No consensus yet exists on how to handle incidental fnd-ings in human subjects research. Yet empirical studies document IFs in a wide range of research studies, where IFs are fndings beyond the aims of the study that are of potential health or reproductive importance to the individual research participant. This paper reports recommendations of a two-year project group funded by NIH to study how to manage IFs in genetic and genomic research, as well as imaging research. We conclude that researchers (...) have an obligation to address the possibility of discovering IFs in their protocol and communications with the IRB, and in their consent forms and communications with research participants. Researchers should establish a pathway for handling IFs and communicate that to the IRB and research participants. We recommend a pathway and categorize IFs into those that must be disclosed to research participants, those that may be disclosed, and those that should not be disclosed. (shrink)

Nanomedicine is yielding new and improved treatments and diagnostics for a range of diseases and disorders. Nanomedicine applications incorporate materials and components with nanoscale dimensions where novel physiochemical properties emerge as a result of size-dependent phenomena and high surface-to-mass ratio. Nanotherapeutics and in vivo nanodiagnostics are a subset of nanomedicine products that enter the human body. These include drugs, biological products, implantable medical devices, and combination products that are designed to function in the body in ways unachievable at larger scales. (...) Nanotherapeutics andin vivonanodiagnostics incorporate materials that are engineered at the nanoscale to express novel properties that are medicinally useful. These nanomedicine applications can also contain nanomaterials that are biologically active, producing interactions that depend on biological triggers. Examples include nanoscale formulations of insoluble drugs to improve bioavailability and pharmacokinetics, drugs encapsulated in hollow nanoparticles with the ability to target and cross cellular and tissue membranes and to release their payload at a specific time or location, imaging agents that demonstrate novel optical properties to aid in locating micrometastases, and antimicrobial and drug-eluting components or coatings of implantable medical devices such as stents. (shrink)

This monograph opens with an examination of the aid industry and the claims of leading practitioners that the industry is experiencing a crisis of confidence due to an absence of clear moral guidelines. The book then undertakes a critical review of the leading philosophical accounts of the duty to aid, including the narrow, instructive accounts in the writings of John Rawls and Peter Singer, and broad, disruptive accounts in the writings of Onora O’Neill and Amartya Sen. Through an elaboration of (...) the elements of interconnection, responsible action, inclusive engagement, and accumulative duties, the comparative approach developed in the book has the potential to overcome the philosophical tensions between the accounts and provide guidance to aid practitioners, donors and recipients in the complex contemporary circumstances of assistance. Informed by real world examples, this book grapples with complex and multi-dimensional questions concerning practices and the ethics of aid. The author judiciously guides us through the debate between deontological and consequentialist moral theories to arrive at a sophisticated consequentialist account that does justice to the complexity of the problems and facilitates our deliberation in discharging our duty to aid, without yielding, as it should not, a determinate answer for each specific situation. Researchers, students, and practitioners of international aid will all find this book rewarding. Win-chiat Lee, Professor and Chair, Department of Philosophy, Wake Forest University Susan Murphy’s book offers us a sophisticated exploration of the philosophical basis for aid. It is grounded in a full understanding of the complexities and pitfalls of the aid industry, but its particular strength lies, mainly through an extensive discussion of Singer, Rawls, O’Neill and Sen, in a comparison of consequentialist and duty-based approaches, eventually endorsing a broad non-idealised, situated consequentialist account in what she calls an interconnected ethical approach to the practice of assistance. For anyone wanting to think carefully about why we should give aid, this book has much to offer. Dr Nigel Dower Honorary Senior Lecturer, University of Aberdeen Author of World Ethics – the New Agenda. (shrink)

Holding life and death in their hands -- Is this for me? -- The intensive care unit. Personnel ; Rhythms ; Economics -- Actors. Patients ; Friends, family, and significant others ; Health care professionals -- Decisions. Informed consent ; Venues ; Affect ; Conflict -- Prognosis. Evidence ; Timing ; Mixed messages ; Negotiation ; Accuracy ; Prognostic framing -- Decision-making scripts. The legal script ; Cognitive scripts ; Conflicts of interest ; Law at the bedside -- Improvisation: decisions (...) in the real world. The patient should decide ; Reprising patient instructions ; Standing in the patient's shoes ; Beneficence ; It's God's decision ; What we want ; Denial, opting out -- Making a difference? The role of physicians ; Opting for a trajectory ; Outcomes ; I thought the law would take care of this ; Does any of this matter? -- The end. Implications ; Before it's too late ; When it's too late ; When "this" happens to me. (shrink)

This paper investigated the effects, ramifications and limitations of categorising and labelling Directors and Boards when measuring or evaluating performance. According to Weiner (1982) labelling can have a profound impact on a person's life, leading to stigmas, reputation bias, prejudice or discrimination which can adversely impact Director and Board performance. Labelling Directors' behavioural traits can lead to the exaggeration of behaviours and lead fellow Directors or shareholders to have preconceived expectations about Directors. This study hypothesised that measurement of Directors and (...) Boards should be measured on a continuum and remain fluid. Fluid measurement takes into account all aspects of a Directors behaviour, circumstances and situational impacts, without categorisation or judgement. Results suggest Directors feel more confident in their ability to perform as Directors and evidence a greater state of preparedness and readiness for change. Findings are discussed in terms of the impacts for Directors, decision-making ability and Board performance. (shrink)

In this paper I use a feminist relational approach to critically examine contemporary mainstream assumptions in the field of development concerning the relationship between poverty and prosperity....

The interface between genetic research results and clinical practice occurs when patients present them- selves to physicians. When patients ask their doctors about the potential impact of a family disease on themselves, their children, and their grandchildren, physicians have an opportunity to be helpful. Unfortunately, the scientific discoveries are occurring faster than most physicians can read about them in their speciality journals and hence adjust their practice. Meanwhile, the press and media are proclaiming the latest scientific breakthroughs, creating a preventive (...) and curative expectation that physicians cannot fulfill.In this time of health system reorganization and consolidation, many people do not know who their primary caregiver is, no less which insurer is likely to cover which visit or genetic test. (shrink)

Prior research on student question-asking has primarily been conducted from a cognitive, epistemological standpoint. In contrast, we present a hermeneutic-phenomenological investigation that emphasizes the moral-practical context in which question-asking functions as a situated way of being in the midst of practice. More particularly, we present a hermeneutic study of student question-asking in a graduate seminar on design theory. The study offers a unique moral-practical perspective on this commonly studied phenomenon. Our analysis yielded four themes regarding the moral-practical intricacies of question-asking (...) in this setting, with a particular focus on time-related constraints on participation, various types of background understanding, and value-laden expectations that participants encountered in this complex ecology of practice. (shrink)

Christian ethics are usually based on a theology of love. In the case of Christian relationships to nature, Christian environmental writers have either suggested eros as a primary source for Christian love, without dealing with traditional Christian arguments against eros, or have assumed agape (spiritual love or sacrificial love) is the appropriate mode, without defining how agape should function in human relationships with the nonhuman portion of the universe. I demonstrate that God’s love for nature has the same form and (...) characteristics as God’s love for human beings, and that because agape is self-giving, it is preferable to eros in relationships with the environment. Agape concerning nature (I) is spontaneous and unmotivated, (2) is indifferent to value, (3) creates value, (4) initiates relationships with the divine, (5) recognizes individuality, (6) provides freedom, and (7) produces action and suffering. Agape might best be defined, not as Platonic ascent above the world, but as completely self-giving engagement with the world. Human love for nature is often limited by a human inability to accept love, including divine love, from nature. Flowing from God, agape cannot require reciprocity; yet agape understands what “the other has to give and can offer it complete valuation. Agape is the ideal form of human interaction with nature, because agape does not require equal status or ability, or common goals or needs. Love between humans and members of the land (or sea) community can be sacrificial, and should be distinguished by a loss of self-regard and a willingness to suffer. Further philosophical and theological discussion of the role of reciprocity and sacrifice in love for nature is highly desirable. (shrink)

The current study is designed to propose and test a model about the ethical reputation of a target manager who must decide whether to engage in earnings management. We employ an experimental approach to examine the potential negative reputation effects within the internal labor market of a firm that occur as a consequence of earnings management. We examine participants’ responses to a hypothetical (target) manager when both the target’s behavior and the corporate incentives were manipulated. Participants assessed how ethical they (...) believed a target manager to be, based on the target’s decision regarding earnings management and the nature of the corporate incentives. Participants also assessed the target’s managerial ability. Participants’ judgments regarding the target’s morality were significantly affected by the target’s behavior, but were not affected by the incentive structure. Ability judgments were significantly and positively related with morality assessments. Further analysis indicates that morality assessments mediate the relationships between the target’s behavior and the participants’ willingness to extend work-related opportunities to the target. Implications of these results for management control systems design and for future research are discussed. (shrink)

Recent, well-publicized accounting scandals have shown that the penalties outsiders impose on those found culpable of earnings management can be severe. However, less is known about how colleagues within internal labor markets respond when they believe fellow managers have managed earnings. Designers of responsibility accounting systems need to understand the reputational costs managers impose on one another within internal labor markets. In an experimental study, 159 evening MBA students were asked to assume the role of a manager in a company (...) and respond to a scenario in which another manager (the target manager) has the opportunity to engage in earnings management. Participants provided causal attributions, assessed the morality of the target manager, and indicated whether they would change their judgments about the target manager's reputation. The study manipulated three between-subjects factors: (1) whether the target manager chose to engage in earnings management, (2) whether the company's budgetary control system was rigid or flexible, and (3) whether the target manager's work history was average or above average. We found that causal attributions are affected more by the budgetary systems when the target did not manage earnings than when the manager did. We also found that morality judgments were significantly associated with the target manager's behavior, but not with the budgetary system. In addition, participants' judgments about the target manager's reputation were more strongly associated with morality judgments than with causal attributions. We discuss implications of the role of reputation in management control systems design. (shrink)

Objectives—To evaluate a departmental computer system.Design—a. Direct comparison of the time taken to use a manual system with the time taken to use a computer system for lung function evaluation, loan of equipment and production of correspondence. b. Analysis of the accuracy of data capture before and after the introduction of the computer system. c. Analysis of the comparative running costs of the manual and computer systems.Setting—Within a department of respiratory medicine serving a hospital of 1323 beds.Main Outcome Measures—a. Time (...) taken to perform functions with the assistance of computerised methods, in comparison to the manual method used alone. b. Accuracy of data capture. c. Relative running costs.Results—a. The computer system was significantly faster than the manual system for lung function evaluation, loan of equipment, and checking for overdue equipment. The production of correspondence was slightly slower with the computer. b. All outpatient episodes, but only 43 of 65 of inpatient episodes, were captured. Lung function and managerial report data were accurate using both manual and computerised methods. The manual system for equipment loans was inefficient, and use of the computer resulted in the recovery of 221 nebulisers. c. Development costs for 1988–1990 were high. Only £1200 to £1845 per year was recovered directly from staff time saved by the computer but larger savings resulted from changes in work practice. After 10 years the projected deficit is £10 000 per annum in running costs.Conclusions—In comparison with the manual methods, the computer system has shown significant advantages which provide accurate information, with significant favourable effects on working practices. In evaluating computer systems used in clinical practice it is essential to ensure that the projected work practice benefits are achieved without unacceptable costs in staff time, inaccurate data and high financial outlay. (shrink)

In his book A Theory of Sentience, Austen Clark argues that the content of sensory representations can be expressed as sentences constructed from a language of sentience. Such sentences specify that a determinate feature obtains in a particular space-time region, but the language's limited vocabulary prohibits the sentences from referring or attributing features to objects. In this paper, I show that this view is flawed in at least two ways. First, if sensation has the capacities that Clark and others attribute (...) to it, then the vocabulary of sense extends further than he supposes, and a limited language of sentience cannot justify a prohibition of object representation within sentience. Second, even if the language of sentience is as impoverished as he claims, and thus even if the representational capacity of sentience is correspondingly limited, object individuation can plausibly occur at the level of sensation. In the course of defusing Clark's major argument for an “object-less” theory of sentience, I offer reasons to believe both that sensory representations can be impressively sophisticated in what they say about the world, and that object representations can be surprisingly basic. (shrink)

Genetic testing poses fundamental questions for insurance. Testing can predict a low probability of future illness and disability, which can help promote the insurability of individuals with a family history of genetic risk, but it can also invite insurers to reject applicants, increase premiums, exclude people with certain illnesses and disabilities, and otherwise adjust the underwriting processes for individuals with certain genotypes. In the workplace, these issues may cause employers who offer or pay for insurance to alter their hiring behavior, (...) either by selecting those with desirable genetic makeup or rejecting, dismissing, or reassigning those who carry an unwanted risk, ultimately threatening employability and the safety net that insurance is intended to provide. (shrink)

Patient counseling is a cornerstone of ethical pharmacy practice and high quality pharmaceutical care. Counseling promotes patient compliance with prescription regimens and prevents dangerous drug interactions and medication errors. Counseling also promotes informed consent and protects pharmacists against legal risks. However, economic, social, and technological changes in pharmacy practice often force community pharmacists to choose between their professional obligations to counsel patients and business objectives. State and federal legislatures have enacted laws that require pharmacists to counsel patients, but these laws (...) have had mixed results. This essay argues that community pharmacy's patient counseling conundrum can be solved through additional moral education and moral persuasion, not through additional legal mandates. (shrink)

Celebrates a half century of television history, from "The Howdy Doody Show" and "I Love Lucy" to "The Simpsons" and "The Sopranos," and the personalities, shows, and landmark events that changed entertainment history.

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

Accession Number: ATLA0001712129; Hosting Book Page Citation: p 207-225.; Language(s): English; General Note: Bibliography: p 222-225.; Issued by ATLA: 20130825; Publication Type: Essay.

The Physician Orders for Life-Sustaining Treatment Paradigm is designed to improve end-of-life care by converting patients’ treatment preferences into medical orders that are transferable throughout the health care system. It was initially developed in Oregon, but is now implemented in multiple states with many others considering its use. Accordingly, an observational study was conducted in order to identify potential legal barriers to the implementation of a POLST Paradigm. Information was obtained from experts at state emergency medical services and long-term care (...) organizations/agencies in combination with a review of relevant state law. Legal analysis of survey responses and existing laws identified several potential state legal barriers to a POLST Paradigm implementation. The most potentially problematic barriers are detailed statutory specifications for out-of-hospital DNR protocols. Other potential barriers include limitations on the authority to consent to forgo life-sustaining treatments, medical preconditions, and witnessing requirements for out-of-hospital DNR protocols. (shrink)

Continuing the debate over whether consciousness causes behaviour or plays no functional role in it, leading scholars discuss the question in terms of neuroscience, philosophy, law, and public policy.