Increased international migration of health professionals is weakening healthcare systems in low‐income countries, particularly those in sub‐Saharan Africa. The migration of nurses, physicians and other health professionals from countries in sub‐Saharan Africa poses a major threat to the achievement of health equity in this region. As nurses form the backbone of healthcare systems in many of the affected countries, it is the accelerating migration of nurses that will be most critical over the next few years. In this paper we present (...) a comprehensive analysis of the literature and argue that, from a human rights perspective, there are competing rights in the international migration of health professionals: the right to leave one's country to seek a better life; the right to health of populations in the source and destination countries; labour rights; the right to education; and the right to nondiscrimination and equality. Creative policy approaches are required to balance these rights and to ensure that the individual rights of health professionals do not compromise the societal right to health. (shrink)

Berenicen statim ab urbe dimisit invitus invitam.As for Berenice, he immediately dismissed her from the city against his will, against her will. Suetonius' laconic description of Titus' dismissal of his consort, the Herodian Berenice, after his accession to the Principate has attracted the attention of readers across the centuries. The biographer's use of polyptoton, invitus invitam, to describe the mental states of the Roman princeps and Judaean princess has been read as particularly moving. Perhaps most notably, Racine turned the emperor's (...) banishment of his lover into the central dilemma of his tragedy Bérénice. At the start of his preface to the text of the play, the dramatist amalgamates this sentence with another from earlier in the chapter, retaining the striking repetition, ‘Titus reginam Berenicen cui etiam nuptias pollicitus ferebatur, statim ab Urbe dimisit invitus invitam’. Racine claims that this account of the dismissal of Berenice provides appropriate subject matter for tragic poetry and, to support his case, he compares Virgil's treatment of the separation of Aeneas and Dido to the situation of Titus and Berenice. Suetonius is not normally read as a literarily sophisticated writer, but we should take a cue from Racine's response to this sentence. In this article, I argue that Suetonius himself chose to compare Titus and Berenice with Dido and Aeneas by an allusion in this sentence to Virgil's Aeneid and to Catullus' translation of the Coma Berenices. Within a rather matter-of-fact presentation of the relationship between the Flavian emperor and his Herodian consort, Suetonius evoked a more dramatic model. (shrink)

This open peer commentary critically examines the concept of unqualified medical confidentiality in the context of clinical genetics. The authors challenge two key assertions about maintaining absolute confidentiality: first, that preventing information sharing is the most effective way to minimize harm, and second, that individuals will take more responsibility for their health under strict confidentiality. Using a case study of a genetic condition with familial implications, they argue for a "qualified confidentiality" approach specific to clinical genetics. The commentary highlights the (...) unique nature of genetic information, which often has direct implications for family members. The authors suggest that in certain medical contexts, particularly those involving inheritable conditions, a more nuanced approach to confidentiality might better protect the health interests of multiple individuals, balancing patient privacy with potential preventative benefits for at-risk family members. (shrink)

Variant Creutzfeldt–Jakob disease is a fatal, transmissible, neurodegenerative disorder for which there is currently no effective treatment. vCJD arose from the zoonotic spread of bovine spongiform encephalopathy. There is now compelling evidence for human to human transmission through blood transfusions from presymptomatic carriers and experts are warning that the real epidemic may be yet to come. Imperatives exist for the development of reliable, non-invasive presymptomatic diagnostic tests. Research into such tests is well advanced. In this article the ethical implications of (...) the availability of these tests are elaborated and comparisons drawn with predictive genetic testing for Huntington’s disease and screening for HIV. Paramount to considerations is the issue of whom to test, weighing up respect for personal autonomy against obligations to benefit and protect society. A paradigm is proposed similar to that used for HIV screening but with unique features: compulsory testing of all blood/organ donors and individuals undergoing surgery or invasive procedures who have a significant risk of disease transmission. (shrink)

The target article explores material culture datasets from three African forager groups. After demonstrating that these modern, contemporary human populations would leave scant evidence of symbolic behaviour or material complexity, it cautioned against using material culture as a barometer for human cognition in the deep past. Twenty-one commentaries broadly support or expand these conclusions. A minority offer targeted demurrals, highlighting (1) the soundness of reasoning from absence; and questioning (2) the “cognitively modern” null; (3) the role of hunter-gatherer ethnography; and (...) (4) the pertinence of the inferential issues identified in the target article. In synthesising these discussions, this reply addresses all four points of demurral in turn, and concludes that there is much to be gained from shifting our null assumptions and reconsidering the probabilistic inferential links between past material culture and cognition. (shrink)

This monograph consists of five parts: (1) introductory material including a conference overview; (2) papers presented at an international symposium on the topic of ethical issues in disability and rehabilitation as a section of the Annual Conference of the Society for Disability Studies; (3) responses to the symposium, prepared by four of the participants; (4) selected additional papers which offer views from perspectives or cultures not represented at the Denver conference; and (5) an annotated international bibliography. Representatives from 10 countries (...) discussed ethical issues and decision making in disability and rehabilitation. Conference papers include: "Genetic Engineering--The New Eugenics? Evolving Medical Attitudes towards the Quality of Life" (Hugh Gallagher);"Description of the Decision-Making Project" (Daryl Evans); "Treatment and Nontreatment Decisions with Respect to Extremely Premature, Very Low Birthweight Infants (500-750g)" (Ernle Young); "Allocation of Resources and Distributive Justice" (John Mather); "Quality Assurance as an Aid to Ethical Decision Making in Disability Management: Lessons from Recent Ethical Issues Involving Disadvantaged Groups in New Zealand" (Peter Gow); "Disability and Ethical Issues: A Point of View from the Netherlands" (Yolan Koster-Dreese); "Who Shall Live or How Shall They Live? Consumer and Professional Perspectives on Treatment/Non-Treatment Decisions" (Joseph Kaufert and Patricia Kaufert); and "Debates across Social Movements on Reproductive Technologies, Genetic Engineering, and Eugenics" (Theresia Degener). Conference commentaries include: "The Meeting of Disability and Bioethics: A Beginning Rapprochement" (Adrienne Asch); "A Plea for More Dialogue: Commentary on Ethics Conference" (Robert Slater); "Healing Our Wounds" (Martha Lentz Walker); "Theories and Values: Ethics and Contrasting Perspectives on Disability" (Harlan Hahn); and "Current Example of Ethical Dilemma" (Susan Lacetti). Selected additional papers include: "High-tech Medicine Is Basic Care" (Frederick Abrams); "Prevention of Disabilities as a Medical Question" (G. Schioler); "The Ethics of Disability Prevention: A Parent's Point of View" (Mrs. J. Baker); "A Reference Matrix for Issues of Life and Personhood" (Mike Miles); "Nazi Scientists and Ethics of Today" (Isabel Wilkerson); "Ethical and Policy Issues in Rehabilitation Medicine (Hastings Center Report)" (Arthur Caplan et al.); and "Differing Approaches to Prevention of Disability and Treatment of Impaired Infants Creates Controversies Worldwide" (Barbara Duncan). (JDD). (shrink)

Navigating limits to confidentiality with adolescent clients can be ethically and professionally challenging. This study follows on from a previous quantitative survey of psychologists about confidentiality dilemmas with adolescents. The current study used qualitative methods to explore such dilemmas in greater depth. Twenty Australian psychologists were interviewed and asked to describe an ethically challenging past case. Cases were then used to facilitate discussion about the decision-making process and outcomes. Interviews were transcribed and analyzed using interpretive content and thematic analysis. Three (...) key findings are discussed. First, it is of little use to perceive confidentiality dilemmas as binary choices because psychologists described 5 distinct options. These can be conceptualized on a spectrum of varying degrees of client autonomy, ranging from “no disclosure” to “disclosure without the client’s knowledge or consent”. Second, confidentiality dilemmas often involve balancing multiple and conflicting risks regarding both immediate and future harm. Third, a range of strategies are employed by psychologists to minimize potential harms when disclosing information. These are primarily aimed at maintaining the therapeutic relationship and empowering clients. These findings and the case studies described provide a valuable resource for teaching and professional development. (shrink)

Austin E. Duncan-Jones; Definition of Identity of Structure, Analysis, Volume 2, Issue 1-2, 1 October 1934, Pages 14–18, https://doi.org/10.1093/analys/2.1-2.14.

Variant Creutzfeldt–Jakob disease is a fatal, transmissible, neurodegenerative disorder for which there is currently no effective treatment. vCJD arose from the zoonotic spread of bovine spongiform encephalopathy. There is now compelling evidence for human to human transmission through blood transfusions from presymptomatic carriers and experts are warning that the real epidemic may be yet to come. Imperatives exist for the development of reliable, non-invasive presymptomatic diagnostic tests. Research into such tests is well advanced. In this article the ethical implications of (...) the availability of these tests are elaborated and comparisons drawn with predictive genetic testing for Huntington’s disease and screening for HIV. Paramount to considerations is the issue of whom to test, weighing up respect for personal autonomy against obligations to benefit and protect society. A paradigm is proposed similar to that used for HIV screening but with unique features: compulsory testing of all blood/organ donors and individuals undergoing surgery or invasive procedures who have a significant risk of disease transmission. (shrink)

Many have interpreted symbolic material culture in the deep past as evidencing the origins sophisticated, modern cognition. Scholars from across the behavioural and cognitive sciences, including linguists, psychologists, philosophers, neuroscientists, primatologists, archaeologists, and palaeoanthropologists have used such artefacts to assess the capacities of extinct human species, and to set benchmarks, milestones, or otherwise chart the course of human cognitive evolution. To better calibrate our expectations, the present paper instead explores the material culture of three contemporary African forager groups. Results show (...) that, although these groups are unequivocally behaviourally modern, they would leave scant long-lasting evidence of symbolic behaviour. Artefact sets are typically small, perhaps as a consequence of residential mobility. When traded materials are excluded, few artefacts have components with moderate–to–strong taphonomic signatures. The present analyses show that artefact function influences preservation probability, such that utilitarian tools for the processing of materials and the preparation of food are disproportionately likely to contain archaeologically traceable components. There are substantial differences in material use among populations, which create important population-level variation in preservation probability, independent of cognitive differences. I discuss the factors – cultural, ecological, and practical – that influence material choice. In so doing, I highlight the difficulties of using past material culture as an evolutionary or cognitive yardstick. (shrink)

_341_ _Objectives: _In patients with multivessel disease both the detection of the culprit lesion and the exact allocation are important preconditions for sufficient treatment and improved outcome. In a vessel based approach the combination of quantitative coronary angiography and fractional flow reserve measured by a pressure wire should be advantageous compared to myocardial SPECT, as morphological and functional information is delivered simultaneously. Therefore our aim was to evaluate MS in the detection and allocation of hemodynamically significant stenoses obtained by the (...) combined gold standard QCA plus FFR in patients with multivessel disease. _Methods: _FFR and QCA of 95 vessels in 80 patients have been evaluated. Hemodynamically significant target lesions were defined as intermediate stenoses between 50 and 75% with an FFR. (shrink)

This book presents a collection of contemporary discourses that reconsider the relationship of democracy as a political ideology and American ideal and education as the foundation of preparing democratic citizens in America.

Synaesthesia is a neurodevelopmental condition characterised by anomalous sensory perceptions and associated alterations in cognitive function. This chapter summarises what is known about the familial transmission of synaesthesia and its genetic underpinnings. Early familiality studies showed evidence for a strong genetic predisposition, a highly skewed female: male ratio, and an absence of male-to-male transmission. These patterns supported an early hypothesis of a single-gene X-linked dominant mode of inheritance with male lethality. Subsequent analyses in larger samples indicated that the mode of (...) inheritance was likely to be more complex, with both the strong female skew and absence of male-to-male transmission brought into question. We review in detail the first whole genome linkage scan for auditory-visual synaesthesia and a subsequent family linkage study on coloured sequence synaesthesia. Together these results suggest linkage to five chromosomes but give no support for linkage to the X-chromosome. We discuss candidate genes within these regions and potential implications for the aetiology of synaesthesia. We also discuss the implications of these pioneering genome scans for our understanding of synaesthesia and of how different synaesthetic phenotypes may arise from different genetic predispositions interacting with other genes and with the environment. (shrink)

The ratio of index- and ring-finger lengths is thought to be related to prenatal androgen exposure, and in many, though not all, populations, men have a lower average digit ratio than do women. In many studies an inverse relationship has been observed, among both men and women, between 2D:4D ratio and measures of athletic ability. It has been further suggested that, in hunter-gatherer populations, 2D:4D ratio might also be negatively correlated with hunting ability, itself assumed to be contingent on athleticism. (...) This hypothesis has been tested using endurance running performance among runners from a Western, educated, and industrialized population as a proximate measure of hunting ability. However, it has not previously been tested among actual hunter-gatherers using more ecologically valid measures of hunting ability and success. The current study addresses this question among Tanzanian Hadza hunter-gatherers. I employ a novel method of assessing hunting reputation that, unlike previous methods, allows granular distinctions to be made between hunters at all levels of perceived ability. I find no statistically significant relationship between digit ratio and either hunting reputation or two important hunting skills. I confirm that Hadza men have higher mean 2D:4D ratios than men in many Western populations. I discuss the notion that 2D:4D ratio may be the consequence of an allometric scaling relationship between relative and absolute finger lengths. Although it is difficult to draw clear conclusions from these results, the current study provides no support for the theorized relationship between 2D:4D ratio and hunting skill. (shrink)

The concept of selecting for a disability, and deafness in particular, has triggered a controversial and sometimes acrimonious debate between key stakeholders. Previous studies have concentrated on the views of the deaf and hard of hearing, health professionals and ethicists towards reproductive selection for deafness. This study, however, is the first of its kind examining the views of hearing children of deaf adults towards preimplantation genetic diagnosis and prenatal diagnosis to select for or against deafness. Hearing children of deaf adults (...) straddle both the deaf and hearing worlds, and this dual perspective makes them ideally placed to add to the academic discourse concerning the use of genetic selection for or against deafness. The study incorporated two complementary stages, using initial, semistructured interviews with key informants as a means to guide the subsequent development of an electronic survey, completed anonymously by 66 individuals. The participants shared many of the same views as deaf individuals in the D/deaf community. The similarities extended to their opinions regarding deafness not being a disability, their ambivalence towards having hearing or deaf children and their general disapproval of the use of genetic technologies to select either for or against deafness. (shrink)

The dominant paradigm of experiments in the social and behavioral sciences views an experiment as a test of a theory, where the theory is assumed to generalize beyond the experiment's specific conditions. According to this view, which Alan Newell once characterized as “playing twenty questions with nature,” theory is advanced one experiment at a time, and the integration of disparate findings is assumed to happen via the scientific publishing process. In this article, we argue that the process of integration is (...) at best inefficient, and at worst it does not, in fact, occur. We further show that the challenge of integration cannot be adequately addressed by recently proposed reforms that focus on the reliability and replicability of individual findings, nor simply by conducting more or larger experiments. Rather, the problem arises from the imprecise nature of social and behavioral theories and, consequently, a lack of commensurability across experiments conducted under different conditions. Therefore, researchers must fundamentally rethink how they design experiments and how the experiments relate to theory. We specifically describe an alternative framework, integrative experiment design, which intrinsically promotes commensurability and continuous integration of knowledge. In this paradigm, researchers explicitly map the design space of possible experiments associated with a given research question, embracing many potentially relevant theories rather than focusing on just one. Researchers then iteratively generate theories and test them with experiments explicitly sampled from the design space, allowing results to be integrated across experiments. Given recent methodological and technological developments, we conclude that this approach is feasible and would generate more-reliable, more-cumulative empirical and theoretical knowledge than the current paradigm – and with far greater efficiency. (shrink)

Most theists believe that they will survive death. Indeed, they believe that any given person will survive death and persist into an afterlife while remaining the very same person. In light of this belief, one might ask: how—or, in virtue of what—do people survive death? Perhaps the most natural way to answer this question is by appealing to some general account of personal identity through time. That way one can say that people persist through the time of their death in (...) the same way that people persist through time in general. Then the obvious question is: how—or, in virtue of what—do people persist through time in general? Many different answers to this question have been proposed. Some philosophers think that personal identity through time consists in something, such as psychological or biological continuity. They think that there are informative necessary and sufficient conditions—i.e., criteria—for personal identity through time. These philosophers are criterialists. Other philosophers are anti-criterialists. Anti-criterialists believe that people persist through time, but they deny that there are any informative criteria for personal identity through time. In this paper I develop a challenge to anti-criterialism. I begin by spelling out the commitments of anti-criterialism. Then I argue that there are good reasons for anyone to reject anti-criterialism. And then I argue that theists have special reasons to reject anti-criterialism (This is particularly important and noteworthy because a substantial portion of those who defend anti-criterialism are theists. Examples include [but may not be limited to] Trenton Merricks, Richard Swinburne, Joseph Butler, and Thomas Reid). I conclude that there is an informative criterion for personal identity through time and death, even if we haven’t heard of it yet. (shrink)

Commentaries on the target article offer diverse perspectives on integrative experiment design. Our responses engage three themes: (1) Disputes of our characterization of the problem, (2) skepticism toward our proposed solution, and (3) endorsement of the solution, with accompanying discussions of its implementation in existing work and its potential for other domains. Collectively, the commentaries enhance our confidence in the promise and viability of integrative experiment design, while highlighting important considerations about how it is used.

The animalist population has swelled since they introduced their thesis – we are animals – within the personal identity debate a few decades ago. Now they’re a dominant force in the debate. However, more recently, their thesis has fallen prey to attacks. For example, I [Duncan, Matt. 2021. “Animalism is Either False or Uninteresting (Perhaps Both).” American Philosophical Quarterly 58 (no. 2): 187–200.] argue that, depending on how it is understood, animalism is either false or uninteresting. If it is (...) merely the thesis that we are identical to animals (‘Animalism Light’), then it is uninteresting, because it doesn’t address the philosophical question it was supposed to address. If, instead, it is a stronger thesis – i.e., that we are essentially or fundamentally animals (‘Robust Animalism’) – then it is false. Even more recently, Andrew M. Bailey, Allison Krile Thornton, and Peter van Elswyk [2021. “Why Animalism Matters.” Philosophical Studies 178 (9): 2929–2942.] attempt to defend animalism against each of my two claims. They argue that Animalism Light holds considerable interest and that Robust Animalism can be defended against my arguments. In this article, I contribute to this exchange by defending my claims about animalism against Bailey et al.’s criticisms. (shrink)