SARS, like HIV, placed healthcare workers at risk and raised issues about the duty to treat. But philosophical accounts of the duty to treat that were developed in the context of HIV did not adequately address some of the ethical issues raised by SARS. Since the next epidemic may be more like SARS than HIV, it is important to illuminate these issues. In this paper, we sketch a general account of the duty to treat that arose in response to HIV. (...) Our purpose is not to defend or criticise this account, but to show that it needs to be developed in order to address three important issues. The first issue concerns how risks should be distributed among healthcare professionals. The second issue concerns the conflicts that arise between professional duties and family duties. The third issue concerns the forms of support that societies owe healthcare workers during epidemics. Our descriptions of these issues are drawn from our experience of the SARS epidemic in Taiwan. (shrink)

Most, perhaps all, states have “myths of origin”: those semi-historical, semi-propagandistic accounts of their founding and (what are termed) essential purposes. There is nothing unusual in the Uni...

J.C.D. Clark demythologizes the history of Thomas Paine, understanding the impact he has had on modern human rights, democracy, and internationalism.

Background: We aimed to determine the smallest changes in health-related quality of life (HRQoL) scores in the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 and the Brain Cancer Module (QLQ-BN20), which could be considered as clinically meaningful in brain cancer patients. Materials and methods: World Health Organisation performance status (PS) and mini-mental state examination (MMSE) were used as clinical anchors appropriate to related subscales to determine the minimal clinically important differences (MCIDs) in HRQoL (...) change scores (range 0-100) in the QLQ-C30 and QLQ-BN20. A threshold of 0.2 standard deviation (SD) (small effect) was used to exclude anchor-based MCID estimates considered too small to inform interpretation. Results: Based on PS, our findings support the following integer estimates of the MCID for improvement and deterioration, respectively: physical (6, 9), role (14, 12), and cognitive functioning (8, 8); global health status (7, 4(star)), fatigue (12, 9), and motor dysfunction (4(star), 5). Anchoring with MMSE, cognitive functioning MCID estimates for improvement and deterioration were (11, 2(star)) and for communication deficit were (9, 7). Estimates with asterisks were <0.2 SD and were excluded from our MCID range of 5-14. Conclusion: These estimates can help clinicians evaluate changes in HRQoL over time, assess the value of a health care intervention and can be useful in determining sample sizes in designing future clinical trials. (shrink)

The contest between “Lockeian liberalism” and “classical republicanism” as explanatory frameworks for the intellectual history of the American Revolution, and therefore of the present-day United States, has been one of the longest running and most distinguished in recent U.S. historiography. It also has major implications for the history of political thought in the North Atlantic Anglophone world more widely. Yet this debate was merely suspended when it was held to have ended in an ill-defined compromise. Although some U.S. historians expressed (...) doubts and qualifications, attention in U.S. historiography moved on to other themes while leaving the initial problem unsolved. This article reopens the question; it suggests that a historicization of both these two categories is now both possible and necessary, and that their supersession will advance understanding of the Revolution. It seeks to help solve this problem by the same means that the debate began: that is, by re-establishing a link between U.S. and U.K. historiographies. (shrink)

This paper is written in an analytic style, but it is meant to deprive analysis of an important prop. The title needs a short introduction. The mistake is to take ‘real’ as governed in its separate uses by criteria; and this paper is meant to show that this is a mistake and that Ausin makes it. In the course of the argument I try to develop my own account and, although I am not altogether satisfied with it, the result gives (...) something to build upon. I believe the mistake is by no means confined to Austin, but that it is connected with a particular conception of philosophy. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

Hobbes’ account of these issues is conspicuously brief and puzzling. Indeed it has been criticized by some commentators as ‘confused.’ I hope to show, however, that it appears confused only because it has not been read with sufficient precision. Properly understood, Hobbes’ account is both exact and profound. It is also, in my view, far more interesting as a conception of natural right than the modern ‘confusions’ which have come to be read into it.To show this, the text must be (...) read as it is presented: on its own terms, analytically and exactly. In what follows, therefore, I shall focus upon Hobbes’ definitive account of the right of nature in chapter XIV of Leviathan, with only minimal reference to other passages and other works. I do not pretend that this is the only possible approach to Hobbes on this point; but it does show how his account may be read intelligibly, and with greater respect for the power and precision of his thought. (shrink)

The missionary work of the Nederduitsch Hervormde Kerk van Afrika in theory and practice: in the past, present and futureIn this article a short survey is given of the missionary work, both in theory and practice, of the Nederduitsch Hervormde Kerk during the last fifty years. There is also an indication that the Church has reached a crucial point which is going to require thorough rethinking and reconsideration of our missionary work.

"Written in clear language, this book offers a seasoned historian's effective response to postmodernism's challenge to culture and history.