Essays on gnosis, Templars, Grigori Narekatsi, G. Deleuze, P. Florensky, J.-P. Sartre, Russia and other topics, mostly translated from Russian.

Background: The Declaration of Helsinki prohibits the publication of articles that do not meet defined ethical standards for reporting of research ethics board approval and informed consent. Despite this prohibition and a call to highlight the deficiency for the reader, articles with potential ethical shortcomings continue to be published.Objective: To determine what proportion of articles in major medical journals lack statements confirming REB approval and informed consent, and whether accompanying commentary alerts readers to this deficiency.Design: Retrospective, observational study.Setting: Online review (...) of five major medical journals.Population: All clinical research articles published online between 1 January 2005 and 31 December 2006 in the BMJ, Lancet, Annals of Internal Medicine, JAMA and the New England Journal of Medicine.Measurements: Statement of REB approval and informed consent.Results: Of 1780 articles reviewed, 1133 met inclusion criteria , 36 articles lacked a statement of REB approval, 62 lacked disclosure of informed consent and 15 articles lacked both. Articles that did not state REB approval were associated with not stating informed consent . There were no editorial comments to alert readers to the lack of either REB approval or informed consent statements associated with any of the deficient articles.Conclusions: Articles that lack explicit statements of REB approval and informed consent are infrequent but continue to be published in major medical journals without editorial statements to alert the reader to this deficiency. (shrink)

Background and objectives Conscientious refusal of abortion has been discussed widely by medical ethicists but little information on practitioners' opinions exists. The American College of Obstetricians and Gynecologists (ACOG) issued recommendations about conscientious refusal. We used a vignette experiment to examine obstetrician-gynecologists' (OB/GYN) support for the recommendations. Design A national survey of OB/GYN physicians contained a vignette experiment in which an OB/GYN doctor refused a requested elective abortion. The vignette varied two issues recently addressed by the ACOG ethics committee—whether the (...) doctor referred and whether the doctor disclosed their objection to the abortion. Participants and setting 1800 OB/GYN randomly selected physicians were asked to complete a mail survey containing the vignette. The response rate was 66% (n=1154) after excluding 40 ineligible cases. Measurement Physicians indicated their approval for the vignette doctor's decision. Main results Overall, 43% of OB/GYN physicians responded that the conscientious refusal exercised by the vignette physician was appropriate. 70% rated the vignette doctor as acting appropriately when a referral was made. This dropped to 51% when the doctor disclosed objections to the patient, and to 12% when the doctor disclosed objections and refused to make a referral. Consistent with previous research, males were more likely to support disclosure and refusal to refer. Highly religious physicians supported non-referral but not disclosure. Conclusion OB/GYN physicians are less likely to support conscientious refusal of abortion if physicians disclose their objections to patients. This is at odds with ACOG recommendations and with some models of the doctor–patient relationship. (shrink)

The founders of reformational philosophy, H. Dooyeweerd and D.H.Th. Vollenhoven, each published in short succession, viz. 1949 and 1950, a voluminous study in the history of philosophy. Whoever reads both works is struck by the remarkable differences in treatment. In this contribution these differences are analysed, but there is also indication of agreement. The article ends with a number of conclusions based on the analysis.

Objective We sought to understand ethics and education needs of emergency nurses and physicians in paediatric and adult emergency departments in order to build ethics capacity and provide a foundation for the development of an ethics education programme. Methods This was a prospective cross-sectional survey of all staff nurses and physicians in three tertiary care EDs. The survey tool, called Clinical Ethics Needs Assessment Survey, was pilot tested on a similar target audience for question content and clarity. Results Of the (...) 123 participants surveyed, 72% and 84% of nurses and physicians fully/somewhat agreed with an overall positive ethical climate, respectively. 69% of participants reported encountering daily or weekly ethical challenges. Participants expressed the greatest need for additional support to address moral distress, conflict management with patients or families and resource issues. Of the 23 reported occurrences of moral distress, 61% were associated with paediatric mental health cases. When asked how the ethics consultation service could be used in the ED, providing education to teams was the most desired method. Conclusions Nurses report a greater need for ethics education and resources compared with their physician colleagues. Ethical challenges in paediatric EDs are more prevalent than adult EDs and nurses voice specific moral distress that are different than adult EDs. These results highlight the need for a suitable educational strategy, which can be developed in collaboration with the leadership of each ED and team of hospital ethicists. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Interpreting a Classic: Demosthenes and His Ancient CommentatorsK. KapparisCraig A. Gibson. Interpreting a Classic: Demosthenes and His Ancient Commentators. Berkeley and Los Angeles: University of California Press, 2002. xii + 261 pp. Cloth, $55.This book aims to provide a comprehensive account of the ancient scholarship on Demosthenes. Gibson points out that Demosthenes was widely read in later antiquity, and this created the need for linguistic and historical commentaries (...) on his speeches. Of these, some have partially survived on papyrus, while excerpts have also been preserved in later lexicographers and the Byzantine scholia found in the margins of Demosthenic manuscripts. The purpose of Gibson's study is to clarify some confusing and difficult issues related to the ancient scholarship on Demosthenes and to provide the text and commentary on the main sources. [End Page 481]Gibson's introduction includes an informative outline of key parameters in the debate, such as the accuracy of excerption from an ancient commentary, the significance of date and place, and the intended readership of these commentaries. The first chapter discusses the form and transmission of ancient commentaries, their relation with lexicographic works, and their impact on the Byzantine scholia. Gibson convincingly argues that the scholia do not reveal direct dependency upon the surviving ancient commentaries but were compiled from lexicographic works such as Harpocration or the Suda, and possibly other works lost for us. The second chapter deals with the sources, critical agenda, and readership of the ancient commentaries. Here, Gibson provides a clear account of the purposes and guiding principles behind the composition of these works. He concludes that ancient commentators were familiar with interpretative problems of the Demosthenic text and tried to explain allusions and references to specific events, people, and places and also provide semantic, etymological and textual explanations of difficult or unusual terms. In this and the third chapter, Gibson discusses in considerable detail the scholarship on Didymus. He rejects the view that Didymus was merely a filter for a "golden era" of Alexandrian scholarship and argues that his prominent position as a commentator is due to the vast quantity of his work and its impact on later scholars. In sum, the first part of the study offers an informative account of ancient Demosthenic scholarship written in a clear and accessible style.The second part of the book contains the texts of ancient commentators of Demosthenes, with English translations, and also linguistic and historical commentary. In the translation, Gibson chooses to leave out many lines from the papyrus texts where only single words or fragments of words are legible; he translates only the most extant sections of the text. This is a valid choice, but readers should be aware of the fact that many important details may be hiding in the leftovers and fragments that have been omitted. Gibson does not provide the readily available text of P.Berol.inv. 9780, the most extensive surviving work of Didymus, while he cites the rest of the texts from reliable modern editions. In the commentary there are interesting discussions on the Spartan mora, the building of the Parthenon, the Helliastic courts, and many other topics noted by the ancient commentators on Demosthenes. An appendix presents and discusses P.Lond.Lit. 179, a prologue and commentary on Dem. 21. The reader will probably find useful the indexes and rich bibliography provided in the last part of this study.Gibson's commentary is certainly thorough but contains a number of errors in detail, and important bibliography is missing on individual topics. For example:Page 113: Gibson adopts the text of Pearson-Stephens. The adjective is, or, as here (later Greek),. Therefore the text should be (see LSJ s.v.).Page 120: Gibson has missed several important contributions to the issue of the theoric fund in recent years (M. H. Hansen, GRBS 17 [1976] 235-46; E. M. [End Page 482] Harris in E. M. Harris and R. Wallace, eds., Transitions to Empire: Essays in Greco-Roman History 360-146 B.C., in Honor of E. Badian [Norman, Okla., 1996]; C. Carey, Apollodoros Against Neaira [Warminster, 1992] 152-57). As a result, his note on P.Berol. 9780, Col. 8.32-44 is... (shrink)

BackgroundThe COVID-19 pandemic has created ethical challenges for intensive care unit (ICU) professionals, potentially causing moral distress. This study explored the levels and causes of moral distress and the ethical climate in Dutch ICUs during COVID-19.MethodsAn extended version of the Measurement of Moral Distress for Healthcare Professionals (MMD-HP) and Ethical Decision Making Climate Questionnaire (EDMCQ) were online distributed among all 84 ICUs. Moral distress scores in nurses and intensivists were compared with the historical control group one year before COVID-19. ResultsThree (...) hundred forty-five nurses (70.7%), 40 intensivists (8.2%), and 103 supporting staff (21.1%) completed the survey. Moral distress levels were higher for nurses than supporting staff. Moral distress levels in intensivists did not differ significantly from those of nurses and supporting staff. “Inadequate emotional support for patients and their families” was the highest-ranked cause of moral distress for all groups of professionals. Of all factors, all professions rated the ethical climate most positively regarding the culture of mutual respect, ethical awareness and support. “Culture of not avoiding end-of-life-decisions” and “Self-reflective and empowering leadership” received the lowest mean scores. Moral distress scores during COVID-19 were significantly lower for ICU nurses (p < 0.001) and intensivists (p < 0.05) compared to one year prior.ConclusionLevels and causes of moral distress vary between ICU professionals and differ from the historical control group. Targeted interventions that address moral distress during a crisis are desirable to improve the mental health and retention of ICU professionals and the quality of patient care. (shrink)

A formal Ethics Consultation Service (ECS) can provide significant help to patients, families and hospital staff. As with any other form of clinical consultation, documentation of the process and the advice rendered is very important. Upon review of the published consult documentation practices of other ECSs, we judged that none of them were sufficiently detailed or structured to meet the needs and purposes of a clinical ethics consultation. Thus, we decided to share our method in order to advance the practice (...) of ethics consultation. Here, we describe a method of ECS documentation practice, including use of a formal consult report template, as well as a log for maintaining a chronological record of the consultations performed. These two documents facilitate order and organisation of the ECS. They also enable the ECS to keep an account of professional time and experience, enable quick consult trend assessments (by consult theme or ward, for example) and establish a potential registry of consults for future research study. This method of documentation, we believe, not only contributes significantly to the primary purpose of the consultation—namely, the evincing and sharing of ethical opinion about a case—but also enables consultants to improve their practice and to pursue research on clinical ethics consultation. (shrink)

There has been longstanding interest in the consistency of decisions made by research ethics committees in the UK, but most of the evidence has come from single studies submitted to multiple committees. A systematic comparison was carried out of the decisions made on 18 purposively selected applications, each of which was reviewed independently by three different RECs in a single strategic health authority. Decisions on 11 applications were consistent, but disparities were found among RECs on decisions on seven applications. An (...) analysis of the agreement between decisions of RECs yielded an overall measure of agreement of κ = 0.286 , indicating a level of agreement that, although probably better than chance, may be described as “slight”. The small sample size limits the robustness of these findings. Further research on reasons for inconsistencies in decision making between RECs, and on the importance of such inconsistencies for a range of arguments, is needed. (shrink)

Humans, animals, and the environment face a universal crisis: antimicrobial resistance. Addressing AR and its multi-disciplinary causes across many sectors including in human and veterinary medicine remains underdeveloped. One barrier to AR efforts is an inconsistent process to incorporate the plenitude of stakeholders about what AR is and how to stifle its development and spread—especially stakeholders from the animal agriculture sector, one of the largest purchasers of antimicrobial drugs. In 2019, The Wellcome Trust released Reframing Resistance: How to communicate about (...) antimicrobial resistance effectively, which proposed the need to establish a consistent and harmonized messaging effort that describes the AR crisis and its global implications for health and wellbeing across all stakeholders. Yet, Reframing Resistance does not specifically engage the animal agriculture community. This study investigates the gap between two principles recommended by Reframing Resistance and animal agriculture stakeholders. For this analysis, the research group conducted 31 semi-structured interviews with a diverse group of United States animal agriculture stakeholders. Participants reported attitudes, beliefs, and practices about a variety of issues, including how they defined AR and what entities the AR crisis impacts most. Exploration of Reframing Resistance’s Principle 2, “explain the fundamentals succinctly” and Principle 3, “emphasis that this is universal issue; it can affect anyone, including you” reveals disagreement in both the fundamentals of AR and consensus of “who” the AR crisis impacts. Principle 2 may do better to acknowledge that animal agriculture stakeholders espouse a complex array of perspectives that cannot be summed up in a single perspective or principle. As a primary tool to combat AR, behavior change must be accomplished first through outreach to stakeholder groups and understanding their perspectives. (shrink)

The United States recognized intellectual property rights from its earliest days and included, in its constitution, a clause which expresses this, "To promote the Progress of Science and useful Arts, by securing for limited Times to Authors and Inventors the exclusive Right to their respective Writings and Discoveries." These few words found in Article 1, Section 8, Clause 8 have grown into a massive body of laws that govern works that were unimaginable to Thomas Jefferson and his contemporaries. Our question (...) today is very simple: is the latest metamorphosis of copyright law, the Digital Millennial Copyright Act of 1998, prudent policy? Specifically, we are concerned with three issues which critics have raised regarding this act: chilling effects on fair use, suppression of innovation, and overreach. We will also touch on the criticism which stresses that the DMCA further expands a system which increasingly and unfairly favors the content industries. This will be limited to illustrating extant tensions between copyright owners and society and also the difficulties law faces in keeping pace with the current, rapid and overwhelming technological and cultural change. We rely primarily on leading cases to establish the impact on fair use and innovation or to demonstrate over reach. (shrink)