Objective The study evaluated patient informed consent (IC) for the Quad screen and examined differences in IC between test acceptors and test refusers. A multidimensional model of IC was used. Methods Women seeking prenatal care at nine obstetrics clinics in a large Midwestern city completed surveys between February and December 2006. Surveys contained measures for three dimensions of IC: intention, understanding and controlling influence. Results 56.2% of women did not meet criteria for all three of our dimensions of IC and (...) therefore failed to give it. The failure rate was higher among women who choose to screen (72.6%) than women who choose not screen (50%) (p < 0.001). Women who met all criteria for IC were over three times less likley to choose to screen (or = 0.32, CI 0.17–0.62 ( p < 0.01)) than women who did not meet criteria for IC. Conclusion The decision to screen for fetal anomalies is less of a deliberated action than the decision not to screen. Women who lack a fundamental understanding of the purpose and nature of the screen may be operating on the belief that the screen is part of standard care and presents no need to deliberate. (shrink)

Psychiatric disorders present distinct clinical challenges which are partly attributable to their multifactorial aetiology and the absence of laboratory tests that can be used to confirm diagnosis or predict risk. Psychiatric disorders are highly heritable, but also polygenic, with genetic risk conferred by interactions between thousands of variants of small effect that can be summarized in a polygenic risk score. We discuss four areas in which the use of polygenic risk scores in psychiatric research and clinical contexts could have ethical (...) implications. First, there is concern that clinical use of polygenic risk scores may exacerbate existing health inequities. Second, research findings regarding polygenic risk could be misinterpreted in stigmatising or discriminatory ways. Third, there are concerns associated with testing minors as well as eugenics concerns elicited by prenatal polygenic risk testing. Fourth, potential challenges that could arise with the feedback and interpretation of high polygenic risk for a psychiatric disorder would require consideration. While there would be extensive overlap with the challenges of feeding back genetic findings in general, the potential clinical use of polygenic risk scoring warrants discussion in its own right, given the recency of this possibility. To this end, we discuss how lay interpretations of risk and genetic information could intersect. Consideration of these factors would be necessary for ensuring effective and constructive communication and interpretation of polygenic risk information which, in turn, could have implications for the uptake of any therapeutic recommendations. Recent advances in polygenic risk scoring have major implications for its clinical potential, however, care should be taken to ensure that communication of polygenic risk does not feed into problematic assumptions regarding mental disorders or support reductive interpretations. (shrink)

Seeking consent for genetic and genomic research can be challenging, particularly in populations with low literacy levels, and in emergency situations. All of these factors were relevant to the MalariaGEN study of genetic factors influencing immune responses to malaria in northern rural Ghana. This study sought to identify issues arising in practice during the enrolment of paediatric cases with severe malaria and matched healthy controls into the MalariaGEN study.

Archaeological discoveries, unless of unusual beauty, are generally of less inherent interest than the conclusions to which they point. Not that they are merely evidence in the court-room sense of the word; they certainly spur the imagination, and provide tangible links with those vast, unknown areas of human knowledge which scholarship seeks to restore to us. The public interest in recovered documents of the past, however, seems mainly in the discovery of the objects themselves rather than in the interpretation of (...) those objects. It is as if proving there was a past at a given date is of more interest than the life which made up that past.It is evident, for example, that public interest in the Dead Sea Scrolls is fading, now that publication of some of the new texts contained in them allows a preliminary assessment of their significance. Contact with the minds of men who composed them seems to be of lesser moment to many than the physical existence of manuscripts written and made use of two thousand years ago. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.4 (2005) 301-305 [Access article in PDF] The Beauty of Psychotherapy R. D. Hinshelwood Keywords awe, psychotherapy, representation, self-esteem The Enlightenment was devoted to clear uncontaminated reason; its success has given us the terrific achievements of science and technology. However, it has bequeathed problems too. Untrammeled reason has led to the devaluing and exclusion of emotions. Emotions are irrational—self-deception, akrasia, and so on. They were (...) a problem for the eighteenth-century philosopher Kant and right through to the modern therapist Aaron Beck. Callender rightly looks around the edges of rationalist thought to see what can be said about the emotional and subjective side of mankind. He argues that there is more to the human mind than cognition. Something has been left out. What can be found to fill the gap?Callender has searched for the missing link that might complete our view of human nature. And he came back with aesthetics. Meaning The Enlightenment failing is writ large for therapists who are confronted with people who feel things. So we need to ask what place the emotions have in understanding the nature of man? It is not a hypothetical question, but a very practical one for a therapist. Emotions, Callender says, and most people would agree with him, are what gives meaning to life, a sense of purpose in living, even an ill-defined or delusional purpose.He presents Kant's description of aesthetics. Aesthetic judgements have a number of features, the most enigmatic and perhaps profound is a "purposiveness without purpose." A work of art, say a portrait, may have a purpose insofar as it represents a person for his aggrandizement or for his descendents through many generations, but the aesthetic quality does not come from that purpose. The aesthetic purpose involves a different set of judgements. They are about the painting as a piece of art in itself. If it is possible to compare this kind of aesthetic judgement with a judgement of a person's life, then I find myself reminded of Wollheim's definition of a person: The simplest way of putting the matter, which is not to be taken as a metaphysical claim, is this: There are persons, they exist; persons lead lives; and as a result, in consequence—in consequence that is, of the way they do it—there are lives, of which those who lead them may, for instance, be proud, or feel ashamed. So there is a thing, and there is a process, and there is a product. (Wollheim 1984, 2) Although many things do not lead lives, we do. And our lives have a process and a product. Like an aesthetic product, our lives have a sense of emotional meaning, without it having a clear purpose.Aesthetic judgements are therefore of a particular and somewhat peculiar kind. They judges talent for producing "that for which no determinate [End Page 301] rules can be given," as the paper quotes Kant. Other kinds of judgements do have determinate rules. First are empirical judgements for getting practical things done; and moral judgements for assessing ethical good from bad. Aesthetic beauty does not have clear rules, although many systems of rules have been proposed starting with the rules of perspective as they were laid out by renaissance painters, through to systems of color, such as that proposed by Paul Klee, once color was correlated with electromagnetic wavelengths. However, artists have always kept one jump ahead and evaded imprisonment in codified rules. So too it is with leading a life, perhaps. The really creative life is not lead according to rules. The art of life is to live meaningfully without simply running along tramlines. Although moral conduct and the practicalities of life remain significant, perhaps leading a life implies simply a "flare for living." Representation Of these three kinds of judgements that a mind makes, two do have sets of rules. Only one based on rationality, empirical evidence, and reason. Reason judges what can be done and achieved in the real physical world. It is about pragmatics and the usefulness of action. Moral judgements, about what... (shrink)

Interest in the retrieval of organs from non-heart-beating cadaver donors has been rekindled by the success of transplantation of solid organs and the insufficient supply of donor organs currently obtained from heart-beating cadaver donors. There are currently two retrieval techniques being evaluated, the in situ cold perfusion approach and the controlled death approach. Both, however, raise ethical concerns. Reanimation is a new method which has been used successfully in animals. We believe this new approach overcomes the ethical objections raised to (...) these other methods. (shrink)

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Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith (...) traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured. (shrink)

This paper first appeared in Modern Theology, Vol. 6, No. 3, July 1989. Copyright (c) Basil Blackwell Publisher Ltd., Oxford. Reprinted by permission.

Hicks' edition of the De Anima contains valuable commentary from Hicks as well as useful summaries of the views of earlier commentators.