The legal requirements and justifications for collecting patient-identifiable data without patient consent were examined. The impetus for this arose from legal and ethical issues raised during the development of a population-based disease register. Numerous commentaries and case studies have been discussing the impact of the Data Protection Act 1998 and Caldicott principles of good practice on the uses of personal data. But uncertainty still remains about the legal requirements for processing patient-identifiable data without patient consent for research purposes. This is (...) largely owing to ignorance, or misunderstandings of the implications of the common law duty of confidentiality and section 60 of the Health and Social Care Act 2001. The common law duty of confidentiality states that patient-identifiable data should not be provided to third parties, regardless of compliance with the DPA1998. It is an obligation derived from case law, and is open to interpretation. Compliance with section 60 ensures that collection of patient-identifiable data without patient consent is lawful despite the duty of confidentiality. Fears regarding the duty of confidentiality have resulted in a common misconception that section 60 must be complied with. Although this is not the case, section 60 support does provide the most secure basis in law for collecting such data. Using our own experience in developing a disease register as a backdrop, this article will clarify the procedures, risks and potential costs of applying for section 60 support. (shrink)

Nanomaterials have the promise of revolutionizing current treatment and diagnosis of diseases, which has led to 33 nanotherapeutics drugs currently on the market and many more in various stages of clinical trials. With an increasing number of products available and in development, along with the unique, emergent properties of the nanoparticle therapeutics themselves, regulatory agencies are now faced with decisions regarding the regulation of such novel technologies. Regulatory guidance, particularly in pre-clinical stages, has the potential to facilitate quick and safe (...) development of these novel materials, but new regulation beyond what is currently in place must be justified in a clear and distinctive toxic response. Herein, we examine literature that compares and correlates in vivo and in vitro nanotoxicity studies to gain a deeper understanding of the modes of nanoparticle toxicity. Additionally, this comparison aims to identify clear and unique toxicity responses caused by nanoparticles, which informs our perspective on pre-clinical nanotherapeutic oversight. (shrink)

Much of the focus of the published 2011 symposium that inspired this work focused on the question, “When have you reduced risk enough to move from bench/animal studies to ‘first in-human’ studies?” Building applied research ethics related to nanotherapeutics requires bench and clinical scientists to have a clear vision about how to test nanotherapeutic safety, and it is clear that there is still much to be considered at the steps before “in-human” assessment. Herein, the perspective of the bench scientist is (...) brought to bear on using in vivo and in vitro models to assess the safety of nanotherapeutics. Much of this work falls under the purview of the field of nanotoxicology that aims to understand the toxicological impact of engineered nanoscale materials. Engineered nanomaterials include a wide variety of materials that are manipulated and controlled on the nanoscale level where, typically, the nanoparticle or nanomaterial has some dimension that is less than 100 nm. (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)

Michael A. PetersBeijing Normal UniversityMy deepest condolences to Pepe, Dom and Marcus and to Jim’s grandchildren. Tina and I spent a lot of time at the Marshall family home, often attending dinn...

Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.

Animal welfare has been conceptualized in such a way that the use of animals in science and for food seems justified. I argue that those who have done this have appropriated the concept of animal welfare, claiming to give a scientific account that is more objective than the sentimental account given by animal liberationists. This strategy seems to play a major role in supporting merely limited reform in the use of animals and seems to support the assumption that there are (...) conditions under which animals may be raised and slaughtered for food that are ethically acceptable. Reformists do not need to make this assumption, but they tend to conceptualize animal welfare is such a way that death does not count as harmful to the interests of animals, nor prolonged life a benefit. In addition to this prudential value assumption, some members of this community have developed strategies for defending suitably reformed farming practices as ethical even granting that death and some other forms of constraints are harms. One such strategy is the fiction of a domestic contract. However, if one accepts the conceptualization of human welfare give by L. W. Sumner, and applies it to animals in the way that I think is justified, an accurate conceptualization of animal welfare has different implications for which uses of animals should be regarded as ethically acceptable. In this paper I give an historical and philosophical account of animal welfare conceptulization and use this account to argue that animal breeders, as custodians of the animals they breed, have the ethical responsibility to help their animal wards achieve as much autonomy as possible in choosing the form of life made available to them and to provide that life. Attempts to avoid these implications by alluding to a contract model of the relationship between custodians and their wards fail to relieve custodians of their ethical responsibilities of care. (shrink)

It is immensely difficult to give a philosophically adequate account of mental imagery. Peter F.R. Haynes, pp. 709–19) objects to the standard accounts, and offers one of his own which avoids the standard difficulties. Unfortunately it in turn seems to lapse into incoherence.Haynes rejects Cartesian accounts which would make images private objects in non-physical space. He also rejects current alternative views: both Rylean or behaviourist ones; and also intentionally complex ones, which assert that the relevant terms change their (...) meaning. He thinks that J. J. C. Smart's “topic neutral” approach may supply “the basis for a correct, intentionally simple, intuitively satisfying account of mental imagery”. But an adequate account must also be neutral, as Smart's is not, between different theories of mind. In addition to avoiding these difficulties an adequate theory has certain other desiderata; in particular Haynes places valuable emphasis on the need to explain the fact that we can sometimes mistake images for real perceptions or, more real perceptions for images. (shrink)

It is immensely difficult to give a philosophically adequate account of mental imagery. Peter F.R. Haynes, pp. 709–19) objects to the standard accounts, and offers one of his own which avoids the standard difficulties. Unfortunately it in turn seems to lapse into incoherence.Haynes rejects Cartesian accounts which would make images private objects in non-physical space. He also rejects current alternative views: both Rylean or behaviourist ones; and also intentionally complex ones, which assert that the relevant terms change their (...) meaning. He thinks that J. J. C. Smart's “topic neutral” approach may supply “the basis for a correct, intentionally simple, intuitively satisfying account of mental imagery”. But an adequate account must also be neutral, as Smart's is not, between different theories of mind. In addition to avoiding these difficulties an adequate theory has certain other desiderata; in particular Haynes places valuable emphasis on the need to explain the fact that we can sometimes mistake images for real perceptions or, more real perceptions for images. (shrink)

The ‘right not to know’ can be used by patients as a safeguard against the effects that certain medical information can have on their well-being. At first glance, one might reason it suitable for a patient to enact their RNTK. However, although Davies states that RNTK gives people the ability to both protect themselves from self-perceived harm and exercise their autonomy, I will argue that ‘not knowing’ hinders patients’ ability to exercise their existential freedom and represents what Sartre calls an (...) instance of ‘bad faith’. Davies argues that the RNTK takes precedence over many related issues and objections associated with a patient’s decision to implement such a resolution.1 Fundamentally, the RNTK gives patients power to protect themselves from subjective harm and to exercise their autonomy. In most cases, objectors of RNTK cite the negative impact on the patient’s state of health, which affects not only the patient but also those persons who would also be negatively affected by patient health outcomes. For the majority of objectors, patients have moral obligations to lessen the degree of burden on others, which refusal can initiate. However, Davies concludes, ‘…the burden placed on others is not sufficiently significant …. (shrink)

This article explores how the type of consent given for organ donation should affect the judgement of a patient's overall benefit with regards to donation of their organs and the pre-mortem interventions required to facilitate this. The findings of a qualitative study of the views of 10 healthcare professionals, combined with a philosophical analysis inform the conclusion that how consent to organ donation is given is a reliable indicator only of the strength of evidence about views on donation and subsequent (...) willingness to undergo pre-mortem interventions. It is not an indicator of the strength of actual desire to donate. Clinical management of living patients prior to donation after circulatory death must therefore respect the values, wishes and beliefs of the potential donation after circulatory death donor. Our participants, however, suggested that the information currently provided is sufficient to authorise donation and that this consent, however provided, was sufficient to proceed with pre-mortem interventions. Respect for autonomy underpinned this ‘all or nothing’ approach. Although the legal requirements for donation authorisation and the protection of patients without capacity are clear, practice and policy regarding consent in donation after circulatory death may be based on donation following brainstem death where the patient is already dead when the family is approached. Custom and practice in donation after circulatory death may need to be revised to protect the interests of the dying potential donor. (shrink)

Still the Heart of Darkness analyzes Richard Preston's best-selling account of an Ebola virus outbreak in Reston, Virginia in 1989. Through a textual examination of The Hot Zone, this essay demonstrates how Preston grounds his narrative about the threat of rare emerging viruses from the third world in terms of the colonialist discourse about Africa as the white man's grave, most notably Joseph Conrad's Heart of Darkness. By foregrounding previous outbreaks in Africa, Preston simultaneously darkens its landscape and inscribes the (...) Ebola filovirus as an external biological threat to Americans in a post-Cold War world with porous borders. (shrink)

Objective: There is lack of information on the presentation of eating disorders (EDs) in Saudi Arabia using gold standard clinical tools. The present study aimed to provide data on the presentation of EDs in Saudi Arabia using clinically validated measures.Method: Hundred and thirty-three individuals (33 male) with a mean age of 22 years (2.63) completed three measures: the Eating Disorder Examination (EDE), a semi-structured interview, the Eating Disorder Examination Questionnaire (EDE-Q), a self-report measure, and the Depression Anxiety and Stress Scale (...) (DASS-21) to measure comorbid symptoms.Results: Individuals in Saudi Arabia reported higher levels of restraint, eating concern and shape concern and a higher global score, but lower levels of weight concern on the EDE-Q compared to the EDE. Female participants reported a higher global score, alongside significantly higher scores on the restraint, shape concern and weight concern subscales than males. The most common ED subtype was other specific feeding or ED. Compared with Western community samples, symptom severity in this purposive sample obtained from community settings was significantly higher in this sample.Discussion: Individuals with eating, weight and shape concerns in Saudi Arabia may feel more comfortable expressing their symptoms on a self-report tool compared with a face to face interview. However, it is possible that a self-report measure may over-estimate the severity of symptoms. The data suggest that clinicians in Saudi Arabia should regularly screen for EDs in all genders. It is also important to note that ED symptoms are a cause for concern in young people in Saudi Arabia. (shrink)

Prince of philosophers -- The emergence of Islam -- Boy genius -- Court physician -- A traveling philosopher -- Death of an intellectual -- A lasting legacy.

Ethical decision making in medicine has recently seen calls to move towards less prescriptive- based approaches that consider the particularities of each case. The main alternative call from the literature is for better understanding of phronesis concepts applied to decision making. A well-cited phronesis-based approach is Kaldjian’s five-stage theoretical framework: goals, concrete circumstances, virtues, deliberation and motivation to act. We build on Kaldjian’s theory after using his framework to analyse data collected from a three-year empirical study of phronesis and the (...) medical community. The data are a set of narratives collected in response to asking a medical community what making ethically wise decisions means to them. We found that Kaldjian’s five concepts are present in the accounts to some extent but that one of the elements, motivation, is constructed as playing a different, though still crucial role. Rather than being an end-stage of the process as Kaldjian’s framework suggests, motivation was constructed as initiating the process and maintaining the momentum of taking a phronesis-based approach. The implications for medical ethics decision-making education are significant as motivation itself is a highly complex concept. We therefore theorise that motivation is required for leading in, continuing and completing the actions of the ethical decision taken. Appreciating the central importance of motivation through the whole of Kaldjian’s framework has implications for cultivating the virtues of phronesis and courage to take the right course of action. (shrink)

This paper presents a cross-sectional study that demonstrates how King Abdulaziz University has responded to the lockdown imposed by the Ministry of Education in Saudi Arabia due to the Covid-19 pandemic. The purpose of this study was to examine the perceptions of students and faculty towards assessment that had to take place online due to physical or social distancing rules and lockdowns. A descriptive mixed-method study was conducted with two different self-administered questionnaires that were developed for students and faculty, respectively. (...) A total of 547 responses were received from undergraduate students and 213 from faculty. The main finding suggests the need for a multilevel approach to the problems of cheating and plagiarism, including raising student awareness and ethics, training teachers to detect cheating methods, and institutions activating their code of practice and applying severe sanctions on those who engage in such practices. (shrink)

Western theology struggles with the rise of secularism and postmodernism. The Radical Orthodoxy sensibility asserts that the ancient principles of methexis (participation) and theosis (deification) presents an alternative metaphysical narrative to the narrative of secularism and the onto-theological tradition. This article addresses the problems of the onto-theological metaphysical tradition in Western theology by analyzing Radical Orthodoxy's rediscovery of the philosophical and theological principles of participation and theosis as articulated in the patristic tradition and in the thought of Thomas Aquinas. Using (...) historical and analytical methods, this article will survey the biblical and patristic literature on theosis, as well as John Milbank's understanding of methexis and theosis in Thomas Aquinas. The result of this study will be to offer theosis, rooted in participation in God, as not only a soteriological model to reclaim for the West, but also a core metaphysical principle for Christian ethics that contravenes both onto-theology and the materialistic reduction of ontology in secularism. (shrink)

Drawing on 2 years of field research conducted between 2008 and 2010 in London’s Kurdish community, I discuss the practical and ethical challenges that confront researchers dealing with violence against women committed in the name of ‘honour’. In examining how feminist methodologies and principles inform my research, I address issues of researcher positioning and the importance of speaking with, rather than for, marginalised groups. I then explore the difficulties of operationalising this position when dealing with honour-based violence. Using the interview (...) data from the 2008–2010 study and a case study of the trial of Mehmet Goren (who was convicted in 2009 of murdering his daughter Tulay for supposedly dishonouring their family), I discuss the socio-cultural norms and values underlying honour codes, examining both the position of men and women in relation to the maintenance of family honour and the regulation of women’s sexuality and conduct. In particular, I explore the difficulties inherent in obtaining and understanding victims’ own personal narratives, especially in legal settings, while simultaneously showing how it is only through empowering women to speak for themselves that we will be able to bring about the deep societal changes needed to eradicate honour-based violence. (shrink)

There have long been calls from industry for guidance in implementing strategies for sustainable development. The Circular Economy represents the most recent attempt to conceptualize the integration of economic activity and environmental wellbeing in a sustainable way. This set of ideas has been adopted by China as the basis of their economic development, escalating the concept in minds of western policymakers and NGOs. This paper traces the conceptualisations and origins of the Circular Economy, tracing its meanings, and exploring its antecedents (...) in economics and ecology, and discusses how the Circular Economy has been operationalized in business and policy. The paper finds that while the Circular Economy places emphasis on the redesign of processes and cycling of materials, which may contribute to more sustainable business models, it also encapsulates tensions and limitations. These include an absence of the social dimension inherent in sustainable development that limits its ethical dimensions, and some unintended consequences. This leads us to propose a revised definition of the Circular Economy as “an economic model wherein planning, resourcing, procurement, production and reprocessing are designed and managed, as both process and output, to maximize ecosystem functioning and human well-being”. (shrink)

This paper examines the problematisation of sex-selective abortion (SSA) in UK parliamentary debates on Fiona Bruce's Abortion (Sex-Selection) Bill 2014–15 and on the subsequent proposed amendment to the Serious Crime Bill 2014–15. On the basis of close textual analysis, we argue that a discursive framing of SSA as a form of cultural oppression of minority women in need of protection underpinned Bruce's Bill; in contrast, by highlighting issues more commonly articulated in defence of women's reproductive rights, the second set of (...) debates displaced this framing in favour of a broader understanding, drawing on postcolonial feminist critiques, of how socio-economic factors constrain all women in this regard. We argue that the problematisation of SSA explains the original cross-party support for, and subsequent defeat of, the policies proposed to restrict SSA. Our analysis also highlights the central role of ideology in the policy process, thus making politics visible in policymaking. (shrink)

Communication between road users is a major key to coordinate movement and increase roadway safety. The aim of this work was to grasp how pedestrians, cyclists, and kick scooter users sought to visually communicate with drivengers when they would face autonomous vehicles. In each experiment, participants were asked to imagine themselves in described situations of encounters between a specific type of vulnerable road user and a human driver in an approaching car. The human driver state and the communicative means of (...) the approaching car through an external Human-Machine Interface were manipulated between the scenarios. The participants were prompted to rate from “never” to “always” the frequency with which they would seek eye contact with the human driver either in order to express their willingness to cross or to make their effective decision to cross. Our findings revealed that a passive human driver in an AV with no visual checking on the road triggered a decline in vulnerable road users’ desire to communicate by eye contact. Moreover, the results of Experiment C demonstrated that the speed screen, the text message screen, and the vibrating mobile app eHMI signals diminished kick scooter users’ desire to communicate visually with the human driver, with some age-based differences. This suggested a better comprehension of the approaching car’s intentions by the kick scooter users, driven by the features of the eHMI. (shrink)

We examine corruption across three Central and Eastern Europe countries through a social psychology framework which integrates social identity theory, social cognitive theory and moral disengagement mechanisms. We illustrate how various social identities influence individual and collective action in terms of ethical behavior and corruption, thereby creating, maintaining and perpetuating petty, grand and systemic public/private corruption through triadic co-determination via cognition, behavior and the environment. Despite growing research on corruption normalization, less is known about the cognitive and behavioral mechanisms in (...) ethical decision making, the cognitive workings of how individuals reconcile unethical behavior and the social psychological processes behind corruption in society and organizations. Expert interviews reveal internally conflicted multi-layered social identities perpetuating corruption, some embedded in nationalistic history and others tied to the European Union, which supports the divergent paths of CEE countries since the fall of communism. Some moral disengagement mechanisms are common across all three countries, while others are linked to specific circumstances. Social identity mechanisms feed into moral disengagement, which individuals draw upon to reconcile the conflict between unethical behavior and moral codes. Patterns of moral disengagement aggregate to the country level and explain normalization of corruption in CEE society and organizations. (shrink)

Sartre's experimentation in February 1935 with the drug mescalin has been well documented by Simone de Beauvoir in her book The Prime of Life. 1 She recalls that Sartre experienced under the influence of the drug not exactly hallucinations, ‘but the objects he looked at changed their appearance in the most horrifying manner:’ [POL 209]. The residual effects of this nightmarish experience left Sartre, not only for several days ‘in a state of deep depression’ [POL 210], but also produced moods (...) that ‘recalled those that had been induced by mescalin.’. (shrink)

Volume 20, Issue 3, March 2020, Page 73-74.

Contemporary clinical ethics was founded on principlism, and the four principles: respect for autonomy, nonmaleficence, beneficence and justice, remain dominant in medical ethics discourse and practice. These principles are held to be expansive enough to provide the basis for the ethical practice of medicine across cultures. Although principlism remains subject to critique and revision, the four-principle model continues to be taught and applied across the world. As the practice of medicine globalizes, it remains critical to examine the extent to which (...) both the four-principle framework, and individual principles among the four, suffice patients and practitioners in different social and cultural contexts. Using the four-principle model we analyze two accounts of surrogate decision making – one from the developed and one from the developing world – in which the clinician undertakes medical decision-making with apparently little input from the patient and/or family. The purpose of this analysis is to highlight challenges in assessing ethical behaviour according to the principlist model. We next describe cultural expectations and mores that inform both patient and clinician behaviors in these scenarios in order to argue that the principle of respect for persons informed by culture-specific ideas of personhood may offer an improved ethical construct for analyzing and guiding medical practice in a globalized and plural world. (shrink)

Serious threats to global order are said to emanate from Al Qaeda, exemplified by bombings and multiple deaths in, inter alia, Bali, Dar es Salaam, Istanbul, Nairobi, New York and Madrid. These outrages raise the question about the ideological assumptions and goals of Al Qaeda ? given that the majority of the dead were not Jews or Christians, but Muslims. What were the bombers trying to achieve? What were their ideological assumptions and goals? This article argues that Al Qaeda first (...) emerged in the late 1980s to challenge the incumbency and authority of rulers in various Middle Eastern countries, including Saudi Arabia, with the objective of replacing them with more plausibly Islamic leaders. Due to a lack of success in this regard, Al Qaeda's attention shifted from the domestic to the global: a war against ?the West? utilising the weapons of terror to achieve ideological goals relating to both specific religious concerns, as well as a wider concern with a global balance of power between the West and the world of Islam. (shrink)