The purpose of this paper is to investigate the nature of rhetoric and rhetorical strategies that are implicit in the standalone sustainability reporting of the top 24 companies of the Fortune 500 Global. We adopt Bormann’s :396–407, 1972) SCT framework to study the rhetorical situation and how corporate sustainability reporting messages can be communicated to the audience. The SCT concepts in the sustainability reporting’s communication are subject to different types of legitimacy strategies that are used by corporations as a validity (...) and legitimacy claim in the reports. A content analysis has been conducted and structural coding schemes have been developed based on the literature. The schemes are applied to the SCT model which recognizes the symbolic convergent processes of fantasy among communicators in a Society. The study reveals that most of the sample companies communicate fantasy type and rhetorical vision in their corporate sustainability reporting. However, the disclosure or messages are different across locations and other taxonomies of the SCT framework. This study contributes to the current CSR literature about how symbolic or fantasy understandings can be interpreted by the users. It also discusses the persuasion styles that are adopted by the companies for communication purposes. This study is the theoretical extension of the SCT. Researchers may be interested in further investigating other online communication paths, such as human rights reports and director’s reports. (shrink)

The Royal College of Physicians of London published the 2013 national clinical guidelines on prolonged disorders of consciousness in vegetative and minimally conscious states. The guidelines acknowledge the rapidly advancing neuroscientific research and evolving therapeutic modalities in PDOC. However, the guidelines state that end-of-life decisions should be made for patients who do not improve with neurorehabilitation within a finite period, and they recommend withdrawal of clinically assisted nutrition and hydration . This withdrawal is deemed necessary because patients in PDOC can (...) survive for years with continuation of CANH, even when a ceiling on medical care has been imposed, i.e., withholding new treatment such as cardiopulmonary resuscitation for acute life-threatening illness. The end-of-life care pathway is centered on a staged escalation of medications, including sedatives, opioids, barbiturates, and general anesthesia, concurrent with withdrawal of CANH. Agitation and distress may last from several days to weeks because of the slow dying process from starvation and dehydration. The potential problems of this end-of-life care pathway are similar to those of the Liverpool Care Pathway. After an independent review in 2013, the Department of Health discontinued the Liverpool Care pathway in England. The guidelines assert that clinicians, supported by court decisions, have become the final authority in nonconsensual withdrawal of CANH on the basis of “best interests” rationale. We posit that these guidelines lack high-quality evidence supporting: 1) treatment futility of CANH, 2) reliability of distress assessment from starvation and dehydration, 3) efficacy of pharmacologic control of this distress, and 4) proximate causation of death. Finally, we express concerns about the utilitarian-based assessment of what constitutes a person’s best interests. We are disturbed by the level and the role of medical authoritarianism institutionalized by these national guidelines when deciding on the worthiness of life in PDOC. We conclude that these guidelines are not only harmful to patients and families, but they represent the means of nonconsensual euthanasia. The latter would constitute a gross violation of the public’s trust in the integrity of the medical profession. (shrink)

The determination of death by neurological criteria remains controversial scientifically, culturally, and legally, worldwide. In the United Kingdom, although the determination of death by neurological criteria is not legally codified, the Code of Practice of the Academy of Medical Royal Colleges is customarily used for neurological death determination and treatment withdrawal. Unlike some states in the US, however, there are no provisions under the law requiring accommodation of and respect for residents' religious rights and commitments when secular conceptions of death (...) based on medical codes and practices conflict with a traditional concept well-grounded in religious and cultural values and practices. In this article, we analyse the medical, ethical, and legal issues that were generated by the recent judgement of the High Court of England and Wales in Re: A [2015] EWHC 443. Mechanical ventilation was withdrawn in this case despite parental religious objection to a determination of death based on the code of practice. We outline contemporary evidence that has refuted the reliability of tests of brainstem function to ascertain the two conjunctive clinical criteria for the determination of death that are stipulated in the code of practice: irreversible loss of capacity for consciousness and somatic integration of bodily biological functions. We argue that: the tests of brainstem function were not properly undertaken in this case; the two conjunctive clinical criteria set forth in the code of practice cannot be reliably confirmed by these tests in any event; and absent authentication of the clinical criteria of death, the code of practice wrongly invokes a secular definition of death based on the loss of personhood. Consequently, the moral obligation of a pluralistic society to honor and respect diverse religious convictions to the greatest extent possible is being violated. Re A is contrasted with the US case of Jahi McMath in which the court accommodated parental religious objection to the determination of neurological death codified in the Uniform Determination of Death Act. We conclude that the legal system in the United Kingdom should not favour a secular definition of death over a definition of death that is respectful of religious values about the inviolability and sanctity of life. We recommend the legal recognition of religious accommodation in death determination to facilitate cultural sensitivity and compassionate care to patients and families in a pluralistic society. (shrink)

In assisted dying, the end-of-life trajectory is shortened to relieve unbearable suffering. Unbearable suffering is defined broadly enough to include cognitive (early dementia), psychosocial or existential distress. It can include old-age afflictions that are neither life-threatening nor fatal in the “vulnerable elderly”. The voluntary refusal of food and fluids (VRFF) combined with continuous deep sedation (CDS) for assisted dying is legal. Scientific understanding of awareness of internal and external nociceptive stimuli under CDS is rudimentary. CDS may blunt the wakefulness component (...) of human consciousness without eradicating internal affective awareness of thirst and hunger. Patients may suffer because of the slow dying process following dehydration and starvation. The difficulty to adequately control distress, without bringing the dying process to a rapid conclusion by lethal pharmacological interventions, can cause feelings of guilt among hospice and medical staff. Furthermore, the double-effect principle is not applicable in these situations because the primary objective of VRFF is to hasten death. Legal and societal debate should focus on sharpening the boundaries between assisted dying and palliative care. This separation is necessary to: 1) uphold trust in the patient-phyician relationship, and 2) preserve integrity and ethics of the medical profession. (shrink)

Statistical distributions have great applicability for modeling data in almost every applied sector. Among the available classical distributions, the inverse Weibull distribution has received considerable attention. In the practice of distribution theory, numerous methods have been studied and suggested/introduced to increase the flexibility level of the traditional probability distributions. In this paper, we implement different distribution methods to obtain five new different versions of the inverse Weibull model. The new modifications of the inverse Weibull model are called the logarithm transformed-inverse (...) Weibull, a flexible reduced logarithmic-inverse Weibull, the weighted TX-inverse Weibull, a new generalized-inverse Weibull, and the alpha power transformed extended-inverse Weibull distributions. To illustrate the flexibility and applicability of the new modifications of the inverse Weibull model, a biomedical data set is analyzed. The data set consists of 108 observations and represents the mortality rate of the COVID-19-infected patients. The practical application shows that the new generalized-inverse Weibull is the best modification of the inverse Weibull distribution. (shrink)

Background Bioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die." Discussion Advances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used (...) for permanent support of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death. Summary Destination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

End-of-life organ donation is controversial in Islam. The controversy stems from: scientifically flawed medical criteria of death determination; invasive perimortem procedures for preserving transplantable organs; and incomplete disclosure of information to consenting donors and families. Data from a survey of Muslims residing in Western countries have shown that the interpretation of religious scriptures and advice of faith leaders were major barriers to willingness for organ donation. Transplant advocates have proposed corrective interventions: reinterpreting religious scriptures, reeducating faith leaders, and utilizing media (...) campaigns to overcome religious barriers in Muslim communities. This proposal disregards the intensifying scientific, legal, and ethical controversies in Western societies about the medical criteria of death determination in donors. It would also violate the dignity and inviolability of human life which are pertinent values incorporated in the Islamic moral code. Reinterpreting religious scriptures to serve the utilitarian objectives of a controversial end-of-life practice, perceived to be socially desirable, transgresses the Islamic moral code. It may also have deleterious practical consequences, as donors can suffer harm before death. The negative normative consequences of utilitarian secular moral reasoning reset the Islamic moral code upholding the sanctity and dignity of human life. (shrink)

Mass media campaigns are widely and successfully used to change health decisions and behaviors for better or for worse in society. In the United States, media campaigns have been launched at local offices of the states’ department of motor vehicles to promote citizens’ willingness to organ donation and donor registration. We analyze interventional studies of multimedia communication campaigns to encourage organ-donor registration at local offices of states’ department of motor vehicles. The media campaigns include the use of multifaceted communication tools (...) and provide training to desk clerks in the use of scripted messages for the purpose of optimizing enrollment in organ-donor registries. Scripted messages are communicated to customers through mass audiovisual entertainment media, print materials and interpersonal interaction at the offices of departments of motor vehicles. These campaigns give rise to three serious concerns: (1) bias in communicating information with scripted messages without verification of the scientific accuracy of information, (2) the provision of misinformation to future donors that may result in them suffering unintended consequences from consenting to medical procedures before death (e.g, organ preservation and suitability for transplantation), and (3) the unmanaged conflict of interests for organizations charged with implementing these campaigns, (i.e, dual advocacy for transplant recipients and donors). We conclude the following: (1) media campaigns about healthcare should communicate accurate information to the general public and disclose factual materials with the least amount of bias; (2) conflicting interests in media campaigns should be managed with full public transparency; (3) media campaigns should disclose the practical implications of procurement as well as acknowledge the medical, legal, and religious controversies of determining death in organ donation; (4) organ-donor registration must satisfy the criteria of informed consent; (5) media campaigns should serve as a means of public education about organ donation and should not be a form of propaganda. (shrink)

We respond to Morgan and Feeley’s critique on our article “Mass Media in Organ Donation: Managing Conflicting Messages and Interests.” We noted that Morgan and Feeley agree with the position that the primary aims of media campaigns are: “to educate the general public about organ donation process” and “help individuals make informed decisions” about organ donation. For those reasons, the educational messages in media campaigns should not be restricted to “information from pilot work or focus groups” but should include evidence-based (...) facts resulting from a comprehensive literature research. We consider the controversial aspects about organ donation to be relevant, if not necessary, educational materials that must be disclosed in media campaigns to comply with the legal and moral requirements of informed consent. With that perspective in mind, we address the validity of Morgan and Feeley’s claim that media campaigns have no need for informing the public about the controversial nature of death determination in organ donation. Scientific evidence has proven that the criteria for death determination are inconsistent with the Uniform Determination of Death Act and therefore potentially harmful to donors. The decision by campaign designers to use the statutory definition of death without disclosing the current controversies surrounding that definition does not contribute to improved informed decision making. We argue that if Morgan and Feeley accept the important role of media campaigns to enhance informed decision making, then critical controversies should be disclosed. In support of that premise, we will outline: (1) the wide-spread scientific challenges to brain death as a concept of death; (2) the influence of the donor registry and team-huddling on the medical care of potential donors; (3) the use of authorization rather than informed consent for donor registration; (4) the contemporary religious controversy; and (5) the effects of training desk clerks as organ requestors at the Department of Motor Vehicles offices. We conclude that organ donation is a medical procedure subject to all the ethical obligations that the medical profession must uphold including that of transparency and truthfulness. (shrink)

This paper critically analyses how Islamization of Knowledge (IOK), Radical Reform (RR), and Maqasid Methodology (MM), three distinct Islamic intellectual projects, attempted to develop discourses of Islamic epistemology in facing contemporary developments of natural and social sciences. Mainly, the paper focuses on similarities, differences, and potential contributions of all three projects respectively. Initially, this paper observes that IOK, RR, and MM have solid agreements among themselves in defining the core crisis of the modern Islamic intellectual tradition, as well as in (...) highlighting the importance of inclusion of Islamic primary sources and its normative guidance in the process of reorienting modern knowledge. Equally, each of those projects presents itself as a new reflection of Islamic primary texts considering current intellectual challenges. Nevertheless, this paper further finds that all three projects have deep disagreements among themselves in terms of defining the scope of epistemic authority of revelation, reason, and spirituality and thereby offer three different visions of Islamic epistemic schema in facing modern knowledge. Finally, this paper reflects how these differences could potentially impact visions of an alternative education system from an Islamic worldview. (shrink)

The American Journal of Bioethics, Volume 11, Issue 8, Page 52-54, August 2011.

In early 2017, Nevada amended its Uniform Determination of Death Act, in order to clarify the neurologic criteria for the determination of death. The amendments stipulate that a determination of death is a clinical decision that does not require familial consent and that the appropriate standard for determining neurologic death is the American Academy of Neurology’s guidelines. Once a physician makes such a determination of death, the Nevada amendments require the withdrawal of life-sustaining treatment within twenty-four hours with limited exceptions. (...) Neurologists have generally supported Nevada’s amendments for clarifying the diagnostic standard and limiting the ability of family members to challenge it. However, it is more appropriate to view the Nevada amendments with concern. Even though the primary purpose of the UDDA is to ensure that all functions of a person’s entire brain have ceased, the AAN guidelines do not accurately assess this. In addition, by characterizing the determination of death as solely a clinical decision, the Nevada legislature has improperly ignored the doctrine of informed consent, as well as the beliefs of particular faiths and cultures that reject brain death. Rather than resolving controversies regarding brain death determinations, the Nevada amendments may instead instigate numerous constitutional challenges. (shrink)

The utilitarian construct of two alternative criteria of human death increases the supply of transplantable organs at the end of life. Neither the neurological criterion (heart-beating donation) nor the circulatory criterion (non-heart-beating donation) is grounded in scientific evidence but based on philosophical reasoning. A utilitarian death definition can have unintended consequences for dying Muslim patients: (1) the expedited process of determining death for retrieval of transplantable organs can lead to diagnostic errors, (2) the equivalence of brain death with human death (...) may be incorrect, and (3) end-of-life religious values and traditional rituals may be sacrificed. Therefore, it is imperative to reevaluate the two different types and criteria of death introduced by the Resolution (Fatwa) of the Council of Islamic Jurisprudence on Resuscitation Apparatus in 1986. Although we recognize that this Fatwa was based on best scientific evidence available at that time, more recent evidence shows that it rests on outdated knowledge and understanding of the phenomenon of human death. We recommend redefining death in Islam to reaffirm the singularity of this biological phenomenon as revealed in the Quran 14 centuries ago. (shrink)

Islam and End-of-Life Practices in Organ Donation for Transplantation: New Questions and Serious Sociocultural Consequences Content Type Journal Article Pages 175-205 DOI 10.1007/s10730-009-9095-8 Authors Mohamed Y. Rady, Mayo Clinic Hospital in Phoenix 5777 East Mayo Boulevard Phoenix Arizona USA 85054 Joseph L. Verheijde, Mayo Clinic College of Medicine 5777 East Mayo Boulevard Phoenix Arizona USA 85054 Muna S. Ali, Arizona State University Phoenix Arizona USA Journal HEC Forum Online ISSN 1572-8498 Print ISSN 0956-2737 Journal Volume Volume 21 Journal (...) Issue Volume 21, Number 2. (shrink)

The concept of informed consent for medical treatment has been well established as a necessary element in ensuring compliance with patients' right to self determination and respect of individual au...

Volume 20, Issue 6, June 2020, Page 22-24.

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. (...) We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination. (shrink)

There is a trend of recruiting faith leaders at mosques to overcome religious barriers to organ donation, and to increase donor registration among Muslims. Commentators have suggested that Muslims are not given enough information about organ donation in religious sermons or lectures delivered at mosques. Corrective actions have been recommended, such as funding campaigns to promote organ donation, and increasing the availability of organ donation information at mosques. These actions are recommended despite published literature expressing safety concerns (i.e., do no (...) harm) in living and end-of-life organ donation. Living donors require life-long medical follow-up and treatment for complications that can appear years later. Scientific and medical controversies persist regarding the international guidelines for death determination in end-of-life donation. The medical criteria of death lack validation and can harm donors if surgical procurement is performed without general anesthesia and before biological death. In the moral code of Islam, the prevention of harm holds precedence over beneficence. Moral precepts described in the Quran encourage Muslims to be beneficent, but also to seek knowledge prior to making practical decisions. However, the Quran also contains passages that demand honesty and truthfulness when providing information to those who are seeking knowledge. Currently, information is limited to that which encourages donor registration. Campaigning for organ donation to congregations in mosques should adhere to the moral code of complete, rather than selective, disclosure of information. We recommend as a minimal standard the disclosure of risks, uncertainties, and controversies associated with the organ donation process. (shrink)

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. (...) We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination. (shrink)

In 1968, the Harvard criteria equated irreversible coma and apnea with human death and later, the Uniform Determination of Death Act was enacted permitting organ procurement from heart-beating donors. Since then, clinical studies have defined a spectrum of states of impaired consciousness in human beings: coma, akinetic mutism, minimally conscious state, vegetative state and brain death. In this article, we argue against the validity of the Harvard criteria for equating brain death with human death. Brain death does not disrupt somatic (...) integrative unity and coordinated biological functioning of a living organism. Neurological criteria of human death fail to determine the precise moment of an organism’s death when death is established by circulatory criterion in other states of impaired consciousness for organ procurement with non-heart-beating donation protocols. The criterion of circulatory arrest 75 s to 5 min is too short for irreversible cessation of whole brain functions and respiration controlled by the brain stem. Brain -based criteria for determining death with a beating heart exclude relevant anthropologic, psychosocial, cultural, and religious aspects of death and dying in society. Clinical guidelines for determining brain death are not consistently validated by the presence of irreversible brain stem ischemic injury or necrosis on autopsy; therefore, they do not completely exclude reversible loss of integrated neurological functions in donors. The questionable reliability and varying compliance with these guidelines among institutions amplify the risk of determining reversible states of impaired consciousness as irreversible brain death. The scientific uncertainty of defining and determining states of impaired consciousness including brain death have been neither disclosed to the general public nor broadly debated by the medical community or by legal and religious scholars. Heart-beating or non-heart-beating organ procurement from patients with impaired consciousness is de facto a concealed practice of physician-assisted death, and therefore, violates both criminal law and the central tenet of medicine not to do harm to patients. Society must decide if physician-assisted death is permissible and desirable to resolve the conflict about procuring organs from patients with impaired consciousness within the context of the perceived need to enhance the supply of transplantable organs. (shrink)

Advance health care directives and informed consent remain the cornerstones of patients' right to self-determination regarding medical care and preferences at the end-of-life. However, the effectiveness and clinical applicability of advance health care directives to decision-making on the use of life support systems at the end-of-life is questionable. The Uniform Anatomical Gift Act (UAGA) has been revised in 2006 to permit the use of life support systems at or near death for the purpose of maximizing procurement opportunities of organs medically (...) suitable for transplantation. Some states have enacted the Revised UAGA (2006) and a few of those have included amendments while attempting to preserve the uniformity of the revised Act. Other states have introduced the Revised UAGA (2006) for legislation and remaining states are likely to follow soon. (shrink)

The American Journal of Bioethics, Volume 11, Issue 6, Page 60-62, June 2011.

The American Journal of Bioethics, Volume 12, Issue 6, Page 17-20, June 2012.

BackgroundBioethics and law distinguish between the practices of "physician-assisted death" and "allowing the patient to die."DiscussionAdvances in biotechnology have allowed medical devices to be used as destination therapy that are designed for the permanent support of cardiac function and/or respiration after irreversible loss of these spontaneous vital functions. For permanent support of cardiac function, single ventricle or biventricular mechanical assist devices and total artificial hearts are implanted in the body. Mechanical ventilators extrinsic to the body are used for permanent support (...) of respiration. Clinical studies have shown that destination therapy with ventricular assist devices improves patient survival compared to medical management, but at the cost of a substantial alteration in end-of-life trajectories. The moral and legal assessment of the appropriateness and permissibility of complying with a patient's request to electively discontinue destination therapy in a life-terminating act in non-futile situations has generated controversy. Some argue that complying with this request is ethically justified because patients have the right to request withdrawal of unwanted treatment and be allowed to die of preexisting disease. Other commentators reject the argument that acceding to an elective request for death by discontinuing destination therapy is 'allowing a patient to die' because of serious flaws in interpreting the intention, causation, and moral responsibility of the ensuing death.SummaryDestination therapy with cardiac and/or ventilatory medical devices replaces native physiological functions and successfully treats a preexisting disease. We posit that discontinuing cardiac and/or ventilatory support at the request of a patient or surrogate can be viewed as allowing the patient to die if--and only if--concurrent lethal pathophysiological conditions are present that are unrelated to those functions already supported by medical devices in destination therapy. In all other cases, compliance with a patient's request constitutes physician-assisted death because of the pathophysiology induced by the turning off of these medical devices, as well as the intention, causation, and moral responsibility of the ensuing death. The distinction between allowing the patient to die and physician-assisted death is pivotal to the moral and legal status of elective requests for death by discontinuing destination cardiac and/or ventilatory medical devices in patients who are not imminently dying. This distinction also represents essential information that must be disclosed to patients and surrogates in advance of consent to this type of therapy. (shrink)

Organ donation after cessation of circulation and respiration, both controlled and uncontrolled, has been proposed by the Institute of Medicine as a way to increase opportunities for organ procurement. Despite claims to the contrary, both forms of controlled and uncontrolled donation after cardiac death raise significant ethical and legal issues. Identified causes for concern include absence of agreement on criteria for the declaration of death, nonexistence of universal guidelines for duration before stopping resuscitation efforts and techniques, and assumption of presumed (...) intent to donate for the purpose of initiating temporary organ-preservation interventions when no expressed consent to donate is present. From a legal point of view, not having scientifically valid criteria of cessation of circulation and respiration for declaring death could lead to a conclusion that organ procurement itself is the proximate cause of death. Although the revised Uniform Anatomical Gift Act of 2006 provides broad immunity to those involved in organ-procurement activities, courts have yet to provide an opinion on whether persons can be held liable for injuries arising from the determination of death itself. Preserving organs in uncontrolled donation after cardiac death requires the administration of life-support systems such as extracorporeal membrane oxygenation. These life-support systems can lead to return of signs of life that, in turn, have to be deliberately suppressed by the administration of pharmacological agents. Finally, allowing temporary organ-preservation interventions without expressed consent is inherently a violation of the principle of respect for a person's autonomy. Proponents of organ donation from uncontrolled donation after cardiac death, on the other hand, claim that these nonconsensual interventions enhance respect for autonomy by allowing people, through surrogate decision making, to execute their right to donate organs. However, the lack of transparency and the absence of protection of individual autonomy, for the sake of maximizing procurement opportunities, have placed the current organ-donation system of opting-in in great jeopardy. Equally as important, current policies enabling and enhancing organ procurement practices, pose challenges to the constitutional rights of individuals in a pluralistic society as these policies are founded on flawed medical standards for declaring death. (shrink)

The extended neoteric ranked set sampling plan proposed by Taconeli and Cabral has proven to outperform many one stages and two stages ranked set sampling plans when estimating the mean and the variance for different populations. Therefore, in this paper, the likelihood function based on ENRSS is proposed and used for estimation of the parameters of the inverted Nadarajah–Haghighi distribution. An extensive Monte Carlo simulation study is conducted to assess the performance of the proposed likelihood function, and the efficiency of (...) the estimated parameters based on ENRSS is compared with the well-known ranked set sampling plan and some of its modifications. These modifications include the extended ranked set sampling plan and the neoteric ranked set sampling plan. The results as foreseeable were very satisfactory and gave similar results to Taconeli and Cabral’s 2019 results. (shrink)

The left ventricular assist device was originally designed to be surgically implanted as a bridge to transplantation for patients with chronic end-stage heart failure. On the basis of the REMATCH trial, the US Food and Drug Administration and the US Centers for Medicare & Medicaid Services approved permanent implantation of the left ventricular assist device as a destination therapy in Medicare beneficiaries who are not candidates for heart transplantation. The use of the left ventricular assist device as a destination therapy (...) raises certain ethical challenges. Left ventricular assist devices can prolong the survival of average recipients compared with optimal medical management of chronic end-stage heart failure. However, the overall quality of life can be adversely affected in some recipients because of serious infections, neurologic complications, and device malfunction. Left ventricular assist devices alter end-of-life trajectories. The caregivers of recipients may experience significant burden (e.g., poor physical health, depression, anxiety, and posttraumatic stress disorder) from destination therapy with left ventricular assist devices. There are also social and financial ramifications for recipients and their families. We advocate early utilization of a palliative care approach and outline prerequisite conditions so that consenting for the use of a left ventricular assist device as a destination therapy is a well informed process. These conditions include: (1) direct participation of a multidisciplinary care team, including palliative care specialists, (2) a concise plan of care for anticipated device-related complications, (3) careful surveillance and counseling for caregiver burden, (4) advance-care planning for anticipated end-of-life trajectories and timing of device deactivation, and (5) a plan to address the long-term financial burden on patients, families, and caregivers. Short-term mechanical circulatory devices (e.g. percutaneous cardiopulmonary bypass, percutaneous ventricular assist devices, etc.) can be initiated in emergency situations as a bridge to permanent implantation of ventricular assist devices in chronic end-stage heart failure. In the absence of first-person (patient) consent, presumed consent or surrogate consent should be used cautiously for the initiation of short-term mechanical circulatory devices in emergency situations as a bridge to permanent implantation of left ventricular assist devices. Future clinical studies of destination therapy with left ventricular assist devices should include measures of recipients' quality of end-of-life care and caregivers' burden. (shrink)

Recently, several articles in the scholarly literature on medical ethics proclaim the need for “responsible scholarship” in the debate over the proper criteria for death, in which “responsible scholarship” is defined in terms of support for current neurological criteria for death. In a recent article, James M. DuBois is concerned that academic critiques of current death criteria create unnecessary doubt about the moral acceptability of organ donation, which may affect the public’s willingness to donate. Thus he calls for a closing (...) of the debate on current death criteria and for journal editors to publish only critiques that “substantially engage and advance the debate.” We argue that such positions as DuBois’ are a threat to responsible scholarship in medical ethics, especially scholarship that opposes popular stances, because it erodes academic freedom and the necessity of debate on an issue that is literally a matter of life and death, no matter what side a person defends. (shrink)

The American Journal of Bioethics, Volume 12, Issue 2, Page 40-42, February 2012.

The competition in higher education has increased, while lecturers are involved in multiple assignments that include teaching, research and publication, consultancy, and community services. The demanding nature of academia leads to excessive work load and stress among academicians in higher education. Notably, offering the right motivational mix could lead to job satisfaction and performance. The current study aims to demonstrate the effects of extrinsic and intrinsic motivational factors influencing job satisfaction and job performance among academicians working in Malaysian private higher (...) educational institutions. Cross-sectional data were collected from the Malaysian PHEIs and the randomly selected 343 samples. The data analysis was performed with the dual analysis of partial least square structural equation modeling and artificial neural network analysis. As a result, it was found that financial rewards, promotion, performance appraisal, classroom environment, and code of conduct significantly predicted job satisfaction. The code of conduct, autonomy, and self-efficacy strongly influenced job performance. The relationship between job satisfaction and job performance was highly moderated by self-efficacy. It was suggested from the ANN analysis that the three prominent factors influencing job satisfaction are financial rewards, performance appraisal, and code of conduct. The analysis supported three significant factors influencing job performance: self-efficacy, performance appraisal, and code of conduct. The management of PHEIs should build the correct policies to transform job satisfaction into job performance. Self-efficacy plays an essential role in activating job performance. Other significant motivating factors that promote job satisfaction and performance, such as emotional intelligence, mindfulness, and other personal traits, should be included in future studies. In addition, future research could use a mixed-method or multi-respondent approach to investigate the important variables and their impact on lecturers’ job satisfaction and performance. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Introduction to the Special Theme Religious Experience and PsychopathologyMohammed Abouelleil Rashed, MD, PhDIn the first verse of the seventeenth sura of the Qur’an, Al-Isra’,1 we learn about Prophet Mohammed’s night-time journey to Al-Quds (Jerusalem):Glory to Him who made His servant travel by night from the sacred place of worship [in Mecca] to the furthest place of worship [in Al-Quds], whose surroundings We have blessed, to show him some of (...) Our signs.The year was 621 AD. The Prophet was transported by a fabled creature known as Al-Buraq—a name that derives from the Arabic word for lightning—that was able to cover the distance of a month-long journey in a matter of hours. Accompanied by the Angel Jibreel, the second part of the journey, Al-Mi’raj,2 involved an ascension to the Heavens. Along the way, the Prophet met several past Messengers until, now all alone, he received communications from Allah and, according to some accounts, encountered the Divine manifestation.When he returned to Mecca the following morning and recounted his miraculous journey, he met with a familiar range of responses. Abu Bakr Al-Siddiq, who was to become the first Caliph following the Prophet’s death, immediately believed him and never doubted the veracity of his account. Members of the Quraish tribe, a polytheistic tribe then dominant in the Arabian Peninsula and hostile to the Prophet, denounced his account outright, mocking him for its apparent impossibility or accusing him of madness. Others agreed that the Prophet had undergone the experiences he described but reasoned that this was a spiritual journey and not a physical one of literal bodily transportation. Later Christian critics went further by reducing the experience to the manifestations of epilepsy and insanity, or by questioning its Divine origin and attributing it to spirits and satanic entities.It really did matter how the Prophet’s experiences were understood and received: the stakes could not be higher. Here was the Prophet in the 11th year of a mission that called for a renewal of the message of monotheism. If true, this journey to the three holy sites of Islam (Mecca, Medina, Al-Quds) and to the Heavens was further evidence of his Prophethood and one of his miracles. His [End Page 195] critics and his followers had their own answer to the question on everyone’s mind: did the Prophet really undergo these experiences, whether in a spiritual or physical sense, or was it an expression of a pathological disturbance?________The year is 1997 AD. Mike Jackson and Bill Fulford publish a paper entitled Spiritual Experience & Psychopathology. The paper engages the exact question that troubled the Prophet’s critics and allies 1,376 years earlier. The question is now framed as a distinction between spiritual and pathological varieties of psychotic phenomena. And even though the stakes do not rise to the level of Prophethood—we have banished Prophets a long time ago—they are high enough:Spiritual experiences, whether welcome or unwelcome, and whether or not they are psychotic in form, have nothing (directly) to do with medicine.... It would be quite wrong, then, to “treat” spiritual psychotic experiences with neuroleptic drugs, just as it is quite wrong to “treat” political dissidents as though they were ill.(Jackson & Fulford, 1997, p. 42)Jackson and Fulford were not the first to invoke the distinction as a problem to be examined. In modern times, this is usually traced to William James’ Varieties of Religious Experience (1902), where he drew attention to the overlap between religious experiences and psychosis. James, like Jackon and Fulford a century later, noted the phenomenological similarities among these two ‘types’ of experience: voices, visions, an ineffable sense of significance to otherwise mundane events, and the loss of agency to external forces and powers.The 1997 paper stimulated much debate, responses, and rebuttals. In the process, at least four approaches for drawing the distinction have emerged: by appealing to the outcome of the experience; by appealing to theological criteria; by examining the organization of the experience; and by paying attention to the process of meaning-making in its cultural context. On the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:What Can (and Cannot) Be Said About the Distinction Between Religious Experience and PsychopathologyMohammed Abouelleil Rashed, MD, PhDThe distinction between religious experience and psychopathology as a puzzle to be pondered, debated, clarified, and analyzed is an example of a thoroughly modern problem. It is modern in that the distinction can only make sense if our starting assumption is the existence of unique and separate types of experience that might (...) overlap phenomenologically but are ultimately different entities that should be distinguished from each other. And it can only have this sort of sense in a secular worldview where the possibility of a fully areligious type of psychological suffering is on the table and widely accepted. By framing the matter in this way, the debate presupposes, rather than argues for, the existence of unique and separate types of experience. This is a major presupposition, and its coherence cannot be assumed, nor can we ignore the impact of our standpoint in the debate on whether or not we can actually make that distinction let alone resolve it. In the original paper (Rashed, 2024), I deconstruct the distinction by examining what can, and cannot, be said about it given the standpoint that we adopt. In what follows, I respond to Awais Aftab’s and Warren Kinghorn’s thoughtful commentaries on my paper and in the process clarify my thesis further.What We Believe and the limits of What We Can ArgueAwais Aftab (2024) perceptively points out that the way I define the terms renders the distinction between religious experience and psychopathology an instance of the broader distinction between the religious worldview and the scientific worldview. Accordingly, my approach deviates from the usual [End Page 219] approach in these debates, which tend to focus on specific areas of phenomenology (delusion, hallucinations, low mood, etc.). This focus then directs the debate toward distinguishing these states from each other, and not toward asking if there is a distinction that needs to made at all, and, if there is, what the distinction is really about. In order to overcome this potential blind spot, we need to step back and examine our assumptions about the possibility and the nature of the allegedly competing conceptions of religious experience and psychopathology. And to do so, we need to apprehend the distinction in the broadest possible sense, as it is there that we can identify our assumptions about those ‘things’ we are trying to distinguish from each other.The first step in deconstructing this debate is to identify our stance towards the categories of religious experience and mental disorder, and what this stance enables us to say and prohibits us from saying. On an ontological stance, we would be dealing with two distinct categories of experience out there in the world for us to identify, study, and differentiate; there is a truth of the matter as to the origin of the experience, a truth that we can get hold of if we can get to the essence of the respective phenomena. On a constructivist stance, there is no sense to this claim, and what we have are two possible interpretations of experience that cannot be differentiated from each other from a natural or a supernatural standpoint; they do not reflect distinct types of experience, merely the attribution of meaning, which can always go the other way depending on the social situation and the cultural context. And so, our initial stance as to an ontological or constructivist understanding will constrain from the outset what can and cannot be said about the distinction between religious experience and psychopathology. The issue is further complicated by the fact that we can hold a range of positions: we can, at the same time, adopt an ontological view of religious experience and a constructivist view of mental disorder, or vice versa, and in each case we might end up in a different place.For philosophers, theologians, and others writing from a religious standpoint, we can assume that they are adopting an ontological reading of religious experience. In other words, they take it to be true that some experiences have a divine origin, connect the person to non... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Treatise of the Three Impostors and the Problem of Enlightenment: A New Translation of the Traité des trois Imposteurs by Abraham AndersonJan W. WojcikAbraham Anderson. The Treatise of the Three Impostors and the Problem of Enlightenment: A New Translation of the Traité des trois Imposteurs. Lanham, MD: Rowman & Littlefield Publishers, 1997. Pp. xiv + 165. Cloth, $52.50. Paper, $21.95.This work results from a seminar, organized by (...) Richard H. Popkin, sponsored by the Foundation for Intellectual History, and held in Leiden in 1990, in which various [End Page 368] aspects of the history and significance of the Traité de trois Imposteurs were studied. As the title of the work indicates, it contains an English translation of the Traité. It also contains three short essays of commentary (the second of which is a modified version of Anderson’s contribution to the volume of essays which resulted from the Leiden seminar, Heterodoxy, Spinozism and Free Thought in Early Eighteenth Century Europe: Studies on the Traité des trois Imposteurs, edited by S. Berti, F. Charles-Daubert, and R. H. Popkin). There is a select bibliography, but no index.The Treatise consists of a critique of revelation (which is exposed as a fiction of the imagination), along with a discussion of the ways in which claims to revelation made by crafty politicians have enslaved humankind. It also includes scurrilous stories about three of the main alleged impostors: Moses, Jesus, and Mohammed, as well as a more philosophical discussion of God, the soul, and demons.The translation is of Pierre Rétat’s 1973 edition of the 1777 edition of the Traité. This edition was chosen out of a number of virtually identical editions because it is accompanied by three very brief documents related to the Treatise (“Sentiments Concerning the Treatise of the Three Impostors: Extract of a Letter or Dissertation of Mr. de La Monnoye on this Subject,” a “Response to the Dissertation of Mr. de La Monnoye,” and a “Copy of Article IX of the Second Part of the First Volume of the Mémoires de Littérature”). Anderson’s reasons for selecting this edition are sound. The accompanying documents are of interest in their own right; in addition, they are the focus of Anderson’s essays of commentary and are (as he claims) necessary for a proper understanding of the significance of the Treatise. Although earlier English translations exist (1844, reprinted 1846, reprinted 1904) they are either not readily available or are not reliable in that the manuscript original is not readily identifiable. Hence Anderson’s translation is a welcome addition to the literature for those (both specialists and nonspecialists) whose circumstances do not permit a study of the 1777 French edition.The first two essays of commentary concern political issues, as indicated by their inclusion in “Part I: The Politics of the Traité des trois Imposteurs.” In the first, entitled “On a Section of Prosper Marchand’s Private Catalogue,” Anderson refutes the claim made by Margaret C. Jacob in The Radical Enlightenment that a section of Prosper Marchand’s library catalogue shows that Marchand considered the Traité to be in the tradition of Protestant radicalism and republicanism. After a careful analysis of the works listed in this section of the catalogue, Anderson concludes that (with one exception) the books in this section constitute a bibliography of works that “either exemplify the uses of literary study for the defense of orthodoxy or belong to a literary tradition of the cynical study of those uses, or consist in a parody and public exposure of that cynical study” (81). In the second essay, “Sallengre, La Monnoye, and the Traité des trois Imposteurs,” Anderson argues that rather than being a work of radical propaganda, the Traité was part of a satirical campaign against the “conformist libertine intelligentia” (x) of Louis XIV—those who believed that the fact of imposture ought not become public knowledge because they believed that religion ought to serve to enforce the rights of monarchy.“Part 2: Philosophy in the Traité des trois Imposteurs” consists of a single essay, “Descartes the Impostor, Bayle, and the Hidden Origins of Enlightenment.” Here, Anderson explores puzzling aspects of the... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Two Different “Religious Experience vs Psychopathology” DistinctionsAwais Aftab, MD (bio)Mohammed Rashed’s analysis of the distinction between “religious experience” and “psychopathology” challenges the assumptions that underlie traditional efforts to make such a distinction and he arrives at a provocative and memorable conclusion: “The distinction between religious experience and mental disorder can only be invoked from a secular standpoint but can only be clarified from a religious standpoint. In other words: (...) if you have the grounds to invoke it, you cannot have the tools to clarify it; and if you have the tools to clarify it, you do not have the grounds to invoke it” (Rashed, 2024). (For another recent discussion that challenges underlying assumptions of this dichotomy, see Gipps and Clark (2024) on the distinction between religious delusion and religious belief.)There is great merit in Rashed’s analysis, and I am in agreement with many aspects of the discussion. In particular, I admire Rashed’s ability here, as well as elsewhere (Rashed, 2021), to break the impasse of definitional debates by deconstructing and destabilizing the distinctions involved. In this commentary I’d like to note some points of disagreement and qualification that I hope can move Rashed’s analysis forward in a constructive way.The first thing I want to bring up is that Rashed defines religious experience very broadly: “Psychological distress or anomalous experience that has a religious origin, content, or end (purpose).” This effectively turns the distinction between religious experience and psychopathology into an instance of the general distinction between the religious worldview and the secular worldview. “Mental disorder” is understood by Rashed to be an exclusively secular concept. I am not sure this way of framing the dichotomy is entirely correct. If our notion of “religious experience” include any anomalous experiences believed to serve a religious purpose, then Rashed is correct that for the religious no anomalous experience would be excluded. And if “mental disorder” requires giving up on the idea of a divine purpose for our [End Page 211] suffering, then indeed the religious do not have the grounds to invoke it.I’d suggest that a better approach may be to think of two different “religious experience vs psychopathology” distinctions, one within the context of the religious worldview and one within the context of the secular worldview. Both are fuzzy and present demarcation problems of their own; both can be and ought to be destabilized.Rashed recognizes that the religious worldview does make space for illness and disease; it’s just that he says even these concepts are understood within a broader religious view of suffering:the proposal is not that religious traditions have no category of distress that is somatic in nature—of course they do—but that even with those categories, religion is never far off the horizon and will make an appearance at some point, if not in the origin or content of distress, then in terms of its broader purpose and so the recommended interventions.(Rashed, 2024, pp. 201)A vital implication of this is that the distinction between religious experience and a secular view of somatic illness would pose the same problem as the distinction between religious experience and mental illness; the religious would not have grounds to invoke it, for no illness is devoid of religious significance. And yet, the religious do meaningfully talk of “illnesses” and “diseases,” and they do meaningfully talk of “madness” (if not mental illness), and many often do meaningfully differentiate between madness and mysticism. This shows that the religious worldview has its own notions of disease and psychopathology, which differ from their secular counterparts in the sense that suffering involved is imbued with a divine purpose. The religious scholars interested in differentiating between the anomalous nature of the mystical experience and the anomalous nature of madness are interested, in part, in marking out abnormalities of thought and behavior so severe that they come to resemble the effects of somatic illness. Madness is where the internal coherence of the mystical experience breaks down, and becomes an instance of suffering at par with somatic illness.The secular worldview recognizes the phenomenology of religious experience—there is religious or mystical content—but... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Mental Disorder and Religious ExperienceThe Need for a Humble, Pragmatic PluralismWarren Kinghorn, MD (bio)Mohammed Abouelleil Rashed follows Charles Taylor’s argument that in the “therapeutic turn” of modernity, “certain human struggles, questions, issues, difficulties, problems are moved from a moral/spiritual to a therapeutic register,... from a hermeneutic of sin, evil or spiritual misdirection, to one of sickness” (Taylor, 2007, pp. 619–620). While the project of construing mental disorder in naturalistic, (...) non-religious terms carries the risk of subsuming “the rest of life” into the realm of the medical, it is nonetheless needed in order “to protect a region of illness and incapacity from the reach and excesses of the hermeneutic disciplines with their tendency to over-interpretation, and from cultural traditions, including religious discourse, that can implicate the person in narratives of evil, sin, faithlessness, spiritual misdirection, and moral deviance.” Rashed notes, however, that this medical narrative is challenged not only by religious communities but also by various forms of identity-based activism including the Mad Pride and Neurodiversity movements. He argues that strict illness/purpose, deficit/value, mechanism/meaning dichotomies have become “unstable” and encourages scholars to focus their attention on resolving the apparently contradictory realities that people sometimes demand and require medical forms of care while investing significance in the sociocultural and existential context of their distress and refusing reductionistic constructions of their distress as illness.I agree wholeheartedly with Rashed’s conclusion that clinicians and scholars must move beyond a strict mechanism/meaning dichotomy with respect to unwanted and/or disvalued experience and behavior, and must remain open to the social and contextual interpretations that particular cultural communities—including religious communities—offer. But as a psychiatrist who is also [End Page 215] a Christian theological ethicist, I suggest that this sensible conclusion can be reached more straightforwardly by adopting a more flexible approach to “religious experience” and by abandoning the assumptions that mental disorder is “a fully areligious type of suffering” and that religious experience and mental disorder are “fundamentally separate apprehensions of our experience.”Although Rashed never defines religious experience, he posits a distinction between “psychological distress or anomalous experience that has a religious origin, content, or end (purpose)” and “psychological distress or anomalous experience that has no religious origin, content, or end (purpose).” He then helpfully describes how Islamic tradition narrates psychological suffering as deviation from fitrah and as God’s trial, arguing that in Islamic perspective “mental disorder cannot be disentangled from the person’s religious situation and from the religious origin, content, or end (purpose) of his distress.” I make no claim about Rashed’s interpretation of Islam, but would observe that many voices within Christian tradition resist both the equation of psychological suffering with wrongdoing and the assertion that God is the direct cause of psychological suffering (see, for example, John Paul II, 1984). Suffering may instead have to do with being sinned against (as in the case of war, assault, or oppression), or the experience of living in a fallen world that God will one day make right. When the psalmist cries, “Save me, O God, for the waters have come up to my neck” (Psalm 69:1, NRSVue), many Christians observe that it is the psalmist’s enemies, not God, who are the proximate cause of the psalmist’s distress. That is to say, Christian tradition allows for a broad range of interpretations about the cause of distress, including distress resulting from injury, physical illness, and oppression. Christians are encouraged to regard all of their lives as in some way related to God as the creator, sustainer, and orienting end of life—and so in that sense all experience is “religious” in nature. But at least for Christians this does not preclude more naturalistic or sociological interpretations of distress and suffering.Rashed is right that a “fully areligious type of suffering” with “no religious origin, content, or end (purpose)” can only be invoked from a secular standpoint—if “secularity” is taken in Charles Taylor’s first sense of “public spaces... [that] have been allegedly emptied of God, or of any reference to ultimate reality” (Taylor, 2007, p. 2). This is not because... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Editorial changes at PPPWelcomes and ThanksJohn Z. Sadler, MDAfter 30 years of co-editing (with Bill Fulford) and editing Philosophy, Psychiatry, & Psychology, I thought it was time for me to step down, and last fall the Association for the Advancement of Philosophy and Psychiatry Executive Council assembled an international search team to select a new Editor-in-Chief. This thoughtful and efficient group, led by Robyn Bluhm, completed the search and (...) selection in a matter of a few months! All of us in the field are grateful to the search committee members for their congenial, disciplined, and fruitful work: Derek Bolton, David Crepaz-Keay, Anthony Fernandez, Brent Kious, Guilherme Messas, and Michael Wong. We are excited about the future of the journal with our new Editor-in-Chief, Professor Werdie van Staden. Briefly, Werdie is the Nelson Mandela Professor of Philosophy and Psychiatry and Director of the Centre for Ethics and Philosophy of the Health Sciences, the University of Pretoria, South Africa.Students, trainees, and early career scholars in our field often ask about how senior scholars found their way to, and through, the field of philosophy/psychiatry. The reading of Werdie's biography, in chronological order, would befuddle a reader trying to predict where he would end up by 2024. In the youth of his adulthood, Werdie was heading toward a career in music, collecting several degrees in music theory, composition, and performance. Indeed, music would occupy a big piece of his life over the decades. Dr. van Staden has continued his musical career as a composer of two symphonies, a concerto, as well as multiple choral and chamber works. He has performed as a flautist for the Pretoria Symphony Orchestra since 2006, and was the Principal for 8 years.However, he was also an individual directed toward service to his fellow human beings. He completed his MBChB medical degree in 1990 and went on to several degree qualifications in medicine, psychiatry, and philosophy. Most significant for us was his early experience with Bill Fulford's master's degree program in the Philosophy of Mental Health at the University of Warwick, later completing a doctoral degree. His Mandela Professorship at Pretoria was the first endowed Professorship in our philosophy/psychiatry multidisciplinary field. Since then his intellectual work has ranged over clinical and research ethics, philosophy of language and psychopathology, Ubuntu virtue theory, person-centered medicine, medical education, and many more areas, making him a most versatile scholar. Over the past three [End Page 91] decades he has functioned as a practicing clinician, a department chair, a clinical trialist, a partner to Bill Fulford in developing and disseminating the Values-Based Practice approach to clinical medicine, a leader in many professional organizations, an editor of the South African Journal of Psychiatry, not to overlook serving as an author, reviewer, and Senior Editor at PPP at various points since the journal's inception. His professional and intellectual activities and accomplishments are too numerous to recount; suffice to say we are delighted to have him bring his vision, creativity, and vigor to us by adding PPP to his to-do list!We congratulate and thank Professor Nancy Potter on her retirement from academia as well as one of our first Senior Editors of PPP. Nancy's path to philosophy/psychiatry was by way of work in the correctional system in her youth, followed by philosophical field work in the emergency psychiatry department at the University of Louisville Hospital, with her psychiatrist colleague Rafi El-Mallakh, MD. However, philosophy has been her first priority, with work in feminist theory, philosophy of peace, virtue theory, and standpoint/social epistemology over her career. Never satisfied with armchair philosophy, Dr. Potter has immersed herself in settings, traditions, and practices to understand them from inside as well as out. As a PPP Senior Editor, Nancy was instrumental in developing the service-user voice, as well as diversifying our authorship in many other ways. I will miss her even-tempered, yet rigorous editorial voice in the journal.My last appointment of a Senior Editor turned out to be one of Dr. van Staden's students. I welcome Dr. Mohammed Abouelleil Rashed as our newest... (shrink)

In recent years, preimplantation genetic testing (PGT) of IVF embryos have gained much traction in clinical assisted reproduction for preventing various genetic defects, including Down syndrome. However, such genetic tests inevitably reveal the sex of IVF embryos by identifying the sex (X and Y) chromosomes. In many countries with less stringent IVF regulations, information on the sex of embryos that are tested to be genetically normal is readily shared with patients. This would thus present Muslim patients with unintended opportunities for (...) sex selection based on personal or social biases without any pressing need or valid medical reason. Additionally, there are other patients who claim using PGT for preventing genetic defects as a pretext or “convenient excuse,” with a secret intention to do sex selection when it is banned in their home country. Currently, non-medical sex selection is a highly-controversial and hotly debated issue in Islam, because there is generally a strong preference for having sons over daughters due to widespread cultural norms of elderly parents depending on their sons for financial support, as well as the need for male heirs to continue the family lineage within the backdrop of local patriarchal cultures. There is a risk of gender imbalance and social disequilibrium occurring in Islamic societies due to prevalent sex selection. Hence, the question is whether opportunistic sex selection with PGT would contravene Islamic ethics and principles, which will thus be discussed here. (shrink)

The problem of academic dishonesty is as old as it is widespread – dating back millennia and perpetrated by the majority of students. Attempts to promote academic integrity, by comparison, are relatively new and rare – stretching back only a few hundred years and implemented by a small fraction of schools and universities. However, the past decade has seen an increase in efforts among universities to promote academic integrity among students, particularly through the use of online courses or tutorials. Previous (...) research has found this type of instruction to be effective in increasing students’ knowledge of academic integrity and reducing their engagement in academic dishonesty. The present study contributes to this literature with a natural experiment on the effects of the Academic Integrity Course (AIC) at The University of Auckland, which became mandatory for all students in 2015. In 2012, a convenience sample of students (n= 780) had been asked to complete a survey on their perceptions of the University’s academic integrity polices and their engagement in several forms of academic dishonesty over the past year. In 2017, the same procedures and survey were used to collect data from second sample of students (n= 608). After establishing measurement invariance across the two samples on all latent factors, analysis of variance revealed mixed support for the studies hypotheses. Unexpectedly, students who completed the AIC (i.e., the 2017 sample) reported: (1) significantly lower (not higher) levels of understanding, support, and effectiveness with respect to the University’s academic integrity policies; (2) statistically equivalent (not higher) levels of peer disapproval of academic misconduct, and; (3) significantly higher (not lower) levels of peer engagement in academic misconduct. However, results related to participants’ personal engagement in academic misconduct offered partial support for hypotheses – those who completed the AIC reported significantly lower rates of engagement on three of the eight behaviors included in the study. The implications and limitations of these findings are discussed as well as possible future directions for research. (shrink)

Singapore, a highly affluent island city-state located in Southeast Asia, has increasingly leveraged new assisted reproductive technologies (ART) to overcome its dismal fertility rates in recent years. A new frontier in ART is preimplantation genetic testing (PGT) for polygenic risk scores (PRS) to predict complex multifactorial traits in IVF (in vitro fertilisation) embryos, such as type 2 diabetes, cardiovascular diseases and various other characteristics like height, intelligence quotient (IQ), hair and eye colour. Unlike well-known safety risks with human genome editing, (...) there are negligible risks with PGT-P, because there are no man-made genetic modifications that can be transmitted to future generations. Nevertheless, the current efficacy of using PGT-P to select IVF embryos for either increased or decreased probability of developing specific polygenic traits is still far from certain. Hence, the regulatory safeguards proposed here will be based on the assumption that the efficacy of this new technology platform has already been validated. These include: (1) restricting the application of PGT-P only for prevention of clinically relevant polygenic disease traits, (2) securely blocking patients’ access to the raw genomic DNA sequencing data of their IVF embryos, (3) validating diagnosis of polygenic disease traits in the prospective parents/grandparents of IVF embryos, and restricting PGT-P only for preventing specifically diagnosed polygenic disease traits and (4) mandating rigorous and comprehensive genetic counselling for IVF patients considering PGT-P. There is an urgent and dire need to prevent abuse of the PGT-P technique, as well as protect the interests and welfare of patients if its clinical application is to be permitted in the country. (shrink)

According to a widely credited model in the business ethics literature, ethical decisions are a function of two kinds of factors, personal(individual) and situational, and these factors interact with each other. According to a contrary view of decision making that is widely held in some areas of business research, individuals’ decisions about ethical issues (and subsequent actions) are purely a function of their self-interest.The laboratory experiment reported in this paper provides a test of the person-situation interactionist model, using the general (...) theoretical and experimental framework used in the experimental economics literature. One individual and two situational factors relating to moral intensity were examined which may influence decisions to misrepresent information in the course of business activities.The individual and one situational variable were significantly related to participants’ actions. The interactions among individual andsituation variables were not individually significant, although the model including interactions had a much higher level of statistical significance. Gender was significant, both directly and in interaction with moral development, suggesting that it may be worthy of further examination. (shrink)