In lieu of an abstract, here is a brief excerpt of the content:Commentary on “Spiritual Experience and Psychopathology”Francis G. Lu (bio), David Lukoff (bio), and Robert P. Turner (bio)Jackson and Fulford have written an impor-tant paper which addresses an area of increasing interest in the United States—the relationship between religious/spiritual experiences and psychopathology. Using primarily the Present State Examination as the diagnostic framework, the authors describe in rich clinical detail three patients where certain phenomena lead to a possible diagnosis (...) of schizophrenia. However, the patients’ outcomes were uniformly positive—how can this be? The authors argue persuasively for the importance of a contextual assessment “in which psychotic phenomena themselves are embedded in the values and beliefs of the person concerned.” In this commentary, we will first present innovations in the DSM-IV relevant to cultural and religious/spiritual issues, which complement the authors’ conclusions, and then comment upon the paper from this perspective.In the DSM-IV Introduction (1994), a section entitled “Ethnic and Cultural Considerations” provides a rationale for innovations in DSM-IV that better enables its use with culturally diverse individuals: “A clinician who is unfamiliar with the nuances of an individual’s cultural frame of references may incorrectly judge as psychopathology those normal variations in behavior, belief, or experience that are particular to the individual’s culture. For example, certain religious practices or beliefs (e.g., hearing or seeing a deceased relative during bereavement) may be misdiagnosed as manifestations of a Psychotic Disorder” (xxiv). In the introduction, three types of information are cited: 1) sections entitled “Age, Gender and Cultural Considerations” in the text of ninety diagnostic categories discuss clinical variations due to these factors; 2) an Outline for Cultural Formulation designed to assist the clinician in systematically evaluating and reporting the impact of the individual’s cultural context; and 3) a Glossary of Culture-Bound Syndromes. These innovations, based on recommendations of the NIMH Workgroup on Culture, Diagnosis and Care to the Task Force on DSM-IV, are described in extensive detail in an important recent book (Mezzich, Kleinman, Fabrega, and Parron 1996).As an example of the importance of the Age, Gender, and Cultural Consideration section relevant to religious and spiritual experiences, consider the section in the text describing schizophrenia, where the following appears: “Clinicians assessing the symptoms of Schizophrenia in socioeconomic or cultural situations that are different from their own must take cultural differences into account. Ideas that may appear to be delusional in one culture (e.g., sorcery and witchcraft) may be commonly held in another. In some cultures, visual or auditory hallucinations with a [End Page 75] religious content may be a normal part of religious experience (e.g., seeing the Virgin Mary or hearing God’s voice)” (281). Secondly, in the analogous section of the text describing Brief Psychotic Disorder, the following appears: “It is important to distinguish symptoms of Brief Psychotic Disorder from culturally sanctioned response patterns. For example, in some religious ceremonies, an individual may report hearing voices, but these do not generally persist and are not perceived as abnormal by most members of the person’s community” (303).The Outline for Cultural Formulation provides the clinician a concise tool to specify the following information concerning the cultural context that is relevant to clinical care: cultural identity of the individual, cultural explanations of the individual’s illness, cultural factors related to psychosocial environment and levels of functioning, cultural elements of the relationship between the individual and the clinician, and overall cultural assessment for diagnosis and care. Religion is explicitly mentioned in the third section so as to encourage the assessment of “the role of religion... in providing emotional, instrumental, and information support” (1994, 844). This outline for cultural formulation is more fully explicated in a recent chapter by Lu, Lim, and Mezzich (1995).A major innovation in DSM-IV relevant to this topic is the new diagnostic category entitled Religious or Spiritual Problem defined as follows: “This category can be used when the focus of clinical attention is a religious or spiritual problem. Examples include distressing experiences that involve loss or questioning of faith, problems associated with conversion to a new faith, or questioning of spiritual values that may not necessarily be related to an organized... (shrink)

This chapter presents the text of a lecture on legal orders in Europe given at the British Academy's 2008 Law Lecture. This text suggests that developments in European and international law make it increasingly hard to sustain the view that a single system of law operates within each sovereign territory. It explains that in Europe, different legal orders seem to coexist, in relation to the same issues, within the same legal space; and questions constantly arise about which law is to (...) prevail. (shrink)

The information required for perception may be available in the energy arrays that stimulate sensory organs but in a form not directly suitable for the planning and execution of the organism's actions in the environment. The requisite form of information is obtained, with no loss of adequate perception, by representation of sensory stimuli in frames of reference determined by internal control signals producing actions. This process seems evolutionarily advantageous but makes perception essentially non-direct, regardless of the degree of intra- or (...) inter-modal sensory integration. (shrink)

This book presents a comprehensive theory of the ethics and political philosophy of public health surveillance based on reciprocal obligations among surveillers, those under surveillance, and others potentially affected by surveillance practices. Public health surveillance aims to identify emerging health trends, population health trends, treatment efficacy, and methods of health promotion--all apparently laudatory goals. Nonetheless, as with anti-terrorism surveillance, public health surveillance raises complex questions about privacy, political liberty, and justice both of and in data use. Individuals and groups can (...) be chilled in their personal lives, stigmatized or threatened, and used for the benefit of others when health information is wrongfully collected or used. Transparency and openness about data use, public involvement in decisions, and just distribution of the benefits of surveillance are core elements in the justification of surveillance practices. Understanding health surveillance practices, the concerns it raises, and how to respond to them is critical not only to ethical and trustworthy but also to publicly acceptable and ultimately sustainable surveillance practices. The book is of interest to scholars and practitioners of the ethics and politics of public health, bioethics, privacy and data technology, and health policy. These issues are ever more pressing in pandemic times, where misinformation can travel quickly and suspicions about disease spread, treatment efficacy, and vaccine safety can have devastating public health effects. (shrink)

Privacy is one of our most essential values, but popular understanding of it lags far behind the heat the concept generates. It's easy to understand why. The concept itself has shifted in U.S. law from autonomy, to property, to confidentiality. Further, with a host of cultural differences as to how privacy is understood globally and in different religions, and with nonstop technological advancements, its significance is continually evolving. Leslie P. and John G. Francis draw upon their extensive expertise in (...) law, philosophy, political science, regulatory policy, and bioethics to parse privacy's meaning in the modern age. This book will inform, appease, and alert readers to what is at stake when privacy is breached. (shrink)

Rothstein (2010) argues that groups may be harmed by research on deidentified data. He concludes that researchers are obligated to minimize group harms and demonstrate respect for a studied group t...

BackgroundThis paper discusses the contentious issue of reuse of stored biological samples and data obtained from research participants in past clinical research to answer future ethical and scientifically valid research questions. Many countries have regulations and guidelines that guide the use and exportation of stored biological samples and data. However, there are variations in regulations and guidelines governing the reuse of stored biological samples and data in Sub-Saharan Africa including Malawi.DiscussionThe current research ethics regulations and guidelines in Malawi do not (...) allow indefinite storage and reuse of biological samples and data for future unspecified research. This comes even though the country has managed to answer pertinent research questions using stored biological samples and data. We acknowledge the limited technical expertise and equipment unavailable in Malawi that necessitates exportation of biological samples and data and the genuine concern raised by the regulatory authorities about the possible exploitation of biological samples and data by researchers. We also acknowledge that Malawi does not have bio-banks for storing biological samples and data for future research purposes. This creates room for possible exploitation of biological samples and data collected from research participants in primary research projects in Malawi. However, research ethics committees require completion and approval of material transfer agreements and data transfer agreements for biological samples and data collected for research purposes respectively and this requirement may partly address the concern raised by the regulatory authorities. Our concern though is that there is no such requirement for biological samples and data collected from patients for clinical or diagnostic purposes.SummaryIn conclusion, we propose developing a medical data and material transfer agreement for biological samples and data collected from patients for clinical or diagnostic purposes in both public and private health facilities that may end up in research centers outside Malawi. We also propose revision of the current research ethics regulations and guidelines in Malawi in order to allow secondary use of biological samples and data collected from primary research projects as a way of maximizing the use of collected samples and data. Finally, we call for consultation of all stakeholders within the Malawi research community when regulatory authorities are developing policies that govern research in Malawi. (shrink)

Statutes criminalizing behavior that risks transmission of HIV/AIDS exemplify use of the criminal law against individuals who are victims of infectious disease. These statutes, despite their frequency, are misguided in terms of the goals of the criminal law and the public health aim of reducing overall burdens of disease, for at least three important reasons. First, they identify individual offenders for punishment, a paradigm that is misplaced in the most typical contexts of transmission of infectious disease and even for HIV/AIDS, (...) despite claims of AIDS exceptionalism. Second, although there are examples of individuals who transmit infectious disease in a manner that fits the criminal law paradigm of identification of individual offenders for deterrence or retribution, these examples are limited and can be accommodated by existing criminal laws not devoted specifically to infectious disease. Third, and most importantly, the current criminal laws regarding HIV/AIDS, like many other criminal laws applied to infectious disease transmission, have been misguided in focusing on punishment of the diseased individual as a wrongful transmitter. Instead of individual offenders, activities that enhance the scale of disease transmission—behaviors that might be characterized as ‘transmission facilitation’—are a more appropriate target for the criminal law. Examples are trafficking in human beings (including sex trafficking, organ trafficking, and labor trafficking), suppression of information about the emergence of infection in circumstances in which there is a legally established obligation to disclose, and intentional or reckless activities to discourage disease treatment or prevention. Difficulties remain with justifications for criminalizing even these behaviors, however, most importantly the need for trust in reducing overall burdens of disease, problems in identifying individual responsible offenders, and potential misalignment between static criminal law and the changing nature of infectious disease. (shrink)