In light of a history of categorical exclusion, it is critical that pregnant people are included in research to help improve the knowledge base and interventions needed to address public health. Yet the volatile legal landscape around reproductive rights in the United States threatens to undue recent progress made toward the greater inclusion of pregnant people in research. We offer ethical and practical guidance for researchers, sponsors, and institutional review boards to take specific steps to minimize legal risks and ensure (...) the ethical conduct of research with pregnant people in an evolving legal environment. (shrink)

ABSTRACT Controlled human infection (CHI) models have been developed for numerous pathogens in order to better understand disease processes and accelerate drug and vaccine testing. In the past, some researchers conducted highly controversial CHIs with vulnerable populations, including children. Ethical frameworks for CHIs now recommend vulnerable populations be excluded because they cannot consent to high risk research. In this paper we argue that CHI studies span a wide spectrum of benefit and risk, and that some CHI studies may involve minimal (...) risk. The categorical exclusion of children from CHIs therefore departs from the standard approach to evaluating research risks, as international regulations and ethical guidance for pediatric research generally permit non‐beneficial research with low risks. The paradigm in research ethics has also shifted from focusing on protecting vulnerable participants to recognizing that inclusion can be important as a matter of justice, providing new reasons to question this default exclusion of children from CHIs. Recognizing that pediatric CHIs can raise complex ethical issues and are easy to sensationalize in ways that may threaten the public’s trust in research and sponsor institutions, we conclude by describing additional complexities that must be addressed before pediatric CHIs beyond licensed vaccine studies might be ethically acceptable. (shrink)

Bernat argues for a unified brain-based determination of death (UBDD), noting that it “conceptually justifies” death determination both in Donation after Circulatory Determination of Death (DCDD) a...

Citizens in wealthy liberal democracies are typically expected to see to basic needs like food, clothing, and shelter out of their own income, and those without the means to do so usually receive assistance in the form of cash transfers. Things are different with health care. Most liberal societies provide their citizens with health care or health care insurance in kind, either directly from the state or through private insurance companies that are regulated like public utilities. Except perhaps for small (...) co-pays or deductibles, citizens are not expected to see to their health needs out-of-pocket, at least for some basic level of care. Instead, when a citizen gets sick, the state or her insurance company foots the... (shrink)

We show that arbitrary tautologies of Johansson’s minimal propositional logic are provable by “small” polynomial-size dag-like natural deductions in Prawitz’s system for minimal propositional logic. These “small” deductions arise from standard “large” tree-like inputs by horizontal dag-like compression that is obtained by merging distinct nodes labeled with identical formulas occurring in horizontal sections of deductions involved. The underlying geometric idea: if the height, h(∂), and the total number of distinct formulas, ϕ(∂), of a given tree-like deduction ∂ of a minimal (...) tautology ρ are both polynomial in the length of ρ, |ρ|, then the size of the horizontal dag-like compression ∂ᶜ is at most h(∂)×ϕ(∂), and hence polynomial in |ρ|. That minimal tautologies ρ are provable by tree-like natural deductions ∂ with |ρ|-polynomial h(∂) and ϕ(∂) follows via embedding from Hudelmaier’s result that there are analogous sequent calculus deductions of sequent ⇒ρ. The notion of dag-like provability involved is more sophisticated than Prawitz’s tree-like one and its complexity is not clear yet. Our approach nevertheless provides a convergent sequence of NP lower approximations of PSPACE-complete validity of minimal logic. (shrink)

It remains unclear what patient advocacy actually entails and what values it ought to embody. It will be useful to ascertain whether advocacy means supporting any decision the patient makes, or if the advocate can claim to represent the patient by asserting well-intentioned paternalistic claims on the patient's behalf. This is especially significant because the position of advocate brings with it certain privileges on the basis of of presumed insight into patient-perceived interests, namely, entitlement to take part in clinical decision (...) making and increased professional standing. Three issues related to patient advocacy will be explored: are patient advocates necessary; what does advocacy entail, and who ought to represent patients in this way—arguments for and against prospective candidates will also be covered. The paper considers whether advocates are necessary since not only can they be dangerously paternalistic, but the salutary values advocacy embodies are already part of good professional health care. (shrink)

Concussion is a common, serious injury in youth ice hockey, affecting up to 25% of players per season by one estimate. • Bodychecking is a major cause of injury and concussion in hockey, yet some Canadian provinces allow players as young as nine years to engage in bodychecking. • Reducing rates of concussion requires eliminating bodychecking for all except elite hockey players aged 16 years and older, as per the recommendations of the Canadian Academy of Sports and Exercise Medicine.

The topic of time is central to Levinas's philosophy. By examining aspects of the Biblical stories of Abraham and Moses compared with Greek myths, mainly that of Cronos devouring his children, this paper aims to show that Levinas's view of time, though certainly indebted to the Greek (i.e. philosophical) tradition, contains traces of Biblical experiences. Moreover, Levinas's interpretation of time will serve as a concrete demonstration of the way the Jewish experience enables Levinas to express his criticism of the philosophical-Greek (...) tradition. (shrink)

Prominent thinkers such as Jurgen Habermas and Michael Sandel are warning that biomedical enhancements will undermine fundamental political values. Yet whether biomedical enhancements will undermine such values depends on how biomedical enhancements will function, how they will be administered and to whom. Since only few enhancements are obtainable, it is difficult to tell whether these predictions are sound. Nevertheless, such warnings are extremely valuable. As a society we must, at the very least, be aware of developments that could have harmful (...) consequences. Indeed, if important values were to be jeopardized, we should take appropriate measures to protect them. This paper focuses on four central values: solidarity, personal responsibility, equality and autonomy. It delineates the conditions under which biomedical enhancements would undermine these values. It also details the circumstances under which these values would be unaffected by enhancements as well as those under which they would be promoted. Specifying these conditions is valuable; it would enable society to prepare appropriate ethical guidelines and policy responses in advance. (shrink)

The practice of covertly administering medications to patients without their consent is often discussed in the framework of legal questions around the right of patients to consent and refuse medical treatment. However, this practice also raises significant questions surrounding the professional duties and obligations of health care professionals as it relates to the decision-making process of whether to engage in the covert administration of medications. In this paper, I present an overview of the origin of those duties and obligations, and (...) discuss how those duties and obligations when seen from different perspectives may either justify or prohibit the practice. Further, I discuss whether the duties and obligations of health care professionals as they are currently framed are suited to address the complexities of this issue both from the health care professional and patient perspectives. This analysis is conducted in the context of duties and obligations that arise from not only legal framework but also from the ethical requirements from professional codes of ethics. (shrink)

South Africa has the highest rate of foetal alcohol syndrome (FAS) in the world. The problem of alcohol abuse in pregnancy has very deep historical roots that are intertwined with the injustices of both apartheid and pre-apartheid colonialism. Much of the research that is being done in these communities is focused on identifying the epidemiological variables associated with these patterns of alcohol abuse. The underlying reasons as to why these patterns continue seem to remain largely obscured from view. In this (...) article, I apply the theory proposed by Powers and Faden of social justice as a ‘moral foundation for public health and health policy’ to the problem of FAS in South Africa. The objective of this application is two-fold: first, to critically explore the additional insights and alternative perspectives to the problem of FAS that this approach may provide and second, to assess the utility of the theory when applied directly to a specific public health problem. I conclude by noting that although this approach could result in the kind of ‘public health scope creep’ that has been criticized by various authors, it does provide fresh insights to the problem of FAS in South Africa. (shrink)

À plusieurs reprises, Heidegger a présenté sa pensée comme inachevée et seulement préparatoire. Comme le signale l'exergue même de la Gesamtausgabe - "Des chemins, pas des oeuvres", il s'agit d'un cheminement et non pas d'une oeuvre aboutie. Or, Heidegger nous invite, semble-t-il, bel et bien par là, à essayer de prolonger sa démarche et finalement à tenter de le comprendre mieux qu'il ne s'est compris lui-même. Ce bref essai, qui s'efforce de mettre en relation sa pensée, non seulement avec celle (...) de Kant, mais aussi avec celles de Bataille et de Lacan, afin que les unes soient éclairées par les autres, tente d'accomplir, précisément, cette démarche périlleuse qui consiste à essayer de comprendre la philosophie heideggérienne en dépassant sa lettre et en montrant qu'on peut ainsi parfois la "traduire" dans un autre langage que le sien (ce qui permettrait d'en finir avec le "jargon heideggérien"). Ainsi éclairée par cette intersection entre sa propre démarche et celles des trois auteurs convoqués dans cet essai, la pensée heideggérienne permettra alors de comprendre, de manière renouvelée et novatrice, le sens ontologique secret de l'existence humaine en tant qu'elle a affaire avec ce que Lacan a nommé la jouissance comme ouverture à la "Chose". Par là, on le verra, la signification de notre histoire occidentale, qui débouche sur le règne de la technique planétaire, apparaîtra sous un jour tout à fait nouveau."--Page 4 of cover. (shrink)

Nikolai Fedorovich Fedorov is one of the most original and as yet inadequately studied Russian thinkers. Neither a professional philosopher, nor a well-known scholar, nor a critical essayist, he led a kind of double existence while working as an ordinary civil servant, developing his original philosophy at his leisure in the hours free from his intensive daily work. Fedorov's life was one of selflessness and self-denial, not at all eventful outwardly. He graduated from the Gymnasium in Tambov and completed three (...) years of study in the Law Department of the Richelieu Lyceum in Odessa, after which he taught for a number of years in the Borovsk, Lipetsk, Podol'sk, and other regional schools. The quarter century he spent working in the Library of the Rumiantsev Museum in Moscow was the most stable period in Fedorov's life. Fedorov's ideas attracted the attention of outstanding cultural figures. F.M. Dostoevskii became acquainted with them in 1878 through Peterson, and on March 24 of that year he wrote: "I am essentially in full accord with these ideas. I read them as if they were my own." L.N. Tolstoy, who knew Fedorov personally, said, "I am proud to be living in the same times as such a man." V.S. Solov'ev, who also associated with Fedorov, wrote to him as follows in the mid-1880s: "Your ‘project’ is the human spirit's first advance along the path of Christ since the advent of Christianity. As for me, I can only acknowledge you as my teacher and spiritual father." A.M. Gorky was especially impressed by the activism in Fedorov's views. But none of this precludes the many and very essential divergences of these authors from Fedorov. One can find some links with his ideas in A.N. Belyi, V. Ia. Briusov, N.A. Zabolotskii, V.V. Maiakovskii, A.P. Platonov, M.M. Prishvin, I.L. Sel'vinskii, O.D. Forsh, and V.N. Khlebnikov. The artist B.N. Chekrygin drafted a large fresco entitled The Resurrection of the Dead [Voskreshenie mertvykh] and a philosophical work entitled The Synod of the Resurrecting Museum [Sobor voskreshaiushchego muzeia], both inspired by Fedorov's teachings. (shrink)

Recalcitrant disputes among health care providers and patients or their families may signal deep cultural differences about what interventions are needed or about clinicians’s professional duties. These issues arose in relation to a mother’s request for hymenoplasty or revirgination for her minor daughter to enable an overseas, forced marriage and protect her from an honor killing. The American College of Obstetrics and Gynecology committee recommends against members performing a hymenoplasty or other female genital cosmetic surgeries due to a lack of (...) data concerning their safety and efficacy. A key issue in such cases is how to determine what is in the minor’s best interest and the scope of health care moral or professional’s duties. The Best Interests Standard can serve as a powerful moral tool for resolving cross-cultural disputes and identifying needed policy. (shrink)

Some of the problems associated with the construction of a manifestly covariant relativistic quantum theory are discussed. A resolution of this problem is given in terms of the off mass shell classical and quantum mechanics of Stueckelberg, Horwitz and Piron. This theory contains many questions of interpretation, reaching deeply into the notions of time, localizability and causality. A proper generalization of the Maxwell theory of electromagnetic interaction, required for the well-posed formulation of dynamical problems of systems with electromagnetic interaction is (...) discussed, and some of the significance of recently found (classical) relativistic chaotic behavior is pointed out. Many results of a technical nature have been achieved in this framework; in this paper, some of these are reviewed, but I shall concentrate on a discussion of the basic ideas and foundations of the theory. (shrink)

A leaf falls to the ground, wafting lazily on the afternoon breeze. Clouds move across the sky, and birds sing. Are these events governed by universal laws of nature, laws that apply everywhere without exception, subsuming events such as the falling of the leaf, the movement of the clouds and the singing of the birds? Are such laws part of a small set of fundamental laws, or descended from such a set, which govern everything there is in the world?

A linguistic barrier between healthcare professional and patient is a challenging experience for both parties. In many cases, the absence of formally trained medical interpreters necessitates that an informal interpreter, drawn from the immediate environment, be used to facilitate communication. While the presence of an interpreter in a medical interview raises many questions about the effectiveness of the communication between healthcare professional and patient, it also gives rise to new speculations revolving on patient rights, medical ethics and patient privacy. In (...) this article we examine the concept of communication competency in medical interviews, as well as translation theory, and link these theories to Western medical ethics in order to identify potential areas in which informal interpretation could impact on the patient. (shrink)

After discussing the interests that ground the right to democratic political participation, arguments for the disenfranchisement of those who commit serious criminal offenses are examined. The arguments are divided into two groups. The first group consists of arguments that are relatively independent of the justifying aims of punishment. It is conceded that two of these arguments establish that some, though by no means all, serious offenders should lose the vote for a period of time that does not necessarily overlap with (...) the duration of the other sanctions visited upon them. These arguments also imply that the state is justified in attempting to exclude the offenders in question from all forms of political participation, a position that arguably runs afoul of moral limits on punishment. The second group of arguments makes explicit reference to the justifying aims of punishment. None supports the blanket disenfranchisement of felons, though some may justify it in relation to some serious offenders for certain periods of time. All of the arguments supporting the disenfranchisement of serious offenders are most persuasive on the assumption that they live in reasonably just societies that are genuinely democratic. If that assumption is false or questionable, then it is argued that the force of such arguments may be weakened considerably. (shrink)

Study of the social determinants of consciousness is one of the more timely problems of contemporary philosophy. It requires a complex study of various factors determining the social nature of human consciousness and the cultural-historical mediation of humankind's reflection of the world. Esthetics, which studies the phenomenon of esthetic consciousness, has a place among these scientific disciplines.

The 2005 Report on Social Responsibility and Health of the UNESCO International Bioethics Committee (Ibc) proposes a new approach to implementing the right to healthcare and suggests a number of Courses of Action to be followed in various fields. Based on the latest available data, we intend to present an overview of the current state of European health systems in two of those fields—decision-making procedures and quality assurance in health care—and to attempt a comparison of the situation with the Report’s (...) provisions, in order to pave the way for the identification of what still has to be done to bridge international recommendations and the reality of policy and practice in Europe’s health care. (shrink)

Up till now, China has not enacted any legal mechanisms governing certification or supervision for ethics committees. This article analyses deficiencies in the protection of subjects in clinical drug trials under China’s current laws and regulations; it emphasizes that investigators, as practitioners who have direct contact with subjects, play significant roles in protecting and safeguarding subjects’ rights and interests. The paper compares the status quo in China in this area to that of other countries and discusses ways China might enhance (...) the protection of rights and interests of trial subjects, such as enhancing the ethical awareness of investigators through training, improving laws and regulations, and strengthening the communication between investigators and ethics committees. (shrink)

In an era of rapidly rising health care costs, physicians and policymakers are searching for new and effective ways to contain health care spending without sacrificing the quality of services provided. These proposals are increasingly articulated in terms of an ethical duty of stewardship. The duty of stewardship in medicine, however, is not at present well understood, and it is frequently conflated with other duties. This article presents a critical analysis of the notion of stewardship, which shows that it has (...) an important and distinctive place in medical ethics. It claims that stewardship in medicine concerns the responsible use of a society’s medical resources and it discusses the extent to which medical professionals are the proper stewards of these resources. The article argues that the duty of stewardship is best understood as a duty that applies in a space between the obligations of health care providers to provide beneficent care to their patients on the one hand and the obligations of citizens to bring about and support a just health care system on the other. Seen with clear eyes, stewardship in medicine is neither a consequence of beneficent medical care nor a substitute for justice. (shrink)