The world’s first living donor liver transplant from an HIV-positive mother to her HIV-negative child, performed by our team in Johannesburg, South Africa (SA) in 2017, was necessitated by disease profile and health system challenges. In our country, we have a major shortage of donor organs, which compels us to consider innovative solutions to save lives. Simultaneously, the transition of the HIV pandemic, from a death sentence to a chronic illness with excellent survival on treatment required us to rethink our (...) policies regarding HIV infection and living donor liver transplantation. Although HIV infection in the donor is internationally considered an absolute contraindication for transplant to an HIV-negative recipient, there have been a very small number of unintentional transplants from HIV-positive deceased donors to HIV-negative recipients. These transplant recipients do well on antiretroviral medication and their graft survival is not compromised. We have had a number of HIV-positive parents in our setting express a desire to be living liver donors for their critically ill children. Declining these parents as living donors has become increasingly unjustifiable given the very small deceased donor pool in SA; and because many of these parents are virally suppressed and would otherwise fulfil our eligibility criteria as living donors. This paper discusses the evolution of HIV and transplantation in SA, highlights some of the primary ethical considerations for us when embarking on this case and considers the new ethical issues that have arisen since we undertook this transplant. (shrink)

Resource constraints in developing countries compel policy makers to ration the provision of healthcare services. This article examines one such set of Guidelines: A patient dialysing in the state sector in South Africa may not refuse renal transplantation when a kidney becomes available. Refusal of transplantation can lead to exclusion from the state-funded dialysis programme. This Guideline is legally acceptable as related to Constitutional stipulations which allow for rationing healthcare resources in South Africa. Evaluating the ethical merit of the Guideline, (...) and exploring the ethical dilemma it poses, proves a more complex task. We examine the actions of healthcare professionals as constrained by the Guideline. From a best interests framework, we argue that in these circumstances directing patient decision making is not necessarily unethical or unacceptably paternalistic. We then scrutinise the guideline itself through several different ethical ‘lenses’. Here, we argue that bioethics does not provide a definitive answer as to the moral merit of rationing dialysis under these circumstances, however it can be considered just in this context. We conclude by examining a potential pitfall of the Guideline: Unwilling transplant recipients may not comply with immunosuppressive medication, which raises questions for policies based on resource management and rationing. (shrink)

Utilising empirical ethics analysis, we evaluate the merits of systems proposed to increase deceased organ donation in South Africa. We conclude that SA should maintain its soft opt-in policy, and enhance it with ‘required transplant referral’ in order to maximise donor numbers within an ethically and legally acceptable framework. In SA, as is the case worldwide, the demand for donor organs far exceeds the supply thereof. Currently utilising a soft opt-in system, SA faces the challenge of how to increase donor (...) numbers in a context which is imbued with inequalities in access to healthcare, multiplicitous personal beliefs and practices, distrust of organ transplant and varying levels of education and health literacy. We argue that a hard opt-in, opt-out or mandated consent system would be problematic, and we present empirical data from Gauteng Province illustrating barriers to ethically sound practice in soft consent systems. Ultimately, we argue that in spite of some limitations, a soft opt-in system is most realistic for SA because its implementation does not require extensive public education campaigns at national level, and it does not threaten to further erode trust at a clinical level. However, to circumvent some of the clinical-level barriers identified in our empirical study, we propose a contextually sensitive option for “enabling” soft opt-in through “required transplant referral”. We argue that this system is legally defensible, enhances ethical practice and could also increase donor numbers as it has in many other countries. (shrink)

This reflection item provides an edited account of human rights lawyer Harriet Wistrich’s conversation with Manvir Grewal, Visiting Lecturer and Ph.D. student, and Harriet Samuels, Reader in Law at the University of Westminster. It summarises the exchange which focused on Harriet Wistrich’s career trajectory and the many public interest law cases that she has brought on behalf her clients, mainly women, in both domestic and international forums. It also includes a condensed version of the question and answer (...) session with the audience. Questions included the broader issues around domestic violence, rape, coercive control, sex work and the nature of feminism. (shrink)

According to the Argument for Autonomous Mental Disorder, mental disorder can occur in the absence of brain disorder, just as software problems can occur in the absence of hardware problems in a computer. This article argues that the AAMD is unsound. I begin by introducing the “natural dysfunction analysis” of disorder, before outlining the AAMD. I then analyze the necessary conditions for realizer autonomous dysfunction. Building on this, I show that software functions disassociate from hardware functions in a way that (...) mental functions do not disassociate from brain functions. It follows that mental disorders are brain disorders necessarily. (shrink)

Malcolm Feeley, one of the founding giants of the law and society field, is also one of its most exciting, diverse, and contemporary scholars. His works have examined criminal courts, prison reform, the legal profession, legal professionalism, and a variety of other important topics of enduring theoretical interest with a keen eye for the practical implications. In this volume, The Legal Process and the Promise of Justice, an eminent group of contemporary law and society scholars offer fresh and original analyzes (...) of his work. They asses the legacy of Feeley's theoretical innovations, put his findings to the test of time, and provide provocative historical and international perspectives for his insights. This collection of original essays not only draws attention to Professor Feeley's seminal writings but also to the theories and ideas of others who, inspired by Feeley, have explored how courts and the legal process really work to provide a promise of justice. (shrink)

I was an altar girl at St. Mary the Virgin, New York City–one of the first, in fact. In the mid‑70s, one of my friends approached the Rector and negotiated a deal: we women, who were interested in acolyting, would be allowed to serve at mass during the week, in street clothes, on the condition that we form and staff an altar guild.

Carte Blanche is the alarming tale of how the right of Americans to say "no" to risky medical research is eroding at a time when we are racing to produce a vaccine and treatments for Covid-19. This medical right that we have long taken for granted was first sacrificed on the altar of military expediency in 1990 when the Department of Defense asked for and received from the FDA a waiver that permitted it to force an experimental anthrax vaccine on (...) the ranks of ground troops headed for the Persian Gulf. Since then, the military has pressed ahead to impose nonconsensual testing of the blood substitute PolyHeme in civilian urbanities, quietly enrolling more than 20,000 non-consenting subjects since 2005. Most Americans think that their right to give or withhold consent is protected by law, but the passing in 1996 of modifications to the Code of Federal Regulations, such as statute CFR 21 50.24, now permit investigators to conduct research with trauma victims without their consent or event their knowledge. More than a dozen studies since have used the 1996 loophole to recruit large numbers of subjects without their knowledge. The erosion of consent is the result of a U.S. medical-research system that has proven again and again that it cannot be trusted. (shrink)

This research investigates the perceptions of five constituent groups of an accredited business school — their perceptions of others'' ethics, of their own ethics and ideal values, and of how business ethics can be improved. Self-described behavior from the constituent groups is quite similar, yet is decidedly different from that which respondents felt others would do. Undergraduate business students tended to have the lowest estimation of others'' ethics in addition to the least ethical self-described behavior compared with other constituent groups. (...) All constituents were solidly in favor of improving ethics by developing principles of business ethics, requiring ethics courses in business schools and introducing industry codes of ethics. People are much more ethical than they are perceived to be. Knowing that others are more ethical may in turn cause other people to act more ethically. Similarly, believing that others are less ethical may encourage less ethical behavior. (shrink)

This paper presents four arguments in favour of respecting Ulysses Contracts in the case of individuals who suffer with severe chronic episodic mental illnesses, and who have experienced spiralling and relapse before. First, competence comes in degrees. As such, even if a person meets the usual standard for competence at the point when they wish to refuse treatment (time 2), they may still belesscompetent than they were when they signed the Ulysses Contract (time 1). As such, even if competent at (...) time 1andtime 2, there can still be a disparity between thelevelsof competence at each time. Second, Ulysses Contracts are important to protect people’smost meaningfulconcerns. Third, on the approach defended, the restrictions to people’s liberty would be temporary, and would be consistent with soft paternalism, rather than hard paternalism: the contracts would be designed in such a way that individuals would be free to change their minds, and to change or cancel their Ulysses Contracts later. Finally, even if one rejects the equivalence thesis (the claim that allowing harm is as bad as doing harm), this is still consistent with the claim that, inparticular cases, it can be as wrong toallowa harm as to do a harm. Nevertheless, controversies remain. This paper also highlights several safeguards to minimise risks. Ultimately, we argue that people who are vulnerable to spiralling deserve a way to protect their autonomy as far as possible, using Ulysses Contracts when necessary. (shrink)

This paper argues that proper functions are proximal functions. In other words, it rejects the notion that there are distal biological functions – strictly speaking, distal functions are not functions at all, but simply beneficial effects normally associated with a trait performing its function. Once we rule out distal functions, two further positions become available: dysfunctions are simply failures of proper function, and pathological conditions are dysfunctions. Although elegant and seemingly intuitive, this simple view has had surprisingly little uptake in (...) the literature. Indeed, our position departs from that of almost every theorist who has engaged with the issue at any depth. We start by presenting three arguments for the position that proper functions are proximal: one from the specificity of functions, one from their relation to intervention, and one from their relation to pathology. We then consider two case studies evidencing the trouble that accepting distal functions causes for philosophical reflection on the nature of pathological conditions. Finally, we anticipate and respond to three objections: that there can be failure of function without dysfunction; that our account is unacceptably revisionary in respect of normal function-talk; and that our thesis over-generalises from a narrow set of cases. (shrink)

Rousseau in Drag is a provocative new interpretation of Rousseau's gender politics. Rosanne Terese Kennedy reads Rousseau's well-known but brief flirtation with cross-dressing as a starting point to dramatically reconsider the standard reading of Rousseau as a misogynist. This study argues that rather than a figure of misogyny, Rousseau challenges normative gender identites, the couple, and traditional kinship relations. Reading Rousseau's classical political and philosophical works alongside his literary texts, Kennedy offers us an alternative vision of both Rousseau's sexual (...) politics and his politics in general. (shrink)

Defining Mental Disorder: Jerome Wakefield and His Critics, edited by Denis Forest and Luc Faucher, is essential reading for students and researchers in philosophy of medicine whose work is informed by that of Jerome Wakefield, or the disease debate in general. If you are anything like me, this book will open the door to a new depth of understanding of the harmful dysfunction analysis (HDA) and its methodical underpinnings, and an enriched appreciation of what is at stake in defining medical (...) disorder. To those confident that they understand Wakefield’s view and the surrounding debate, thinking perhaps that they do not need a refresher, I would say: perhaps you do not understand it as well as you think. Defining Mental Disorder provides much more than an overview of previously well-trodden ground. The chapters themselves, and Wakefield’s own detailed responses, help to elucidate a number of methodological nuances and peculiarities that have rarely been covered in such depth before. I was startled to learn how philosophically complex Wakefield’s position actually is, and how shallow my own understanding of it has been. It emerges as a far more nuanced and sophisticated account than I had given it credit for, and one that deserves serious reevaluation. (shrink)

This study examined knowledge of sea lions for both residents and tourists on San Cristóbal Island in the Galápagos, a famous nature tourism destination. Participants obtained through convenience and snowball sampling answered questionnaires about their knowledge of sea lions. Participants with higher education received higher overall scores, but participants’ education and age influenced answers on only a few questions. Residents and tourists obtained comparable overall scores, exhibiting extensive knowledge of sea lion behavior and life history. Whether participants were residents or (...) tourists influenced answers to several questions, but when only participants with 13 years of education or more were examined, few differences in answers remained between residents or tourists. Participants’ broad knowledge of sea lions may be attributed to the items of knowledge tested, participants’ motivations for travel to the Galápagos, and the fact that sea lions are an engaging and ubiquitous animal. (shrink)

To mark International Women’s Day the Research Group for Law, Gender and Sexuality at Westminster Law School held an evening conversation on 10 March 2016 on Women and Asylum. Speakers working in different areas of the asylum system shared their insights and experiences with an audience of staff, students, activists and other visitors. Harriet Samuels chaired the conversation and the speakers were Princess Chine Onyeukwu, Debora Singer, Priya Solanki and Zoe Harper. This article is an edited extract from the (...) transcript of the presentations and wide-ranging discussion, including the question and answer session. The discussion focused on the different steps in the refugee determination process and considered, in particular, the gendering of credibility and how women’s perceived lack of credibility has a significant impact on determinations and processes. (shrink)

There is a mystery, present from conception, namely, how the human person, who transcends the individual elements of sperm and ovum, can nevertheless come to exist at the first instant of the sperm’s interaction with the ovum, an event marked by the formation of an “embryonic skin,” or wall. In this essay, the author holds that the full complexity of the human person implies such a profound unity-in-diversity of human being that we must, in the end, let the dialogue between (...) reason and revelation lead us to conclude that the first instant of embryonic life is the first instant that the person comes to exist: that the first sign of embryonic life is a “natural sacrament” of the internal act of God which brings the person to exist, one in soul and body. National Catholic Bioethics Quarterly 12.3 (Autumn 2012): 421–430. (shrink)

The triumph was the most prestigious accolade a politician and general could receive in republican Rome. After a brief review of the role played by the triumph in republican political culture, this article analyzes the severe limits Augustus placed on triumphal parades after 19 BC, which then became very rare celebrations. It is argued that Augustus aimed at and almost succeeded in eliminating traditional triumphal celebrations completely during his lifetime, by using a combination of refusing them for himself and his (...) relatives and of rewarding his legates who fought under his auspices with ornamenta triumphalia and an honorific statue in the Forum of Augustus. Subsequently, the elimination of the triumph would have been one natural result of the limit placed on further imperial expansion recommended by Augustus in his will, a policy his successors chose not to follow. Tiberius, however, was unwilling to conform to this new order and retired from public life to Rhodes the year after celebrating a triumph in 7 BC, the first such celebration since 19 BC. Tiberius' two triumphs and the senate's repeated offers of further triumphs to Augustus himself represented a different vision of the role triumphal celebration should take in a restored res publica and an ongoing challenge to the princeps. (shrink)

The Perceived Role of Ethics and Social Responsibility (PRESOR) instrument was developed in the United States by Singhapakdi et al. (1996b) as a reliable and valid scale to measure the perceived role of ethics and social responsibility in achieving organizational effectiveness. This study was carried out to confirm the factorial structure of the instrument and to assess its reliability and validity for use in Hong Kong, the finance and service heart of the Asia-Pacific region and a culture with clear differences (...) in ethical attitudes and perceptions from those of the United States. Constructive replication of the exploratory factor analytic procedure of the original study with a representative sample of Hong Kong managers failed to support the hypothesized scale structure but instead suggested a different, two-factor, structure. Confirmatory factor analysis defined the alternative model which comprised two interpretable, negatively intercorrelated factorial scales, "Importance of ethics and social responsibility" and "Subordination of ethics and social responsibility in the achievement of organizational effectiveness". The model showed a high level of goodness-of-fit for the population and the two subscales, comprised of five items and four items respectively, were shown to have acceptable internal consistency reliability. Correlational and multiple regression analysis showed highly significant levels of association with the ethical ideology dimensions of the EPQ (Forsyth, 1980), used in the validation of the original scale, and with two ethical philosophy subscales derived from the ATBEQ (Preble and Reichel, 1988). The instrument is short, easily administered, is psychometrically sound and has considerable potential in the study of the perceived role of ethics and social responsibility in the achievement of organizational effectiveness. (shrink)

The disease debate in philosophy of medicine has traditionally been billed as a debate over the correct conceptual analysis of the term “disease.” This paper argues that although the debate’s participants overwhelmingly claim to be in the business of conceptual analysis, they do not tend to argue as if this is the case. In particular, they often show a puzzling disregard for key parameters such as precise terminology, linguistic community, and actual usage. This prima facie strange feature of the debate (...) points to an interesting and potentially instructive hypothesis: the disease debate makes little sense within the paradigm of conceptual analysis but makes good sense on the assumption that pathology is a real kind. (shrink)

This bibliography seeks to offer a comprehensive overview of nuclear criticism, tracing its development from the 1984 issue of diacritics which saw the publication of Derrida's seminal article “No Apocalypse, Not Now ” to the present day. Particular attention is paid to areas of interest which are underrepresented in the available literature, and every attempt has been made to offer a resource which is wide-ranging in outlook while providing a clear sense of the central texts which have shaped and reshaped (...) what we understand as nuclear criticism. Texts focusing solely on individual works have, by and large, been excluded. Brief notes accompany some of the entries, although it has not been practical to provide these for all the works mentioned: they should be taken as a record of an individual approach to the texts in question rather than as marks of overarching significance. (shrink)

The ethical limbo in which frozen human embryos exist is, tragically, a real limbo, and in their untouchability lies an apparent contradiction: that God cannot rescue a person whom man, in his pride, has co-created outside the truly necessary incorporation within a family. The author explores the possibility that ethical objections to embryo adoption are based on a flawed conflation of two problems: the immorality, injustice, and harm of the procedure that supplants the marriage act; and the rights of the (...) child conceived outside the welcoming nature of the marriage act—the primary rights of every conceived person to completing, wholesome, and relational nurture. The author argues for the humanitarian right to embryo adoption, within marriage, from the point of view of the rights of the person conceived. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medical Tourism:Crossing Borders to Access Health CareHarriet Hutson Gray (bio) and Susan Cartier Poland (bio)Traveling abroad for one's health has a long history for the upper social classes who sought spas, mineral baths, innovative therapies, and the fair climate of the Mediterranean as destinations to improve their health. The newest trend in the first decade of the twenty-first century has the middle class traveling from developed countries to those (...) with emerging economies to avoid treatment delays, prohibitive costs for life-saving procedures, or simply high costs for elective surgery. Others leave to have access to assisted suicide in countries that have legalized it: Belgium, The Netherlands, and Switzerland. This new era of globalization in health care has arrived without the benefit of international standards, government oversight, or ethical and legal review.Howard Staab, a self-employed carpenter from North Carolina, flew to India for his medically necessary heart surgery, scheduled a side trip to the Taj Mahal, and returned home to work in North Carolina. He spent a total of less than $10,000, instead of the $200,000 required from the local hospital (I, Milstein and Smith 2006).At first blush, the outsourcing of medical care to India seems to be a particular solution for a particular problem. However, the particularity of Mr. Staab is not unique. His experience is emblematic of those patients in the United States with a medical need for major and elective procedures, but who also must bear the total cost of these procedures. These middle-class, under-insured Americans go abroad.In tandem with increasingly aggressive marketing campaigns, American hospitals and companies have begun to leverage their connections in Asia to grow the medical tourism business into a major economic force. What are the consequences of this?Several authors point to the effect on the host country's population, particularly the poor, to be pushed farther down the queue to receive adequate, affordable care. Resources are applied to the foreign trade instead of building the local [End Page 193] medical infrastructure. Another potential problem is the obligation of the home-country physician to provide follow-up care. What are the legal ramifications when the procedure was illegal to begin with? Are there opportunities for redress for medical errors?These factors may be converging into a "perfect storm" for health care in the U.S., in which the potential participation of the major insurance companies in promoting offshore care will be the tipping point in the precarious structure that represents the economic currents in health care. Third-party administrators and self-funded employers may be on the cutting edge in 2009 by providing incentives to employees to travel overseas for care.I. Economic ConsiderationsConnell, John. Medical Tourism: Sea, Sun, Sand and... Surgery. Tourism Management 27: 1093–1100, 2006.As evidence of the interest of traditional tour operators in this newer twist on the industry, the author explores medical tourism as an element of the growth of world tourism. In promoting medical tourism, he urges consideration of such issues as the privatization of health care, the foundational role of technology, and uneven access to health resources.Dunn, Philip. Medical Tourism Takes Flight. H and HN: Hospitals and Health Networks: 40–44, November 2007.Writing for U.S. health care executives, Dunn emphasizes that the reality of medical tourism competes with the local medical center for patients and their insurance dollars in a significant way. He examines the possibility that U.S. insurance plans soon may offer to pay for what is currently a cash only business and that the economic impact to the local medical center could be significant or even devastating.Frontiers of Health Services Management [Selected Articles] 24 (2), Winter 2007.In "Managing Healthcare Services in the Global Marketplace" (pp. 3–18), Bruce J. Fried and Dean M. Harris consider legal, ethical, and financial implications of the international workforce. In "Globalization of Health Care" (pp. 19–30), Lynn Schroth and Ruthy Khawahja point out that the transfer of comprehensive management expertise and intellectual property from U.S. medical centers to international sites is driving the success of collaboration between U.S. and foreign health care centers. In "Is... (shrink)

Justin Garson has recently advanced a Generalised Selected Effects Theory of biological proper function. According to Garson, his theory spells trouble for the Dysfunction Account of Disorder. This paper argues that Garson’s critique of the Dysfunction Account from the Generalised Theory fails, and that we should reject the Generalised Theory outright. I first show that the Generalised Theory does not, as Garson asserts, imply that neurally selected disorders are not dysfunctional. Rather, it implies that they are both functional and dysfunctional. (...) I argue on this basis that the Generalised Theory yields conflicting functional norms, and we that should reject it outright on these grounds. (shrink)

This paper asks when a natural disease kind is truly 'reactive' and when it is merely associated with a corresponding social kind. I begin with a permissive account of real kinds and their structure, distinguishing natural kinds, indifferent kinds and reactive kinds as varieties of real kind characterised by super-explanatory properties. I then situate disease kinds within this framework, arguing that many disease kinds prima facie are both natural and reactive. I proceed to distinguish ‘simple dependence’, ‘secondary dependence’ and ‘essential (...) dependence’ between a natural kind and its classification, and argue that a natural kind is only really reactive, in an important sense, under conditions of essential dependence. On this basis, I offer a principled hypothesis for why psychiatric kinds tend to be more metaphysically unstable than paradigm somatic disease kinds. (shrink)

A 365 million year‐old trilobite moult‐carcass assemblage was described by Błażejowski et al. (2015) as the oldest direct evidence of moulting in the arthropod fossil record. Unfortunately, their suppositions are insufficiently supported by the data provided. Instead, the morphology, configuration and preservational context of the highly fossiliferous locality (Kowala Quarry, Poland) suggest that the specimen consists of two overlapping, queued carcasses. The wider fossil record of moulting actually extends back 520 million years, providing an unparalleled opportunity to study behaviour, ecology (...) and development in early animals. Taking cues from modern analogues, it is possible to quantify precise details about moulting behaviour to determine broad‐scale evolutionary trends, ontogenetic sequences and morphological selection pressures. In this review, we argue that this rich source of data has been underused in evolutionary studies, though has great potential for investigating the life history and evolution of arthropods in deep time. (shrink)

In the last two decades, prizes in the sciences have proliferated and, in particular, rich prizes with large honoraria. These developments raise several questions: Why have rich prizes proliferated? Have they greatly changed the reward system of science? What effects will such prizes have on scientists and on science? The proliferation of such prizes derives from marked limitations on the numbers and types of scientists eligible for Nobel prizes and consequent increases in the number of uncrowned laureate-equivalents. These would-be surrogates (...) for Nobel prizes extend the reward system of science in its upper reaches but this change is not fundamental. The spread of rich prizes to new fields provides added incentives to potential winners, which has its own disutilities; it reinforces competitiveness, concern for priority and attendant secrecy, all this amplifying ambivalence toward the reward system in science. There may also be modest positive effects of such new awards in the form of heightened popular esteem for science and interest in it. (shrink)

What tensions arise between philosophy of religion and theology? What strengths and weaknesses of analytical methods emerge in relation to strongly confessional philosophical theologies, or to Continental philosophies? Faith and Philosophical Analysis evaluates how well philosophy of religion serves in understanding religious faith. Figures who rarely share the space of the same book - leading exponents of analytic philosophy of religion and those who question its legacy - are drawn together in this book, with their disagreements harnessed to positive effect. (...) Figures such as Richard Swinburne and Basil Mitchell reflect on their life-long projects from a perspective which has not previously been seen in print. A wide range of approaches found in contemporary philosophy of religion are explored, including: reformed epistemology, 'traditional' metaphysical theory building, feminist methodologies, Wittgensteinian approaches, and American pragmatism. Considering the trends in philosophy of religion as they are interacting across continents, looking particularly at philosophical influences in North America, Britain, and Continental Europe, this book will appeal to students, scholars and general readers with an interest in philosophy of religion, theology, or analytical philosophy. (shrink)

Background Generally, there is unanimity about the value of community engagement in health-related research. There is also a growing tendency to view genetics and genomics research (GGR) as a special category of research, the conduct of which including community engagement (CE) as needing additional caution. One of the motivations of this study was to establish how differently if at all, we should think about CE in GGR. Aim To assess the perspectives of genetics and genomics researchers in Uganda on CE (...) in GGR. Method A cross-sectional qualitative study was conducted at Makerere University and Uganda Virus Research Institute. Twenty-five individuals participated, the majority being male (sixteen). Participants included nineteen genetics and genomics researchers (researchers and research coordinators), two CE officers, three nurses and one nursing counsellor. Data were collected using in-depth interviews and analyzed in a thematic manner using NVivo version 12 Plus. Study findings Thirteen of the respondents had conducted CE in their GGR in either a geographical and disease-specific community. Some respondents said CE principles are the same and there is no need for special consideration for CE in GGR. Others gave ethical issues in GGR that require special consideration for CE in such research and these were categorized into six themes: GGR is new to communities, Difficulty in communicating GGR by the researchers, Genes are shared in communities, Cultural sensitivities against GGR, Community attitude toward GGR, Some GGR studies take long to end, and Negotiation of research benefits. Special considerations for CE when conducting GGR were suggested and categorized into seven themes: creating awareness of GGR in communities, obtaining both community acceptance and individual consent, CE team composition, involve communities in solving GGR challenges, prolong CE in some GGR, develop guidelines for CE in GGR, and legal considerations on GGR. Conclusion GGR was characterized by special issues that require special CE considerations for such research. (shrink)