This case is about a study of burn patients that included a request to the IRB for a waiver of consent for perianal specimen collection–a request which ultimately was not approved by a reviewing IR...

There is little information about the content of ethics consultations in pediatrics. We sought to describe the reasons for consultation and ethical principles addressed during EC in pediatrics through retrospective review and directed content analysis of EC records at St. Jude Children's Research Hospital. Patient-based EC were highly complex and often involved evaluation of parental decision making, particularly consideration of the risks and benefits of a proposed medical intervention, and the physician's fiduciary responsibility to the patient. Nonpatient consultations provided guidance (...) in the development of institutional policies that would broadly affect patients and families. This is one of the few existing reviews of the content of pediatric EC and indicates that the distribution of ethical issues and reasons for moral distress are different than with adults. Pediatric EC often facilitates complex decision making among multiple stakeholders, and further prospective research is need.. (shrink)

Volume 19, Issue 11, November 2019, Page 39-41.

Emergency nurses apply specialist knowledge to the practice of emergency care. This paper discusses the ways in which three emergency nurses understand the nature of their care from their own frames of reference and experiences and presents some of the data collected in a larger study. Various discourses, which compete to inform emergency nurses' understandings of practice, are linked with the notion of nurses as subjects; that is, each discourse may inform, shape and constitute the practice of the nurse and, (...) in turn, the ways in which the patient comes to be known and understood. I will examine the ways in which emergency nurses come to experience or position themselves vis‐à‐vis extant forms of knowledge of emergency care and the extent to which they articulate new or distinctive formulations of emergency care. This paper illuminates the commonalities that constitute the discourses of emergency nursing care, and also analyse nurses' language which demonstrates that within each discourse variations, contradictions and resistances exist. Emergency nursing care occurs in a context of a biomedical discourse that dominates, or tends to dominate, the work of the emergency setting and so to determine acceptable or possible practices. Nevertheless, nurses contest in various ways the ‘truths' that they understand to underpin their practice. Challenges to biomedical discourses are revealed, to some extent, by drawing attention to specific situations and particular struggles encountered in emergency nurses' everyday practice. (shrink)

In crafting our paper on addressing the ethical challenges in HIV prevention research with people who inject drugs,1 we had hoped to stimulate further discussion and deliberation about the topic. We are pleased that three commentaries on our paper have begun this process.2 3 4 The commentaries rightly bring up important issues relating to community engagement and problems in translating research into practice in the fraught environments in which PWID face multiple risks. These risks include acquisition of HIV as well (...) as criminalisation, stigma and lack of access to needed healthcare, prevention and social services. We take this opportunity to respond to the excellent points raised by the commentators. All of the commentaries support our emphasis on robust community engagement with PWID and other stakeholders in designing and conducting HIV prevention research, but urge us to go farther. Wolfe highlights the difficulty of even engaging with community members in oppressive settings, where authorities severely restrict civil liberties of PWID so that even discussing issues related to drug use and enforcement may place individuals at risk. To overcome such limitations, he appropriately suggests interviewing confidentially those who have previously been detained in closed settings as part of the community engagement process. Similarly, Wolfe observes that critical issues can be overlooked with a narrow focus on study procedures if contextual factors before, during or after a study are ignored. For example, he cites the risk of overdose for study participants who have been abstinent during a study and subsequently resume injecting when the study concludes. These kinds of risks may not be obvious …. (shrink)

Volume 20, Issue 10, October 2020, Page 39-41.

Eyal et al have recently argued that researchers should consider conducting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) human challenge studies to hasten vaccine development. We have conducted (J. L.) and overseen (L. D.) human challenge studies and agree that they can be useful in developing anti-infective agents. We also agree that adults can autonomously choose to undergo risks with no prospect of direct benefit to themselves. However, we disagree that SARS-CoV-2 challenge studies are ethically appropriate at this time, for (...) 3 reasons: (1) current scientific knowledge of SARS-CoV-2 infection is insufficient to manage risks; (2) autonomous decision making, while necessary, does not override concerns about risk; and (3) undertaking challenge studies now would imperil confidence in the research enterprise, potentially undermining the global response to the coronavirus disease 2019 (COVID-19) pandemic. (shrink)

Volume 19, Issue 10, October 2019, Page 97-98.

İbâdet, bütün akıl sahibi varlıkların Allah'ın varlığını idrak edebilme ve O'na karşı şükretme duygusu olarak tanımlanır. İbadet eylemini incelemek, ibadet edenin doğasını tahlil etmeyi gerektirir. Bu tahlil bizi ibadet eylemine eşlik eden bilgi/kavrayış, niyet/yönelimsellik ve sürecin sonunda ortaya çıkan özgürlükle buluşturur. Bilgi/kavrayış, Kur'an'ın ibâdet olarak işaret ettiği ilişki formuna en derin mânâyı verir. İbadet, Tanrı'nın mutlak yaratıcı iradesini keşfetme ve ona insanî seviyede eşlik etme arzusudur. Allah’ın varlığını ve birliğini bilmeye yapılan çağrı, ibadetin bilgi ve niyet unsuruna en üst seviyede (...) yapılan daveti içerir. Bu davete icabet sırasında devreye giren semboller ve her bir eyleme ibadet sırasında yüklenen anlam, insan yaşamında yeni olgulara hayat verir. Niyet yahut yönelimsellik ise, insanların parçası oldukları doğal nedensel bağları aşma arzusunu içinde barındırır. İnsanın verili olan bu düzeni ve illiyyet bağını aşarak kendine yeni bir ufuk arama çabası ibadetin niyetle ilgili kısmında içerilir. İbadet bir tanınma talebidir. Sonlu varlığın sonluluğunu ve sınırlılığını aşma arzusunu tatmin etmeyi amaçlayan bir ‘ilişki’ eylemidir. Sonlu ile Sonsuz arasındaki bu ilişkinin bilgi zemininde inşa edilmesi, Allah ile insan arasındaki sınırın bulanıklaşmasını değil tam tersine daha belirgin hale gelmesini sağlar. İbadetteki bilme, bilen öznenin her zaman bu sınırların farkında olması demektir. Niyet, sonlu varlığın Sonsuz olanla iletişime geçerek sonluluğun getirdiği değer yitimini dindirme arzusudur. Özgürlük ise sonlu varlığın Sonsuz Olan’la iletişimi yoluyla, kendisini çepeçevre kuşatan bütün kısıtlama ve dayatmalardan azade olma isteğidir. Allah’tan başkasına tapanların bir düşüş, parçalanma ve kayboluş trajedisi yaşamalarının sebebi her zaman bir kısıtın ve dayatmanın nesnesine dönüşmüş olmasındandır. Onun için Allah ısrarla ibadetin sadece kendine yapılmasını talep ederek bu trajediyi bloke etmek istemektedir. İbadetin kabulü için nasıl ibadetten önce yerine getirilmesi gereken şartlar, ibadet sırasında takip edilmesi gereken rükünler varsa, aynı şekilde ibadetten sonra yerine getirilmesi gereken şartlar vardır. Bunlar yapılan ibadetin gerçekten ibadet niteliğine sahip olup olmadığını denetleyen ibadet sonrası kriterlerdir; bu ibadetin fenomenolojisidir: İbadet bireyi kendi iç dünyasında bir itmi’nana kavuşturmalı, kamusal alanda ise ahlakî bir özne olarak inşa etmelidir. (shrink)

This chapter contains sections titled: Metaphysical Approaches Metaphysical Problems References.

Volume 20, Issue 10, October 2020, Page 82-83.

Volume 20, Issue 4, May 2020, Page 111-113.

Narrative has proven itself a continuous as well as adaptable means for environmentally oriented expression. Its role goes beyond the mediation of pre-existing knowledge imported into the realm of storytelling from other domains; rather, influential models of the natural world tend to circulate as storyworlds. This special issue of SubStance proceeds from the premise that narratives are not only a sequence of signs encoding a story but also “invisible, elusive representations that exist only in the mind”. Narrative forms generate and (...) transfer environmental knowledge; moreover, any specifically narrative concerns are important contributing factors to the models of agency, change... (shrink)

This paper examines how three Dutch political parties employ the Internet as a tool to enhance ‘digital democracy’. The potential of digital democracy is considered to be strongest in the sphere of collective action outside the domain of political institutions. In this article, however, attention is given to how institutionalized channels might be supportive of digital democracy. Three components of the democratic process – information provision, deliberation, and political decision-making – are examined in the content and user assessments of the (...) web sites of the Socialist Party, the Christian Democratic Party and the Green Party. Minor differences were found in the party web sites regarding information provision; substantial differences were found regarding the degree and nature of political deliberation available on the sites. Indicators of the third component, political decision-making, were least evident on all three web sites. User assessments of the sites and opportunities for political deliberation followed, more or less, the general public images of the related political parties. (shrink)

Genomic sequencing is becoming more common both in clinical practice and as a routine aspect of much research. Over the last 15 years there has been ongoing discussion about the implications of gen...

We report on the deliberations of an interdisciplinary group of experts in science, law, and philosophy who convened to discuss novel ethical and policy challenges in stem cell research. In this report we discuss the ethical and policy implications of safety concerns in the transition from basic laboratory research to clinical applications of cell-based therapies derived from stem cells. Although many features of this transition from lab to clinic are common to other therapies, three aspects of stem cell biology pose (...) unique challenges. First, tension regarding the use of human embryos may complicate the scientific development of safe and effective cell lines. Second, because human stem cells were not developed in the laboratory until 1998, few safety questions relating to human applications have been addressed in animal research. Third, preclinical and clinical testing of biologic agents, particularly those as inherently complex as mammalian cells, present formidable challenges, such as the need to develop suitable standardized assays and the difficulty of selecting appropriate patient populations for early phase trials. We recommend that scientists, policy makers, and the public discuss these issues responsibly, and further, that a national advisory committee to oversee human trials of cell therapies be established. **NB we did not reccommend a NAC, we think it might be appropriate**. (shrink)

Deizm başından beri kendini ana akım dinî kabullere karşı heterodoks dinî bir kimlik olarak konumlandırmış, felsefe ve teolojinin temel düşünce üretim alanları olan Tanrı tasavvurları, Allah-âlem ilişkisi, din-bilim ilişkisi, kötülük meselesinden kaynaklı ahlakî tartışmalarda geleneksel kabullere aykırı görüşler ileri sürmüştür. Bu yönüyle deizm, dinin kendi içinden bir eleştirisidir. İngiltere’de deizmin babası olarak isimlendirilen E. Herbert of Cherbury’nin deizmin beş ilkesi bu eleştirinin en başat örneğidir. Ona göre; 1. Yüce bir Tanrı vardır, 2. Bu yüce Varlığa ibadet edilmelidir, 3. Erdem ibadetin (...) yarattığı bir değer olduğu için din ve ahlak arasında doğrudan bir ilişki vardır, 4. İnsanlar zayıf yaratıldıkları için tövbe ihtiyacındadırlar; bu da Tanrı’yla iletişime açıklık demektir, 5. Ölümden sonraki hayatta ceza ve mükâfat vardır. Deizmin iddiaları zaman içinde değişikliğe uğramıştır. Bu değişimi, farklı deizm iddialarını tasnif eden ve eleştiren Samuel Clarke’ta görmek mümkündür. Bununla birlikte, deistler şu konularda ortak fikre sahiptirler: imanın kurtarıcılığına karşı bilginin kurtarıcılığı esastır; kurumsal dinî yapılar reddedilmelidir; akıl ve insan doğası yüceltilmelidir; ahlak akılla temellendirilebilir; (vahyin imkânını kabul eden deistlere göre) vahyin doğrusu ile aklın doğrusu uyum içinde olmalıdır. Türkiye’de deistler dini reddetmekten daha çok onun akılla uyumunu talep etmekte, hurafelerden arındırılmasını ve radikal söylemlerden temizlenmesini istemektedirler. Kurumsal dinî otorilerin yerine, insanın aklına ve doğasına yaslanan doğruları önermektedirler. Bu doktrin temeline ek olarak Türkiye’de deizm ilginç veriler ve sonuçlar üretmektedir. Türkiye’de muhafazakâr bir yönetim iş başındayken deizmin artış kaydetmesi çok çarpıcıdır. Kamusal alanda dinin daha fazla görünür olmasına rağmen, deizmin ve sekülerleşmenin artması, din-siyaset ilişkisinin çok sıkı kurulduğu ülkelerde dine yabancılaşma gibi bir sonucun ortaya çıktığı tezini bir kez daha doğrulamış görünmektedir. Bu çalışma deizmin farklı iddialarını dikkate alarak ve Türkiye’de lise öğrencileri arasında yapılan araştırmalara dayanarak şu sonuçları okuyucuyla paylaşmaktadır: Mezhep farklılığının tetiklediği şiddet, radikal söylemler, buyurgan din dili, mitolojik anlatımlar genç zihinleri geleneksel olarak tevarüs ettikleri birikimi yeniden değerlendirmeye itmektedir. Kendilerini dinin dışında konumlandırmak istemeyen bu zihinler, yeni bir dini kimliği tercih etmektedirler. Bu kimlik bugün artık heterodoks bir kimlik olarak kendini göstermektedir. Bu aynı zamanda sekülerleşmiş bir ortodoksinin ortaya çıktığının da açık göstergesidir. (shrink)

Informed Consent: What Must Be Disclosed and What Must Be Understood seeks to challenge the “standard view” of consent. It seeks to do so by segregating the “disclosure function” from the “understa...

As part of the regulatory review process, both the Food and Drug Administration and Office for Human Research Protections (U.S. Department of Health and Human Services [HHS]...

The ‘managed care’ idea: implications for health service systems in Australia The growth of corporatism in health‐care in the US, and the consequences arising from US models of health‐care delivery systems provide an enormously valuable point of comparison with health systems of other developed economies, such as Australia. If lessons are to be learnt from the US, then an analysis of the structure and performance of the US health‐care system provides important background for understanding and assessing contemporary policy changes to (...) administrative and organizational designs and techniques for patient care in Australia. (shrink)

This article discusses two issues of majority-minority relations in deeply divided societies. The first is the legitimacy of the transfer of a homeland minority — along with the territory it inhabits — to a neighboring kin-state against the will of the minority or most of its members. The second is the constitutional validity of legislation that renders citizenship or the right to vote contingent upon an oath of allegiance to the state or to its fundamental attributes. These two interrelated steps, (...) advanced by a central partner in the current government coalition in Israel, are aimed at the Arab-Palestinian minority. This article’s main focus is the examination of Israeli constitutional law safeguards that may prevent the implementation of these initiatives, which I find to be very dangerous. (shrink)

This article seeks to advance ethical dialogue on choosing standards of prevention in clinical trials testing improved biomedical prevention methods for HIV. The stakes in this area of research are high, given the continued high rates of infection in many countries and the budget limitations that have constrained efforts to expand treatment for all who are currently HIV-infected. New prevention methods are still needed; at the same time, some existing prevention and treatment interventions have been proven effective but are not (...) yet widely available in the countries where they most urgently needed. The ethical tensions in this field of clinical research are well known and have been the subject of extensive debate. There is no single clinical trial design that can optimize all the ethically important goals and commitments involved in research. Several recent articles have described the current ethical difficulties in designing HIV prevention trials, especially in resource limited settings; however, there is no consensus on how to handle clinical trial design decisions, and existing international ethical guidelines offer conflicting advice. This article acknowledges these deep ethical dilemmas and moves beyond a simple descriptive approach to advance an organized method for considering what clinical trial designs will be ethically acceptable for HIV prevention trials, balancing the relevant criteria and providing justification for specific design decisions. (shrink)

As medicine and science advance, new ethical questions emerge. Over time, deliberation and analysis result in a somewhat settled approach to a problem. Often the settled approach is based on group...

The American Journal of Bioethics, Volume 12, Issue 6, Page 33-34, June 2012.

In this paper Grice's requirements for assertability are imposed on the disjunction of Classical Logic. Defining material implication in terms of negation and disjunction supplemented by assertability conditions, results in the disappearance of the most important paradoxes of material implication. The resulting consequence relation displays a very strong resemblance to Schurz's conclusion-relevant consequence relation.

This article deals with political socialization and political participation, in the context of visiting phenomenon, in Turkey. We took the Ali Baba Tomb in central Sivas and Celtek Baba Tomb in Celtek village as the sample of our study. In the study, political socialization and participation was seen as a dialectical process between individual and society. Visiting phenomenon embodying a rich historical, religious and cultural accumulation is important in that it defines the religious tendency of huge masses. As a matter (...) of fact, they have realized their potitical socialization in a pretty much authentic culture with different interests, duties, roles and positions. At the same time, they have shown their political participation with reference to the religious world of meaning. -/- SUMMARY In the contrast to the secular paradigm, religion continues to keep its reciprocal relations with the whole social system without giving an opportunity to any speculation. Religion and politics are two important fields in which this living relationship is stood for institutional structures. This article focuses on political socialization and political participation in Turkey by taking into consideration the phenomenon of visiting. The question of how the visiting phenomenon provided an input to the political system in terms of political socialization and political participation constitutes the problem of the research. Ali Baba Tomb in the center of Sivas province and Celtek Baba Tomb situated in central Celtek Village were selected as samples for the study. The political socialization and participation were talked with 33 visitors who had been selected randomly from different days between September and December 2015 and were tried to understand the data obtained by semi-standardized interview form. It has been examined in terms of its historical development and orientation of relationship between the visiting phenomenon in the research and the political system. For this reason, the basic methodological acceptance of the research has been to understand and interpret political socialization and participation in its specific environment. In this framework, firstly, the socialization of the sample in the context of family, school, mass communication and social environment was evaluated. Later, it has been tried to understand the religiousness in the context of the visiting through the same group. Their political participation has also been resolved according to the classification of Milbrath and Goel’s hierarchical political participation level through the field of political socialization and religiousness. Finally, this research, which is considered as a singular case study, has been subjected to a systematic and phenomenological analysis according to gender, age, education and belief variables on the basis of data obtained through problem-centered interviewing and participatory observation. The visiting in a phenomenological sense involves a trip and travel made with certain requests to the people who are believed to have been buried in places such as tombs, attributed to certain spiritual powers and virtues. The visiting phenomenon in the field of research had brought a rich historical and cultural content, exceeding a simple grave visit. Today, in the religious and traditional meaning world the traumas caused by the modernization and other socio-psychological thrillers have brought a different interest in Turkish society than ever before. The visiting phenomenon has created a continuity with a perception of sanctity and understanding which were shaped by an interaction with many different cultures, pre-Islamic beliefs and eventually mystical and charismatic personalities. However, the visiting phenomenon according to the severity of the individual and social crises experienced in the modern period has also revealed some variations that included popular patterns in both structural and practical contexts. Thus, the visiting phenomenon today is seen in a change by creating new universes appropriate to tradition in different social categories. In the modern era the influence of this change on the political culture is evident. This effect is generally related to the social structure of Turkish society and manifests itself as a closing within the sense of protection of the world of meaning. The visiting phenomenon, which has a special place in the religious life of very large masses in Turkey, has created a peculiar structure of political socialization and political participation around a profound historical accumulation. The participants have realized their political socialization in a unique cultural environment. This culture was formed in the context of family, school, mass communication and social environment. The dramatic situations that have taken place in the process have brought the important socialization problems in this environment. The community associations, the system of obsolete values, the distorted hierarchical relationships and the insecure environments created no longer lead to the searching for meaning by them. These people, who express themselves not like politics (27 people) at last, instead of expressing politics themselves with ideological concepts like ideological rightist, leftist, Islamist, communities people (ʾumma), Kemalist (5 people), but rather Turkish, Muslim, homeland, nation, human and righteousness as the concepts and words to prefer to identify. This should be a socialization that they carry out by transferring the objective world they created outwardly around a set of meanings to their subjective consciousness again. It should be a socialization again that they carry out by transferring the objective world they created outwardly around a set of meanings to their subjective consciousness. The visitors have carried out a political participation with the accumulation created by this field of political socialization. They saw themselves as often religious and the visiting activity as a sign of religiosity. As a result, the visiting a tomb could have been a simple manifestation of inner happiness and ease in a happy moment or an entertainment as much as it was in distress in this environment. The mystical attitude which is far from the world that many poor people built around the visit has caused them to put reserves in the political institution that represents a secular field. As a matter of fact, the visitors often characterize the world with the terms like empty, lie, trial, and so on. Politics, on the other hand, had been seen as a relationship of interest, cheating and lying. It has been understood that it provides a political input in the framework that Milbrath and Goel conceptualize as audience actions when we look at the political participation of the visiting phenomenon in the Sivas universe. According to this visit, in the sample of the phenomenon 29 people of the participants said that they are not open to the politics while 4 of them said that they are open to the politics. However, given that voting attitudes in the elections, only 2 of the participants did not see this very important; others (31 people) regard voting as a responsibility in the name of country, nation, country or even religion. From time to time, those who say either that they have started to the political discussions or that they have participated in political debates (11 people of them) are less than those who have never attended this kind of debates (22 people). In this sample, the number of people trying to persuade a person to vote for a particular party is 6; the number of people carrying a rosette of a party or hanging the symbols of the party to the house, to the car, was only 4 among those participants. Visiting people usually provide the political socializations in a fatalistic and restrictive environment. Their political participation is also in accord with the symbolic world of this hierarchical structure in which life is defined by certain rules. Therefore, they had produced an unquestionability of the authority as it is in family as well as political institutions. The politics is frightening for them; it is not interested in them and they should be away from it. (shrink)