increasingly recognised. In this paper, we draw on qualitative observation and interview data collected alongside a six month basic science study which involved a team of FWs regularly visiting 47 participating households in their homes. The (...) qualitative study documented how relationships between field workers and research participants were initiated, developed and evolved over the course of the study, the shifting dilemmas FWs faced and how they handled them. Even in this one case study, we see how the complex and evolving relationships between fieldworkers and study participants had important implications for consent processes, access to benefits and mutual understanding and trust. While the precise issues that FWs face are likely to depend on the type of research and the context in which that research is being conducted, we argue that appropriate support for field workers is a key requirement to strengthen ethical research practice and for the long term sustainability of research programmes. (shrink)

There has been a long debate on whether demonstratives are directly referential as Kaplan originally argued, or indirectly referential like a definite description. I propose a new analysis of demonstratives that combines intuitions from both direct and indirect approaches. The demonstrative is analyzed as an indirectly referential expression with a binary maximality operator that takes two arguments, where the second argument can be a deictic pointing, an anaphoric index, or a relative clause. Direct reference is encoded not in the meaning (...) of the demonstrative but in the meaning contributed by the pointing gesture, thus capturing both direct and indirect uses. I further propose that some pronouns in English function as demonstratives, realizing the binary structure and competing with the demonstrative. The main advantages of this proposal include (a) deriving the distribution of pronominal and adnominal demonstratives systematically; (b) capturing the unique interaction that demonstratives have with a pointing gesture; and (c) locating English demonstratives against a larger, cross-linguistic picture. (shrink)

The continuing spread and development of electronic data interchange in health care settings is fuelling a significant global debate about the practicality, ethics, and legality of such a practice. The uncertainties implicit in this debate are particularly acute in the context of disease or population groups for whom multidisciplinary, multipleagency teamworking has become acknowledged as the “best practice” for providing effective and timely care or support. The greying of the population is a demographic phenomenon that will have a profound impact (...) on the health care system, social care agencies, and caregivers, and will require a greater degree of service coordination in order to meet the complex care needs of both care-receiver and caregiver. (shrink)