The World Health Organisation recently listed air pollution as the most significant threat to human health. Air pollution comprises particulate matter (PM), metals, black carbon and gases such as ozone (O3), nitrogen dioxide (NO2) and carbon monoxide (CO). In addition to respiratory and cardiovascular disease, PM exposure is linked with increased risk of neurodegeneration as well as neurodevelopmental impairments. Critically, studies suggest that PM crosses the placenta, making direct in utero exposure a reality. Rodent models reveal that neuroinflammation, neurotransmitter imbalance (...) and oxidative stress are triggered following gestational/early life exposure to PM, and may be exacerbated by concomitant mitochondrial dysfunction. Gestational PM exposure (potentiated by mitochondrial impairment in the metabolically active neonatal brain) not only impacts neurodevelopment but may sensitise the brain to subsequent cognitive impairment. Having reviewed this field, we conclude that strategies are urgently required to reduce exposure to PM during this sensitive developmental period. (shrink)

The moral/conventional task has been widely used to study the emergence of moral understanding in children and to explore the deficits in moral understanding in clinical populations. Previous studies have indicated that moral transgressions, particularly those in which a victim is harmed, evoke a signature pattern of responses in the moral/conventional task: they are judged to be serious, generalizable and not authority dependent. Moreover, this signature pattern is held to be pan‐cultural and to emerge early in development. However, almost all (...) the evidence for these claims comes from studies using harmful transgressions of the sort that primary school children might commit in the schoolyard. In a study conducted on the Internet, we used a much wider range of harm transgressions, and found that they do not evoke the signature pattern of responses found in studies using only schoolyard transgressions. Paralleling other recent work, our study provides preliminary grounds for skepticism regarding many conclusions drawn from earlier research using the moral/conventional task. (shrink)

The recently proposed Cognitive Experiential Leadership Model (CELM) states that leaders’ preference for rational thinking and behavioral coping will be related to their level of transformational leadership. The CELM was based on research that principally used cross-sectional self-report methods. Study 1 compared both self-ratings and follower-ratings of leadership styles with leaders’ self-rated thinking styles in 160 leader-follower dyads. Study 2 compared both self-ratings and coworker-ratings of leadership styles with leaders’ self-rated thinking styles for 74 leaders rated by 607 coworkers. In (...) both Studies, leaders’ rational thinking, imaginative thinking, and behavioral coping correlated positively with their self-rated transformational leadership. However, only behavioral coping, but not rational thinking, was correlated with follower-rated (FR) transformational leadership in Study 1, and thinking styles were unrelated to other-rated transformational leadership in Study 2. These results partly support and partly challenge the CELM. Practically, this study suggests that leadership may be improved by leaders developing their capacity for behavioral coping. (shrink)

Throughout the developing world, it is a well-documented fact that women farmers tend to get lower yields than their male counterparts. Typically this is attributed to disproportionate access to high-quality inputs and labor, with some even arguing there could be a skills-gap stemming from unbalanced access to training and education. This article examines the gender-based yield gap in the context of Zambian maize producers. In addition to the usual drivers, we argue that Zambia’s patriarchal and multi-tiered land distribution system could (...) disfavor women with respect to accessing quality soils. We are uniquely able to control for soil characteristics using farm data from a sample of 1573 fields with accompanying soil analysis. We find an expected difference in yields, but no evidence of a gap in unobserved characteristics, like skill, after controlling for access to inputs, especially quality soil, suggesting women are indeed disproportionately disadvantaged. We discuss how our findings could be used to develop self-targeting policy interventions that could empower women and would be consistent with the government’s stated equity goals. (shrink)

The ability to resist distracting stimuli whilst voluntarily focusing on a task is fundamental to our everyday cognitive functioning. Here, we investigated how this ability develops, and thereafter declines, across the lifespan using a single task/experiment. Young children (5–7 years), older children (10–11 years), young adults (20–27 years), and older adults (62–86 years) were presented with complex visual scenes. Endogenous (voluntary) attention was engaged by having the participants search for a visual target presented on either the left or right side (...) of the display. The onset of the visual scenes was preceded – at stimulus onset asynchronies (SOAs) of 50, 200, or 500 ms – by a task-irrelevant sound (an exogenous crossmodal spatial distractor) delivered either on the same or opposite side as the visual target, or simultaneously on both sides (cued, uncued, or neutral trials, respectively). Age-related differences were revealed, especially in the extreme age-groups, which showed a greater impact of crossmodal spatial distractors. Young children were highly susceptible to exogenous spatial distraction at the shortest SOA (50 ms), whereas older adults were distracted at all SOAs, showing significant exogenous capture effects during the visual search task. By contrast, older children and young adults' search performance was not significantly affected by crossmodal spatial distraction. Overall, these findings present a detailed picture of the developmental trajectory of endogenous resistance to crossmodal spatial distraction from childhood to old age and demonstrate a different efficiency in coping with distraction across the four age-groups studied. (shrink)

I will take a famous paragraph from J S. Mill as a starting point for defending the idea that moral philosophy has to take charge definitively of those who have been less fortunate in the natural lottery. This means that we must to take seriously the possibility of increasing the capacity for the well-being of nonhuman animals. The aim of the text is to show the relevance of the current ethical debate on enhancement also in the context of reflection on (...) our obligations towards sensitive non-human animals. (shrink)

Individuals with Down syndrome (DS) are widely believed to possess considerable socialization strengths. However, the findings on social cognition capabilities are controversial. In the present study, we investigated whether individuals with DS exhibit shortage in face tuning, one of the indispensable components of social cognition. For this purpose, we implemented a recently developed Face-n-Food paradigm with food-plate images composed of food ingredients such as fruits and vegetables. The key benefit of such ‘face like non-face’ images is that single elements do (...) not facilitate face processing. In a spontaneous recognition task, 25 children with DS aged 9 to 18 years were presented with a set of Face-n-Food images bordering on the Giuseppe Arcimboldo style. The set of images was administered in a predetermined order from the least to most resembling a face. In DS individuals, thresholds for recognition of the Face-n-Food images as a face were drastically higher as compared not only with typically developing controls, but also with individuals with autistic spectrum disorders and Williams-Beuren syndrome. This outcome represents a significant step towards better conceptualization of visual social world in DS and neurodevelopmental disorders in general. (shrink)

This paper completes an argument that the problem of moral distress offers philosophical counselors an opportunity to do work that is both socially useful and philosophically interesting in its own right. A previous Philosophical Practice article answered the question, What's Philosophical About Moral Distress? by conceptualizing it as a phenomenon that arises within a moral worldview (Matchett 2018). The present paper investigates ways in which a philosophical counseling response to moral distress might differ from the strategies deployed by the nursing (...) profession to date. Though they are often quite subtle, the presence of some differences opens the possibility that philosophical counseling might be more effective than those strategies; in addition to helping individual nurses feel better, this could strengthen the nursing profession's efforts to mitigate nursing shortages and enhance quality of patient care. Though case studies are necessary to support these claims, there are reasons to think they are warranted. (shrink)

An introduction to vision counseling - the principles, method, and strategies of helping clients develop their rational and supra-rational tendencies.

Survival after solid-organ transplantation has improved significantly, and many contemporary transplant recipients are of childbearing potential. There are limited data to guide decision-making surrounding pregnancy after transplantation, variations in clinical practice, and significant knowledge gaps, all of which raise significant ethical issues. Post-transplant pregnancy is associated with an increased risk of maternal and fetal complications. Shared decision-making is a central aspect of patient counselling but is complicated by significant knowledge gaps. Stakeholder interests can be in conflict; exploring these tensions can (...) help patients to evaluate their options and inform their deliberations. We argue that uniform, evidence-based recommendations for pregnancy after solid organ transplantation are needed. Conducting research, including patient-engaged studies, in this area should be priority for the transplant community. (shrink)

There is currently a movement advocating “philosophical counseling.” My own development as a philosopher, then a human services professional, then a psychoanalyst, charts how I came to believe that philosophical training was underrated, and training in psychology was overrated, as an appropriate intellectual foundation for psychotherapy. However, these fields are not distinct. Laws governing the practice of psychology are arrogant in their scope, and make virtually everything out to be the practice of psychology. The scope and nature of philosophy isn’t (...) any clearer. The kind of thinking encouraged in psychology is liable to be exactly the wrong sort of thing for training therapists. Unfortunately, philosophers are liable to not be good therapists either. The lack of neat distinctions between philosophical counseling and psychotherapy provides an argument against a monopoly on therapy-like activities by psychologists. On the liberal side this is an argument in favor of freedom of speech, of belief, and trade, for the applied philosopher. On the conservative side, it may also be an argument for certification (as opposed to licensure) for both psychologists and philosophers, in the interest of protecting the vulnerable by promoting truthful self-representation. (shrink)

The book is structured as a dialogue between the American intellectual William James and one of his famous students (Gertrude Stein, Theodore Roosevelt, W.E.B. Du Bois, etc.) discussing a topic.

This commentary shows how philosophical counseling offers an alternative way for consultants to facilitate "closure" in bioethical disputes.

During an Australian qualitative and empirical study looking at lesbian, gay, bisexual, and transgender client's experiences of counseling, and counselor's experiences of working with minority clients, a large body of unsolicited data emerged related to experiences of religious-based homophobia. Analysis of the data suggests that a lifelong process of posttraumatic recovery for many lesbian, gay, bisexual, and transgender people follows prior experiences of religious-based homophobia. This paper discusses the sociological debate related to how counselors find themselves at the crossroad between (...) a healthy lifestyle model of homosexuality based in well established contemporary professional ethics versus long standing religious-based attitudes and constraints toward homosexuality. This intersection of conflicting beliefs generates a controversial social and political environment in which counselors must make a basic decision to either support minority clients according to ethical guidelines or to side with socially conservative constructs that, rightly or wrongly, rely largely on Western religious traditions. (shrink)

Background In the early 2010s, a phenomenon known as do-it-yourself (DIY) fecal microbiota transplant (FMT) emerged as lay individuals began self-administering FMTs at home. Although prior research indicates that many individuals who perform DIY FMT have sought advice from healthcare providers, to date there has been no investigation of physicians’ experiences with DIY FMT. The objective of this qualitative study was to examine the attitudes of physicians who offer FMT regarding the practice of DIY FMT and to assess how they (...) navigated the ethical challenges of patient requests for DIY FMT.Methods We recruited physicians listed on two patient-created online databases of FMT providers. All physicians who indicated having been approached for advice about DIY FMT were included in the study. Semi-structured interviews with physicians explored their attitudes toward and experiences with DIY FMT.Results Of 18 physicians interviewed, one reported having provided counsel in response to an initial patient inquiry about DIY FMT, 2 indicated they explicitly advised against DIY FMT and refused to provide advice, and 15 fell in a middle category of discouraging DIY FMT and discussing reasons why. Among the physicians in this third category, four reported that they had changed their approach to providing counsel in response to a patient telling them they were going to perform DIY FMT anyway.Conclusions Physicians in our study employed a wide range of strategies for promoting safety in the DIY FMT context, from explicitly advising against the procedure to the provision of guidance aimed at mitigating potential harms. While there has been increasing attention to the practices of DIY medicine, this study underscores the need for greater attention to the ethically complex situations that physicians face when patients request guidance for unapproved at-home treatments. (shrink)

Advances in genetic research have created the need to inform consumers. Yet, the communication of hereditary risk and of the options for how to deal with it is a difficult task. Due to the abstract nature of genetics, people tend to overestimate or underestimate their risk. This paper addresses the issue of how to communicate risk information on hereditary breast and ovarian cancer through an online application. The core of the paper illustrates the design of OPERA, a risk assessment instrument (...) that applies the UK National Institute of Health and Clinical Excellence's guidelines on the basis of (i) the number of relatives on the same side of the family with the same cancer or cancers that are known to run together; (ii) the ages of these relatives at diagnosis and (iii) the closeness of the family relationship with the person who is doing the assessment. By relying on the argumentation theory, we explain how the communication strategy that OPERA implements is essentially based on Perelman and Olbrechts-Tyteca's deductive argumentation by association. By using as premises “facts” (propositions about reality that can be assumed without further justification) and “truths” (propositions that make connections about facts), OPERA delivers its claims with an ex auctoritate causal link aimed at transferring the audience's acceptance of the cause to the effect. Overall, the design of OPERA rests on its capacity to induce users' active processing of risk information through an appeal to their reasoning faculty. In the conclusion, we present some results from a pilot evaluation of users' acceptance of OPERA. (shrink)

Since the appearance of Th. Birt's monumental edition of Claudian in 1892, followed in the next year by the Teubner one of Julius Koch, but little has been done for the text of a poet who for more reasons than one deserves something better than neglect. And I shall be glad if the publication of the ensuing notes draws the attention of scholars to the work that has yet to be done. The majority of my corrections were made some sixteen (...) years ago; but only two have seen the light, and these merely in passing mention, Laus Serenae 86 sqq. in my review of the two editions, Classical Review IX p. 167 b, and Panegyricus dictus Probino et Olybrio cons. 48 sqq in my note on Lucan VII 755. (shrink)

Misattributed paternity or ‘false’ paternity is when a man is wrongly thought, by himself and possibly by others, to be the biological father of a child. Nowadays, because of the progression of genetics and genomics the possibility of finding misattributed paternity during familial genetic testing has increased. In contrast to other medical information, which pertains primarily to individuals, information obtained by genetic testing and/or pedigree analysis necessarily has implications for other biologically related members in the family. Disclosing or not a (...) misattributed paternity has a number of different biological and social consequences for the people involved. Such an issue presents important ethical and deontological challenges. The debate centres on whether or not to inform the family and, particularly, whom in the family, about the possibility that misattributed paternity might be discovered incidentally, and whether or not it is the duty of the healthcare professional to disclose the results and to whom. In this paper, we consider the different perspectives and reported problems, and analyse their cultural, ethical and legal dimensions. We compare the position of HCPs from an Italian and British point of view, particularly their role in genetic counselling. We discuss whether the Oviedo Convention of the Council of Europe can be seen as a basis for enriching the debate. (shrink)

The principle of non-directiveness remains an important tenet in genetics. However, the concept has encountered growing criticism over the last two decades. There is an ongoing discussion about its appropriateness for specific situations in genetics, especially in light of recent significant advancements in genetic medicine. Despite the debate surrounding non-directiveness, there is a notable lack of up-to-date international research empirically investigating the issue from the perspective of those who actually do genetic counselling. Addressing this gap, our article delves into the (...) viewpoints and experiences of medical geneticists in Germany and Switzerland. Twenty qualitative interviews were analysed employing reflexive thematic analysis. Participants’ responses revealed substantial uncertainties and divergences in their understanding and application of the concept. It seems to cause distress since many geneticists stated that the principle was difficult to put into clinical practice and was no longer ethically justified given the increasing likelihood of therapeutic implications resulting from genomic testing outcomes. The insights provided by our qualitative empirical study accord with the ongoing theoretical debate regarding the definition, legitimacy, and feasibility of the principle. An adequately nuanced understanding and application of non-directiveness seems crucial to circumvent the risks inherent in the principle, while promoting patient autonomy and beneficence. (shrink)

The medical concept of prognosis is analysed into its basic constituents: patient data, medical intervention, outcome, utilities and probabilities; and sources of utility and probability values are discussed. Prognosis cannot be divorced from contemplated medical action, nor from action to be taken by the patient in response to prognostication. Regrettably, the usual decision-theoretic approach ignores this latter aspect. Elicitation of utilities, decision contemplation and prognostic counselling interweave, diagnostics playing a subsidiary role in decision-oriented clinical practice. At times the doctor has (...) grounds for withholding information. As this is known to the patient, prognostic counselling becomes a conflict-prone and rationality-thwarting activity. The meaning of standard phrases such as prognosis of a disease, the prognosis of this patient, the prognosis is unknown, is examined. (shrink)

The success or failure of an ineffective assistance of counsel claim turns largely on the testimony of trial counsel. It is therefore common for the government to communicate ex parte with trial co...

Aristotle's doctrine of the mean is not a counsel to perform mean or moderate actions. It states that excellence of character is a mean state with regard to the having and displaying of emotions. All emotions are morally neutral; character is shown by displaying emotions on the right occasions, Not too often or too rarely, Not too strongly or too weakly, For sufficient and only sufficient reasons, Etc. The difficulties for such a view presented by justice and such bad emotions (...) as envy are discussed. The conclusion is that basically aristotle's theory can resist critical scrutiny. (shrink)

The author, a scientist working in clinical genetics, outlines the functions of the genetic counsellor and discusses some of the ethical issues involved. The paper is based on one given at a London Medical Group conference.

Jeffrie G. Murphy's third collection of essays further pursues the topics of punishment and retribution that were explored in his two previous collections: Retribution, Justice and Therapy and Retribution Reconsidered. Murphy now explores these topics in the light of reflections on issues that are normally associated with religion: forgiveness, mercy, and repentance. He also explores the general issue of theory and practice and discusses a variety of topics in applied ethics - e.g., freedom of artistic expression, the morality of gambling, (...) and the value of forgiveness in psychological counseling. As always, his perspective may be described as Kantian; and, indeed, this collection contains the first extended piece of Kant scholarship that he has done in years: a long essay on Kant on theory and practice. (shrink)

Foundations of Humanism is a primer on secular humanism written by one of the leading figures in the movement. J.P. van Praag writes that the modern world is shaped by a central paradox: the technology that provides us with unprecedented possibilities at the same time imposes an oppressive organization on society. This organization, with its trappings of overspecialization and overcentralization, promotes feelings of impotence and alienation and a spirit of rebellion, especially in the young. In this book, van Praag examines (...) the ways in which the philosophy of humanism can be applied to this paradox of modern life. Humanism holds that the purpose of life is life itself. Van Praag demonstrates how, through the application of this principle, the paradox can be transcended and how personal fulfillment and social creativity can be achieved. Foundations of Humanism is designed to give the reader a comprehensive view of secular humanism, including its historical roots in classical Greece and the Renaissance, its elaboration as a formal philosophy, and its practical aspects as a social philosophy. Finally, it explores the application of humanist principles in counseling and education. (shrink)

This guide accompanies the following article(s): ‘Full Disclosure of the “Raw Data” of Research on Humans: Citizens’ Rights, Product Manufacturer’s Obligations and the Quality of the Scientific Database.’Philosophy Compass 6/2 (2011): 90–99. doi: 10.1111/j.1747‐9991.2010.00376.x Author’s Introduction Securing consent (and informed consent) from patients and research study participants is a key concern in patient care and research on humans. Yet, the legal doctrines of consent and informed consent differ in their applications. In patient care, the judicial doctrines of consent and informed (...) consent are disclosure doctrines based on the obligation of physicians to inform their patients of the following types of information: the nature of the procedure the physician is recommending in the patent’s care (P), the alternatives to the physician‐recommendation (A), and the risks of procedure and its alternatives (R). In addition, the physician must provide truthful answers to the patient’s questions (Q) to the best of the physician’s abilities. In research on humans, the onus of disclosure by study sponsors and principal investigators is much greater than in patient care precisely because the purpose of research is not patient care. The purpose of research is the identification and development of new generalizable knowledge. Thus, participation in a research study or trial may not benefit the study volunteer at all. In addition, the participant may carry a heavy risk burden in relationship to any testing of a newly designed drug or device as part of their experiences in the research study. Presently, despite the risks borne by the research study participant, the raw data collected from volunteers in research trials are treated by courts as if they were the private property of the study sponsor rather than generally owed to the public as would be expected by an effort like research participation aimed at contributing to the development of generalizable knowledge. This paper reviews the obligations that study sponsors owe to their study participants based on the very definition of research as a systematic activity whose purpose is to develop generalizable knowledge to help all humans. Author Recommends Court cases Canterbury v. Spence, United States Court of Appeals, District of Columbia Circuit 464 F.2d 772 (1972). (Federal appellate decision heard in the District of Columbia, USA) Reibl v. Hughes, 2 S.C.R. 880 (1980). (Supreme Court of Canada) Rogers v. Whitaker, 175 C.L. R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Canterbury v. Spence is the landmark Federal informed consent case in the United States heard in the District of Columbia. In this case, Judge Spottswood Robinson articulated the reasonable person standard of informed consent. This standard was subsequently adopted by the Supreme Court of Canada (Reibl v. Hughes, 2 S.C.R. 880 (1980)) and the High Court of Australia (Rogers v. Whitaker, 175 C.L. R. 479 (1992)). The House of Lords rejected the reasonable person standard in England in Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985). Book Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. This book is a detailed guide for the review of scientific and ethical aspects of research on humans contained in the research study protocols and research informed consent forms which need to be submitted by study sponsors and principal investigators to institutional review boards (IRBs) for IRB review before a research study can receive approval to be conducted within a human study population in those institutions over which the IRB has authority. It also presents basic definitions in the area of research on humans and basic approaches to help conduct a deep review of the underlying scientific and ethical issues that are present within a research study protocol and its accompanying research informed consent form. Report National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). This U.S. National Commission in the Belmont Report argued for the necessity of a reasonable volunteer standard in research on humans in the United States. Arguing that the professional standard and the reasonable person standard of consent and informed consent were insufficient to base a disclosure standard in research on humans, this National Commission developed the reasonable volunteer standard where a study participant is to be approached in research informed consent with that information that a reasonable volunteer would want to know. Online Materials Belmont Report: Syllabus Topics for Lecture and Discussion Week I: Introduction and Overview Readings: Rogers v. Whitaker, 175 C.L.R. 479 (1992). (High Court of Australia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week II: The Different Standards of Consent and Informed Consent Readings: Canterbury v. Spence, 464 F.2d 772 (1972). (Federal appellate opinion heard in the District of Columbia) Sidaway v. Board of Governors of the Bethlem Royal Hospital and the Maudsley Hospital and Others. 1 A.C. 871 (1985) (House of Lords) Week III: Definition of Research Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 2 and 3) Week IV: How to Review a Research Study Protocol and Research Informed Consent Form Reading: Mazur, Dennis J. The Science and Ethics of Research on Humans. Baltimore, MD: Johns Hopkins University Press, 2007. (Especially Chapters 4–6, 10, and 12–14) Week V: Obligations in Research of Humans Versus Patient Care Reading: National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research. The Belmont Report: Ethical Guidelines for the Protection of Human Subjects of Research. Washington, DC: DHEW Publications, 1978 (78‐0012). Focus Questions • How do the judicial doctrines of consent in England and Australia compare to the judicial doctrines of informed consent in the United States and Canada? • How does a professional standard of disclosure differ from a reasonable person standard of disclosure? • What is the definition of research? • How is a research study (study proposal and research informed consent form) reviewed from scientific and ethical bases for considerations of approval by an IRB? • How do the obligations of a study sponsor, a principal investigator, and a research team conducting a research trial on human study participants differ from the obligations of a physician caring for a patient? • Should all raw data of research derived from humans be made available to the public for use in developing generalizable knowledge to help others, or should raw data be considered the private property of the study sponsors (for example, prescription drug manufacturers), who fund the research trials? Seminar/project Idea Draw a timeline of the development of the basic concepts of consent and informed consent in patient care and in patient research. On this timeline, first place the dates of the key court cases in England, the United States, Canada, and Australia on consent and informed consent. Then place the date of the development of the Belmont Report. Why do differences exist between these four countries in terms of the legal requirements of informedness of a patient (in medical care) and a study participant (in medical research)? What roles if any do the concepts of self‐determination and self‐decision have in consent and informed consent in patient care and in informed consent in research on humans among the four countries of interest? What are the realities of research on human participants that require a new standard of informed consent, the reasonable volunteer standard, to be developed beyond the two standards in patient care, the professional standard, and the reasonable person standard? Counterpoint Arguments The following are counterpoint arguments that need to be appreciated to more fully understand the concepts that impact the thesis that ‘raw data’ should be open to the public to allow the opportunity of checking of the results of its associated scientific paper and for further analysis. De‐Identified (Anonymized) Raw Data A current approach to identifying (anonymizinig) raw data is based on the Health Insurance Portability and Accountability Act (HIPAA) of 1996 (P.L.104‐191). HIPAA was enacted by the U.S. Congress in 1996 to keep a person’s medical information private. In a research study, a person’s private medical information can become research data. HIPAA’s Privacy Rule allows a covered entity to de‐identify data by removing all 18 elements that could be used to identify the individual or the individual’s relatives, employers, or household members; these elements are enumerated in the Privacy Rule. The covered entity must also have no actual knowledge that the remaining information could be used alone or in combination with other information to identify the individual who is the subject of the information. Under this method, the identifiers that must be removed are the following: 1 Names. 2 All geographic subdivisions smaller than a state, including street address, city, county, precinct, ZIP Code, and their equivalent geographical codes, except for the initial three digits of a ZIP Code if, according to the current publicly available data from the Bureau of the Census: 2a. The geographic unit formed by combining all ZIP Codes with the same three initial digits contains more than 20,000 people. 2b. The initial three digits of a ZIP Code for all such geographic units containing 20,000 or fewer people are changed to 000. 3 All elements of dates (except year) for dates directly related to an individual, including birth date, admission date, discharge date, and date of death, and all ages over 89 and all elements of dates (including year) indicative of such age, except that such ages and elements may be aggregated into a single category of age 90 or older. 4 Telephone numbers. 5 Facsimile numbers. 6 Electronic mail addresses. 7 Social security numbers. 8 Medical record numbers. 9 Health plan beneficiary numbers. 10 Account numbers. 11 Certificate/license numbers. 12 Vehicle identifiers and serial numbers, including license plate numbers. 13 Device identifiers and serial numbers. 14 Web universal resource locators (URLs). 15 Internet protocol (IP) address numbers. 16 Biometric identifiers, including fingerprints and voiceprints. 17 Full‐face photographic images and any comparable images. 18 Any other unique identifying number, characteristic, or code, unless otherwise permitted by the Privacy Rule for re‐identification. Even though ‘raw data’ can be de‐identified (anonymized) so that there is no way to trace back the data to the study participant from which it was drawn, there are still questions whether the ‘de‐identified raw data’ can be given to other researchers or made public without the original study participant’s approval. It may be the case that this approval could be done at the start of any research study where the individual considering study participation would be counseled on what the process of de‐identification consists of and would be asked whether the participant would allow use of the data by other researchers or made available to the public in a de‐identified state. However, there may be questions of the study participants as to whether the data are truly de‐identified and untraceable back to the study participant since the participant would not be able to see the process actually being carried out in detail in all relevant circumstances. Using Raw Data in Context Simply being in possession of raw data is never enough to build on that data from a research perspective. Researchers need to understand the context of the scientific research study in which the data were collected. This research context includes (but is not limited to): (i) the scientific hypothesis of the research study, (ii) the inclusion and exclusion criteria selected by the research designers of the study to determine which study participants were included and which were excluded from the study, (iii) the methods used to collect the data and possibilities of errors in the data collection processes, and (iv) answers to questions regarding whether any data were excluded from the study data and why these data were excluded. Ownership Rights Over Data There are ownership rights over data. Ownership rights include court decision making related to the question which parties are to be considered as the owners of the data. Possible owners here include (but are not limited to) (i) the study sponsor whose only role was to fund that study, (ii) the principal investigator(s) who developed the scientific hypothesis, and (iii) individual study participants through special contracts made by individual participants who negotiate such contracts with study sponsors and principal investigators to share in the ownership of data. Examples of such data are participant sources of unique gene lines or unique cell lines to be used in future research. Objections to Data Sharing Finally, individual researchers may simply object to sharing data. A researcher’s arguments here may be simply stating that he or she has a right to fully analyze the data since the collection of the data was the researchers’ idea in the first place. These researchers may argue that they have the right to mine the data as fully as they can before deciding to make the data open to the public for others to analyze. Works Cited 1 Kaiser, J. ‘Making Clinical Data Widely Available.’Science 322.5899 (10 Oct. 2008): 217–8. 2 de Lusignan, S., J.F. Metsemakers, P. Houwink, V. Gunnarsdottir, and J. van der Lei. ‘Routinely Collected General Practice Data: Goldmines for Research? A Report of the European Federation for Medical Informatics Primary Care Informatics Working Group (EFMI PCIWG) from MIE2006, Maastricht, The Netherlands.’Informatics in Primary Care 14.3 (2006): 203–9. 3 Sim, I. ‘Human Studies Database Project’, CTSA Data Repositories Symposium (17 Oct. 2008). 23 Nov. 2010. 4 Sim, I., C.G. Chute, H. Lehmann, R. Nagarajan, M. Nahm, and R.H. Scheuermann. ‘Keeping Raw Data in Context.’Science 323.5915 (6 Feb. 2009): 713. 5 U.S. Department of Health and Human Services, National Institutes of Health, HIPAA Privacy Rule, Information for Researchers. 13 Nov. 2010. 6 Wilczynski, N.L., R.B. Haynes, and Hedges Team. ‘EMBASE Search Strategies for Identifying Methodologically Sound Diagnostic Studies for Use by Clinicians and Researchers.’BMC Medicine 29.3 (March 2005): 7. (shrink)

IN THE beginning Parmenides sought to deny the void. But he found himself trapped by his language and his thought into admitting what he sought to deny. Wisely, he counseled others to avoid the whole region in which the problem arises, lest they too be unwarily ensnared. Plato, being less easily intimidated and grasping for the first time the urgency of the paradox, unearthed each snare in turn until he felt he had found a safe path through the forbidden terrain (...) in a new conception of being and the derivation of its linguistic consequences in the Sophist. Aristotle evidently took Parmenides’ advice; and save for a few groping scholastics, perhaps Leibniz, Brentano, and Meinong, and Frege only in passing, no one else attempted the crossing before Russell made his spectacular dash through the posted ground from the completely new direction of linguistic reference. Again the problem lay dormant for half a century until Strawson constructed a new low road through ordinary language and Quine improved Russell’s high algebraic pass. Refinements of these routes have been forthcoming, especially from Searle and Kripke, until today it might appear that there are two super highways through Parmenides’ forbidden country of nonbeing. In this essay I will first argue that these new linguistic highways are no more than flimsy camouflage hiding but not resolving the old paradoxes. I will then show how Plato’s ontological way out, though more difficult, is the straight and narrow path. (shrink)

Any case raising the profile of ‘assisted-dying’ and public policy naturally causes consternation, excitement, heated debate and concerns from different parties, worried that the law is unclear, unfair, too conservative, too permissive, neglectful of ‘the vulnerable’ or indifferent to the proper scope of freedom for ‘the competent’. It was unsurprising, then, that much attention focused on the litigation between Debbie Purdy and the Director of Public Prosecutions .1–4 Ms Purdy has muscular sclerosis, and would like to be free, at a (...) time of her choosing, to travel to receive assisted suicide in a jurisdiction that permits this. To do so, she will need the help of her husband. In contrast with the famous Pretty case,5 Ms Purdy did not seek a proleptic immunity from prosecution under the Suicide Act 1961. Rather, she invoked her human right to respect for private and family life, and argued that the DPP should publish guidance detailing the basis on which he exercises his discretion to bring a prosecution for the crime of aiding, abetting, counselling or procuring a suicide in England and Wales. Her case, when heard in the House of Lords, was successful. 3A decision to prosecute cases of assisted suicide pivots on the satisfaction of two key issues: the ‘evidential test’—is there sufficient evidence to justify bringing a prosecution?; and the ‘public interest test’—is it in the public interest to bring a prosecution? Rightly or wrongly, the threshold for meeting the evidential test seems to be set very low.6 Focus tends to fall, therefore, on the public interest aspect of the decision. In September 2009, the DPP published interim guidance, which detailed the offence of ‘assisting a …. (shrink)