The Institute of Medicine's report, the American Medical Association's project, the Open Society Institute's and the initiative sponsored by the Robert Wood Johnson Foundation have focused attention on improving the care of dying patients. These efforts include advance care planning and the use of written advance directives. Although previous studies have provided quantitative descriptions of patient preferences for life-sustaining treatment, including those documented in written ADs, to our knowledge open-ended written preferences have not been studied. Studies of these open-ended preferences (...) could highlight issues with respect to quality end-of-life care. The purpose of this study was to explore the open-ended proxy, health, and personal care preferences of people with HIV as expressed in a written AD form. (shrink)

While it is no secret that Valerius Flaccus’Argonauticaexplores civil-war themes at great length, the conflicts arising on the island of Peuce between the Colchians and the Argonauts and within the Argonautic party itself in the epic's final book (8.217–467) have been overlooked in critical studies of Valerian civil war. This article argues that Valerius presents the conflicts on Peuce as examples of civil war—emphasizing the bonds of kinship between the conflicting parties and illustrating effects of this discord using imagery of (...) stasis and cosmic dissolution associated with civil war in the wider Latin literary tradition—and thus invites reflection on the development and manifestation of internecine strife within theArgonautica. (shrink)

Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...) moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice. (shrink)

Since the cloned sheep Dolly was born, reproductive cloning of humans (i.e. the cloning of complete human individuals) has seemed to be – at least in principle – achievable. The technical possibility of reproductive cloning leaves the question unanswered of whether the actual production of a clone would be morally acceptable. Considering several arguments against reproductive cloning – which claim that the moral status of a cloned individual and its clone respectively renders it morally objectionable to carry out cloning – (...) we defend the thesis that these arguments are not apodictic (i.e. relative to all ends and means of cloning humans) but are only hypothetical (i.e. relative to some ends and means of cloning humans). Although at present we think it is difficult to find a plausible aim of cloning that is not an instrumentalisation of the cloned (and, therefore, morally objectionable), it could, nevertheless, be that in the future there might be ends and means that justify reproductive cloning. We conclude by criticising the apodictic ban on reproductive cloning declared by most international resolutions and much national legislation. (shrink)

The purpose of this article is to offer an alternative, more nuanced analysis of the labelling of frontline workers as heroes than originally proposed. Here, we argue that the hero narrative in itself need not be problematic, but highlight a number of wider factors that have led to the initial rise in support for labelling frontline workers as heroes. Through our related work, we have gathered similar stories from frontline workers where they feel betrayed, let down or otherwise short-changed by (...) the hero label, and we have sought to make sense of this through understanding more about how the hero label is used rather than what it means. In this article, we propose a way forward where there is greater discussion around the hero label in this context where individuals can be heroes but still struggle, still fail and still feel vulnerable, and where heroism is viewed as a state of interdependence between heroic actor and the wider group. It is true that heroes can inspire, lead, guide and build morale and camaraderie, but collective responsibility is held with us all. We can draw hope and energy from our heroes, but we must dig deep and be proactive, particularly in the face of adversity. In doing so, we support the heroes to lead from the front and ensure that even though we cannot physically help; we are not making their situation worse. (shrink)

Sustainability science seeks to extend scientific investigation into domains characterized by a distinct problem-solving agenda, physical and social complexity, and complex moral and ethical landscapes. In this endeavor it arguably pushes scientific investigation beyond its usual comfort zones, raising fundamental issues about how best to structure such investigation. Philosophers of science have long scrutinized the structure of science and scientific practices, and the conditions under which they operate effectively. We propose a critical engagement between sustainability scientists and philosophers of science (...) with respect to how to engage in scientific activity in these complex domains. We identify specific issues philosophers of science raise concerning current sustainability science and the contributions philosophers can make to resolving them. In conclusion we reflect on the steps philosophers of science could take to advance sustainability science. (shrink)

Leading scholars examine the relation between Irigaray’s early writings and her later, more political work.

Stiff Person Syndrome is a rare autoimmune disorder associated with antibodies against glutamic acid decarboxylase, the key enzyme in γ -aminobutyric acid synthesis. In order to investigate the role of cerebral benzodiazepinereceptor binding in SPS, we performed [ 11 C]flumazenil positron emission tomography in a female patient with SPS compared to nine healthy controls. FMZ is a radioligand to the postsynaptic central benzodiazepine receptor which is co-localized with the GABA-A receptor. In the SPS patient, we found a global reduction of (...) cortical FMZ binding. In addition, distinct local clusters of reduced radiotracer binding were observed. These data provide first in vivo evidence for a reduced postsynaptic GABA-A receptor availability which may reflect the loss of GABAergic neuronal inhibition in SPS. (shrink)

The Dutch law states that a physician may perform euthanasia according to a written advance euthanasia directive when a patient is incompetent as long as all legal criteria of due care are met. This may also hold for patients with advanced dementia. We investigated the differing opinions of physicians and members of the general public on the acceptability of euthanasia in patients with advanced dementia.

Accumulating evidence for the unique social, behavioral, and physical health benefits of positive emotion and related well-being constructs has led to the development and testing of positive psychological interventions to increase emotional well-being and enhance health promotion and disease prevention. PPIs are specifically aimed at improving emotional well-being and consist of practices such as gratitude, savoring, and acts of kindness. The purpose of this narrative review was to examine the literature on PPIs with a particular focus on positive emotion outcomes. (...) We evaluated the evidence on the effects of PPIs on positive emotion specifically, and discussed the range of evidence regarding the relative responsiveness of emotion measures to PPIs in order to gain a better understanding of the specific emotional pathways through which PPIs influence psychological and physical well-being. We conclude with recommendations for best evaluating effects of PPIs on positive emotion outcomes. (shrink)

The coronavirus pandemic has necessitated extraordinary human resilience in order to preserve and prolong life and social order. Risks to health and even life are being confronted by workers in health and social care, as well as those in roles previously never defined as “frontline,” such as individuals working in community supply chain sectors. The strategy adopted by the United Kingdom government in facing the challenges of the pandemic was markedly different from other countries. The present study set out to (...) examine what variables were associated with resilience, burnout, and wellbeing in all sectors of frontline workers, and whether or not these differed between the UK and Republic of Ireland. Individuals were eligible if they were a frontline worker in the UK or RoI during the pandemic. Part of a larger, longitudinal study, the participants completed an online survey to assess various aspects of their daily and working lives, along with their attitudes toward their government’s handling of the crisis, and measurement of psychological variables associated with heroism. A total of 1,305 participants provided sufficient data for analysis. UK-based workers reported lower wellbeing than the RoI-based participants. In multivariate models, both psychological and pandemic-related variables were associated with levels of resilience, burnout, and wellbeing in these workers, but which pandemic-related variables were associated with outcomes differed depending on the country. The judgment of lower timeliness in their government’s response to the pandemic appeared to be a key driver of each outcome for the UK-based frontline workers. These findings provide initial evidence that the different strategies adopted by each country may be associated with the overall wellbeing of frontline workers, with higher detriment observed in the UK. The judgment of the relatively slow response of the UK government to instigate their pandemic measures appears to be associated with lower resilience, higher burnout, and lower wellbeing in frontline workers in the UK. (shrink)

BackgroundIn research ethics, the most basic question would always be, “which is an ethical issue, which is not?” Interestingly, depending on which ethics guideline we consult, we may have various answers to this question. Though we already have several international ethics guidelines for biomedical research involving human participants, ironically, we do not have a harmonized document which tells us what these various guidelines say and shows us the areas of consensus. In this manuscript, we attempted to do just that.MethodsWe extracted (...) the imperatives from five internationally-known ethics guidelines and took note where the imperatives came from. In doing so, we gathered data on how many guidelines support a specific imperative.ResultsWe found that there is no consensus on the majority of the imperatives and that in only 8.2 % of the imperatives were there at least moderate consensus. Of the 12 clusters, Informed Consent has the highest level of consensus and Research Collaboration and Regulatory Sanctions have the least.ConclusionThere was a lack of consensus in the majority of imperatives from the five internationally-known ethics guidelines. This may be partly explained by the differences among the guidelines in terms of their levels of specification as well as conceptual/ideological differences. (shrink)

The context of Covid-19 has offered an unusual cultural landscape for examining how workers view their own position relative to others, and how individuals respond to prolonged exposure to workplace stress across different sectors and cultures. Through our recent work tracking the well-being of frontline workers in the UK and Ireland, we have uncovered additional psychological factors that have not been accounted for in previous models of occupational stress or burnout. In recent months, frontline workers have worked to protect the (...) community from the threat of SARS-CoV-2 and, simultaneously, have evaluated their perceptions of collective efforts of others as either congruent or incongruent with collective goals : we call this novel aspect solidarity appraisal. These frontline workers have been hailed as heroes, which we argue has led to the creation of an implicit psychological contract between frontline workers and the public. Here, the heroes are willing to “go above and beyond” for the greater good, with the expectation that we do our part by adhering to public health guidelines. Where frontline workers perceive incongruence between the words and actions of others in working toward collective goals this drives negative affect and subsequent burnout. In this perspective article, we evaluate the cultural context of the pandemic in the UK and Ireland and suggest important socio-cultural factors that contribute to perceptions of solidarity, and how this may relate to burnout and worker welfare during and beyond the pandemic context. (shrink)

The behavior of people in the presence of scarce resources has long been a source of ethical concern and debate. Many of the responses, ranging from outright brutality and cheating on the one hand to altruism, nobility, and sacrifice on the other, were most recently demonstrated in the movie Titanic. It should come as no surprise, then, that rational efforts to allocate the very scarce life-saving resource of organs are sometimes circumvented by these natural human impulses and sheer human creativity. (...) This is especially true when the organs in question are required for continued life and cannot be temporarily or permanently replaced by technology. Thus the focus of this paper will be on the competition for livers. (shrink)

Background In the EU, clinical assessors, rapporteurs and the Committee for Medicinal Products for Human Use are obliged to assess the ethical aspects of a clinical development program and include major ethical flaws in the marketing authorization deliberation processes. To this date, we know very little about the manner that these regulators put this obligation into action. In this paper, we intend to look into the manner and the extent that ethical issues discovered during inspection have reached the deliberation processes. (...) Methods To gather data, we used the Dutch Medicines Evaluation Board database and first searched for the inspections, and their accompanying site inspection reports and integrated inspection reports, related to central marketing authorization applications of drugs submitted to the European Medicines Agency from 2011 to 2015. We then extracted inspection findings that were purely of ethical nature, i.e., those that did not affect the benefit/risk balance of the study. Only findings graded at least major by the inspectorate were included. Lastly, to identify how many of the ethically relevant findings reach the application deliberation processes, we extracted the relevant joint response assessment reports and reviewed the sections that discussed inspection findings. Results From 2011 to 2015, there were 390 processed applications, of which 65 had inspection reports and integrated inspection reports accessible via the database of the Dutch Medicines Evaluation Board. Of the 65, we found ERFs in 37. The majority of the ERFs were graded as major and half of the time it was informed-consent related. A third of these findings were related to research ethics committee processes and requirements. Of the 37 inspections with ERFs, 30 were endorsed in the integrated inspection reports as generally GCP compliant. Day 150 joint response assessment reports and Day 180 list of outstanding issues were reviewed for all 37 inspections, and none of the ERFs were carried over in any of the assessment reports or list of outstanding issues. Conclusion None of the ethically relevant findings, all of which were graded as major or critical in integrated inspection reports, were explicitly carried over to the joint assessment reports. This calls for more transparency in EMA application deliberations on how ERFs are considered, if at all, in the decision-making processes. (shrink)

BackgroundResearch ethics committees (RECs) are tasked to assess the risks and the benefits of a trial. Currently, two procedure-level approaches are predominant, the Net Risk Test and the Component Analysis.DiscussionBy looking at decision studies, we see that both procedure-level approaches conflate the various risk-benefit tasks, i.e., risk-benefit assessment, risk-benefit evaluation, risk treatment, and decision making. This conflation makes the RECs’ risk-benefit task confusing, if not impossible. We further realize that RECs are not meant to do all the risk-benefit tasks; instead, (...) RECs are meant to evaluate risks and benefits, appraise risk treatment suggestions, and make the final decision.ConclusionAs such, research ethics would benefit from looking beyond the procedure-level approaches and allowing disciplines like decision studies to be involved in the discourse on RECs’ risk-benefit task. (shrink)

BackgroundThe Netherlands is one of the few countries where euthanasia is legal under strict conditions. This study investigates whether Dutch newspaper articles use the term ‘euthanasia’ according to the legal definition and determines what arguments for and against euthanasia they contain.MethodsWe did an electronic search of seven Dutch national newspapers between January 2009 and May 2010 and conducted a content analysis.ResultsOf the 284 articles containing the term ‘euthanasia’, 24% referred to practices outside the scope of the law, mostly relating to (...) the forgoing of life-prolonging treatments and assistance in suicide by others than physicians. Of the articles with euthanasia as the main topic, 36% described euthanasia in the context of a terminally ill patient, 24% for older persons, 16% for persons with dementia, and 9% for persons with a psychiatric disorder. The most frequent arguments for euthanasia included the importance of self-determination and the fact that euthanasia contributes to a good death. The most frequent arguments opposing euthanasia were that suffering should instead be alleviated by better care, that providing euthanasia can be disturbing, and that society should protect the vulnerable.ConclusionsOf the newspaper articles, 24% uses the term ‘euthanasia’ for practices that are outside the scope of the euthanasia law. Typically, the more unusual cases are discussed. This might lead to misunderstandings between citizens and physicians. Despite the Dutch legalisation of euthanasia, the debate about its acceptability and boundaries is ongoing and both sides of the debate are clearly represented. (shrink)

We argue that imaginary worlds gain much of their appeal because they fulfill the fundamental need of human beings to feel connected to other humans. Immersion into story worlds provides a sense of social connection to the characters and groups represented in the world. By fulfilling the need to belong, imaginary worlds provide a buffer against rejection and loneliness.

This empirical study concerns the authorship credit decision-making processes and outcomes that occur among coauthors in cases of multiauthored publications. The 2002 American Psychological Association (APA) Ethics Code offers standards for determining authorship order; however, little is known about how these decisions are made in actual practice. Results from a survey of 109 randomly selected authors indicated that most authors were satisfied with the decision-making process and outcome with few disagreements. Participants reported cases of both undeserved authorship being given and (...) omission of deserving contributors' names as coauthors. Some factors associated with authorship decisions included "sense of loyalty or obligation," "publish or perish pressures," and "power differentials." Authors who used APA standards were significantly more satisfied with both the process and outcome of authorship credit decisions. (shrink)

This book addresses the challenges of living together after empire in many post-colonial cities. It is organized in two sections. The first section focuses on efforts by people of multiple faiths to live together within their contexts, including such efforts within a neighborhood in urban Manchester; the array of attempts at creating multi-faith spaces for worship across the globe; and initiatives to commemorate divisive conflict together in Northern Ireland. The second section utilizes particular postcolonial methods to illuminate pressing issues within (...) specific contexts—including women’s leadership in an indigenous denomination in the variegated African landscape, and baptism and discipleship among Dalit communities in India. In the context of growing multiculturalism in the West, this volume offers a postcolonial theological resource, challenging the epistemologies in the Western academy. (shrink)