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...

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.

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)

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)

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)

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)

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 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)

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)

This collection of articles pays homage to the creativity and scientific rigor Jerome Singer has brought to the study of consciousness and play. It will interest personality, social, clinical and developmental psychologists alike.

Biography of Habermas -- Critical theory -- Habermas and his works -- An assessment of the impact of Habermas -- Conclusion.

I. Singminji sigi p'yŏn -- II. Chŏnhwan'gi ŭi iron oe.

The phenomenon whereby severely disabled persons self-report a higher than expected level of subjective well-being is called the “disability paradox.” One explanation for the paradox among brain injury survivors is “response shift,” an adjustment of one’s values, expectations, and perspective in the aftermath of a life-altering, disabling injury. The high level of subjective well-being appears paradoxical when viewed from the perspective of the non-disabled, who presume that those with severe disabilities experience a quality of life so poor that it might (...) make their lives not worth living. This presumption has profound consequences, for it may inform end-of-life choices made in advance directives, or influence decisions made by surrogates on behalf of persons who are unable to direct their own medical treatment. -/- Peterson et al propose a cautious, well-considered plan to use fMRI-based brain-computer interfaces to assess the decision making capacity of covertly aware, behaviorally non-responsive individuals who retain high levels of preserved cognition. Their plan, if it succeeds, could eventually restore autonomy and empower some severely disabled persons, allowing them to participate in clinical decision making. Peterson et al discuss possible in-principle objections to their proposal, among them the “argument from psychological health,” and the “changing sets of values” objection. These objections both presume that deviations from a pre-injury norm could indicate diminished decision making capacity. This presumption threatens the autonomy of the patient who is capable of making decisions, but whose post-injury decisions appear to diverge from pre-injury preferences or values. In light of the potential for response shift, and the disability paradox, it should not be inferred that changes in values or preferences are unreflective of the true current preferences of a brain-injured person, nor are they conclusive evidence of diminished capacity. Presuming diminished capacity on the basis of unexpected or unconventional preferences has, in the past, been used to disempower patients whose autonomy and capacity would not have been doubted had they made choices that accorded with the expectations or values of others. We must be cautious, and vigilant, to prevent similarly diminishing the autonomy of covertly aware, behaviorally non-responsive individuals on the basis of empirically and ethically questionable inferences about their decision making capacity. (shrink)

This chapter contains section titled: Rights and Goals Rules, Rights, and Utility Rights and Liberty.

Yūsuf al-Ardabīlī is one of the Shāfiʿī jurists who lived in Azerbaijan in the 8th century of Hijri. This scholar, whose birth date we couldn’t find any information about, even though it has been searched in both local and foreign literature, died in Ardabīl in the year 799/1397 as bibliographical scholars agreed on. Ardabīlī is a person known by his work al-Anwār li-aʿmāl al-abrār, which he dedicated to Shāfiʿī jurisprudence, and someone with jurisprudential knowledge whom Shāfiʿī jurists benefit from. In (...) his work on jurisprudence (furūʿ al-fiqh), al-Anwār, he discussed the issues without delving deeply into evidences and partially mentioned uṣūl al-fiqh. Yūsuf al-Ardabīlī addressed the topics in his work by classifying them as acts of worship (ʿibādāt), transactions (muʿāmalāt), inheritance (farāʾiḍ), marriage and divorce (munākaḥāt-mufāraqāt), punishments (ʿuqūbāt), the conduct of judges (adab al-qāḍī), and freeing slaves (ʿitq). Moreover, in his work, he provides explanations that shed light on recent studies by addressing the subject of fatwā in detail. By addressing the fatwā institutions, Ardabīlī includes information on topics like the etiquette of istiftāʾ, fatwā with sharīʿah tricks (ḥiyal sharʿiyyah), and exceptions in divorce (ṭalāq). Because no academic studies have been done on his explanations in this field, the subject requires further attention. Additionally, presenting his explanations on the fatwā institution to the scholarly community is greatly important for shedding light on future studies. Islamic jurists recognize fatwā activities as a duty that requires responsibility in terms of religion and worldly life. Therefore, they do not favor the participation of those who lack knowledge and the capability of deducing religious rulings from sharīʿah evidences in fatwā activities.This study aims to contribute to the Islamic jurisprudence literature by addressing the principles of fatwā procedure through Ardabīlī’s perspective in his work, al-Anwār. (shrink)