The world’s first living donor liver transplant from an HIV-positive mother to her HIV-negative child, performed by our team in Johannesburg, South Africa in 2017, was necessitated by disease profile and health system challenges. In our country, we have a major shortage of donor organs, which compels us to consider innovative solutions to save lives. Simultaneously, the transition of the HIV pandemic, from a death sentence to a chronic illness with excellent survival on treatment required us to rethink our policies (...) regarding HIV infection and living donor liver transplantation. Although HIV infection in the donor is internationally considered an absolute contraindication for transplant to an HIV-negative recipient, there have been a very small number of unintentional transplants from HIV-positive deceased donors to HIV-negative recipients. These transplant recipients do well on antiretroviral medication and their graft survival is not compromised. We have had a number of HIV-positive parents in our setting express a desire to be living liver donors for their critically ill children. Declining these parents as living donors has become increasingly unjustifiable given the very small deceased donor pool in SA; and because many of these parents are virally suppressed and would otherwise fulfil our eligibility criteria as living donors. This paper discusses the evolution of HIV and transplantation in SA, highlights some of the primary ethical considerations for us when embarking on this case and considers the new ethical issues that have arisen since we undertook this transplant. (shrink)

Utilising empirical ethics analysis, we evaluate the merits of systems proposed to increase deceased organ donation in South Africa. We conclude that SA should maintain its soft opt-in policy, and enhance it with ‘required transplant referral’ in order to maximise donor numbers within an ethically and legally acceptable framework. In SA, as is the case worldwide, the demand for donor organs far exceeds the supply thereof. Currently utilising a soft opt-in system, SA faces the challenge of how to increase donor (...) numbers in a context which is imbued with inequalities in access to healthcare, multiplicitous personal beliefs and practices, distrust of organ transplant and varying levels of education and health literacy. We argue that a hard opt-in, opt-out or mandated consent system would be problematic, and we present empirical data from Gauteng Province illustrating barriers to ethically sound practice in soft consent systems. Ultimately, we argue that in spite of some limitations, a soft opt-in system is most realistic for SA because its implementation does not require extensive public education campaigns at national level, and it does not threaten to further erode trust at a clinical level. However, to circumvent some of the clinical-level barriers identified in our empirical study, we propose a contextually sensitive option for “enabling” soft opt-in through “required transplant referral”. We argue that this system is legally defensible, enhances ethical practice and could also increase donor numbers as it has in many other countries. (shrink)

Resource constraints in developing countries compel policy makers to ration the provision of healthcare services. This article examines one such set of Guidelines: A patient dialysing in the state sector in South Africa may not refuse renal transplantation when a kidney becomes available. Refusal of transplantation can lead to exclusion from the state-funded dialysis programme. This Guideline is legally acceptable as related to Constitutional stipulations which allow for rationing healthcare resources in South Africa. Evaluating the ethical merit of the Guideline, (...) and exploring the ethical dilemma it poses, proves a more complex task. We examine the actions of healthcare professionals as constrained by the Guideline. From a best interests framework, we argue that in these circumstances directing patient decision making is not necessarily unethical or unacceptably paternalistic. We then scrutinise the guideline itself through several different ethical ‘lenses’. Here, we argue that bioethics does not provide a definitive answer as to the moral merit of rationing dialysis under these circumstances, however it can be considered just in this context. We conclude by examining a potential pitfall of the Guideline: Unwilling transplant recipients may not comply with immunosuppressive medication, which raises questions for policies based on resource management and rationing. (shrink)

Rousseau in Drag is a provocative new interpretation of Rousseau's gender politics. Rosanne Terese Kennedy reads Rousseau's well-known but brief flirtation with cross-dressing as a starting point to dramatically reconsider the standard reading of Rousseau as a misogynist. This study argues that rather than a figure of misogyny, Rousseau challenges normative gender identites, the couple, and traditional kinship relations. Reading Rousseau's classical political and philosophical works alongside his literary texts, Kennedy offers us an alternative vision of both Rousseau's sexual (...) politics and his politics in general. (shrink)

Malcolm Feeley, one of the founding giants of the law and society field, is also one of its most exciting, diverse, and contemporary scholars. His works have examined criminal courts, prison reform, the legal profession, legal professionalism, and a variety of other important topics of enduring theoretical interest with a keen eye for the practical implications. In this volume, The Legal Process and the Promise of Justice, an eminent group of contemporary law and society scholars offer fresh and original analyzes (...) of his work. They asses the legacy of Feeley's theoretical innovations, put his findings to the test of time, and provide provocative historical and international perspectives for his insights. This collection of original essays not only draws attention to Professor Feeley's seminal writings but also to the theories and ideas of others who, inspired by Feeley, have explored how courts and the legal process really work to provide a promise of justice. (shrink)

This study examined knowledge of sea lions for both residents and tourists on San Cristóbal Island in the Galápagos, a famous nature tourism destination. Participants obtained through convenience and snowball sampling answered questionnaires about their knowledge of sea lions. Participants with higher education received higher overall scores, but participants’ education and age influenced answers on only a few questions. Residents and tourists obtained comparable overall scores, exhibiting extensive knowledge of sea lion behavior and life history. Whether participants were residents or (...) tourists influenced answers to several questions, but when only participants with 13 years of education or more were examined, few differences in answers remained between residents or tourists. Participants’ broad knowledge of sea lions may be attributed to the items of knowledge tested, participants’ motivations for travel to the Galápagos, and the fact that sea lions are an engaging and ubiquitous animal. (shrink)

According to the Argument for Autonomous Mental Disorder, mental disorder can occur in the absence of brain disorder, just as software problems can occur in the absence of hardware problems in a computer. This article argues that the AAMD is unsound. I begin by introducing the “natural dysfunction analysis” of disorder, before outlining the AAMD. I then analyze the necessary conditions for realizer autonomous dysfunction. Building on this, I show that software functions disassociate from hardware functions in a way that (...) mental functions do not disassociate from brain functions. It follows that mental disorders are brain disorders necessarily. (shrink)

The archive can take many forms but all are marked by a connective sequence: archive, memory, the past, narrative. The author explores this sequence through an account of her engagement with four different types of archive, constructing a phenomenology of the archive which highlights the promises and seductions offered to the researcher. Postmodern questioning may throw in doubt older conceptions, whereby the archive is used to legitimate knowledge claims about the past of a nomological nature. However, in a context where (...) intellectuals become interpreters rather than legislators, the role of the archive as repository of inert meanings is strengthened rather than weakened; using the archive helps us to understand the dialectical nature of the relationship between past and present and our own positioning within this. (shrink)

Sabellianism, the doctrine that the Persons of the Trinity are roles that a single divine being plays either simultaneously or successively, is commonly thought to entail that the Father is the Son. I argue that there is at least one version of Sabellianism that does not have this result and meets the requirements for a minimally decent doctrine of the Trinity insofar as it affirms that each Person of the Trinity is God and that the Trinity of Persons is God (...) while maintaining monotheism without undermining the distinctness of Persons. (shrink)

The prior issue of Krisis (42:1) published Critical Naturalism: A Manifesto, with the aim to instigate a debate of the issues raised in this manifesto – the necessary re-thinking of the role (and the concept) of nature in critical theory in relation to questions of ecology, health, and inequality. Since Krisis considers itself a place for philosophical debates that take contemporary struggles as starting point, it issued an open call and solicited responses to the manifesto. This is one of the (...) sixteen selected responses, which augment, specify, or question the assumptions and arguments of the manifesto. (shrink)

Justin Garson has recently advanced a Generalised Selected Effects Theory of biological proper function. According to Garson, his theory spells trouble for the Dysfunction Account of Disorder. This paper argues that Garson’s critique of the Dysfunction Account from the Generalised Theory fails, and that we should reject the Generalised Theory outright. I first show that the Generalised Theory does not, as Garson asserts, imply that neurally selected disorders are not dysfunctional. Rather, it implies that they are both functional and dysfunctional. (...) I argue on this basis that the Generalised Theory yields conflicting functional norms, and we that should reject it outright on these grounds. (shrink)

This bibliography seeks to offer a comprehensive overview of nuclear criticism, tracing its development from the 1984 issue of diacritics which saw the publication of Derrida's seminal article “No Apocalypse, Not Now ” to the present day. Particular attention is paid to areas of interest which are underrepresented in the available literature, and every attempt has been made to offer a resource which is wide-ranging in outlook while providing a clear sense of the central texts which have shaped and reshaped (...) what we understand as nuclear criticism. Texts focusing solely on individual works have, by and large, been excluded. Brief notes accompany some of the entries, although it has not been practical to provide these for all the works mentioned: they should be taken as a record of an individual approach to the texts in question rather than as marks of overarching significance. (shrink)

This paper asks when a natural disease kind is truly 'reactive' and when it is merely associated with a corresponding social kind. I begin with a permissive account of real kinds and their structure, distinguishing natural kinds, indifferent kinds and reactive kinds as varieties of real kind characterised by super-explanatory properties. I then situate disease kinds within this framework, arguing that many disease kinds prima facie are both natural and reactive. I proceed to distinguish ‘simple dependence’, ‘secondary dependence’ and ‘essential (...) dependence’ between a natural kind and its classification, and argue that a natural kind is only really reactive, in an important sense, under conditions of essential dependence. On this basis, I offer a principled hypothesis for why psychiatric kinds tend to be more metaphysically unstable than paradigm somatic disease kinds. (shrink)

Can a materialist look for the resurrection of the dead and the life of the world to come? Dean Zimmerman’s Falling Elevator Model is a speculative account of how persons, understood as material beings, might survive in a post-mortem resurrected state—a just-so story. It assumes endurantism, the doctrine that persons and other ordinary objects are three-dimensional beings which are wholly present at every time they exist. I argue that neither endurantism, nor purdurantism, according to which persons are four-dimensional ‘worms’ who (...) have proper temporal parts at every time that they exist, provides a plausible account of personal survival. If you want to be a Christian materialist you should embrace exdurantism, the ‘stage theory’, according which persons are instantaneous stages and are not identical to their temporal successors either in this world or in any world to come. Exdurantism provides a plausible account of survival in ordinary cases and extraordinary cases of this-worldly fission, and of post-mortem survival. (shrink)

Background Generally, there is unanimity about the value of community engagement in health-related research. There is also a growing tendency to view genetics and genomics research (GGR) as a special category of research, the conduct of which including community engagement (CE) as needing additional caution. One of the motivations of this study was to establish how differently if at all, we should think about CE in GGR. Aim To assess the perspectives of genetics and genomics researchers in Uganda on CE (...) in GGR. Method A cross-sectional qualitative study was conducted at Makerere University and Uganda Virus Research Institute. Twenty-five individuals participated, the majority being male (sixteen). Participants included nineteen genetics and genomics researchers (researchers and research coordinators), two CE officers, three nurses and one nursing counsellor. Data were collected using in-depth interviews and analyzed in a thematic manner using NVivo version 12 Plus. Study findings Thirteen of the respondents had conducted CE in their GGR in either a geographical and disease-specific community. Some respondents said CE principles are the same and there is no need for special consideration for CE in GGR. Others gave ethical issues in GGR that require special consideration for CE in such research and these were categorized into six themes: GGR is new to communities, Difficulty in communicating GGR by the researchers, Genes are shared in communities, Cultural sensitivities against GGR, Community attitude toward GGR, Some GGR studies take long to end, and Negotiation of research benefits. Special considerations for CE when conducting GGR were suggested and categorized into seven themes: creating awareness of GGR in communities, obtaining both community acceptance and individual consent, CE team composition, involve communities in solving GGR challenges, prolong CE in some GGR, develop guidelines for CE in GGR, and legal considerations on GGR. Conclusion GGR was characterized by special issues that require special CE considerations for such research. (shrink)

Modal counterpart theory identifies a thing’s possibly being F with its having a counterpart that is F at another possible world; temporal counterpart theory, the stage view, according to which people and other ordinary objects are instantaneous stages, identifies a thing’s having been F or going to be F, with its having a counterpart that is F at another time. Both counterpart theories invite what has been called ‘the argument from concern’ (Rosen, G. 1990. “Modal Fictionalism.” Mind 99 (395): 327–54). (...) Why should I be concerned about my counterparts at other possible worlds or other times? I care about how things might have gone for me—not how they go for other people at other possible worlds; I care about my prospects—not the way go for other people at other times. Jiri Benovsky has argued that while modal counterpart theory can be defended against this style of argument, temporal counterpart theory cannot (Benovsky, J. 2015. “Alethic Modalities, Temporal Modalities, and Representation.” Kriterion: Journal of Philosophy 29: 18–34). I argue that temporal counterpart theory, like modal counterpart theory, resists the argument from concern. (shrink)

Modal counterpart theory identifies a thing’s possibly being F with its having a counterpart that is F at another possible world; temporal counterpart theory identifies a thing’s having been F or going to be F, with its having a counterpart that is F at another time. Benovsky, J. 2015. “Alethic Modalities, Temporal Modalities, and Representation.” Kriterion: Journal of Philosophy 29: 18–34 in this journal endorses modal counterpart theory but holds that temporal counterpart theory is untenable because it does not license (...) the ascription of the intuitively correct temporal properties to ordinary objects, and hence that we should understand ordinary objects, including persons, as transtemporal ‘worms’. I argue that the worm theory is problematic when it comes to accounting for what matters in survival and that temporal counterpart theory provides a plausible account of personal persistence. (shrink)

Defining Mental Disorder: Jerome Wakefield and His Critics, edited by Denis Forest and Luc Faucher, is essential reading for students and researchers in philosophy of medicine whose work is informed by that of Jerome Wakefield, or the disease debate in general. If you are anything like me, this book will open the door to a new depth of understanding of the harmful dysfunction analysis (HDA) and its methodical underpinnings, and an enriched appreciation of what is at stake in defining medical (...) disorder. To those confident that they understand Wakefield’s view and the surrounding debate, thinking perhaps that they do not need a refresher, I would say: perhaps you do not understand it as well as you think. Defining Mental Disorder provides much more than an overview of previously well-trodden ground. The chapters themselves, and Wakefield’s own detailed responses, help to elucidate a number of methodological nuances and peculiarities that have rarely been covered in such depth before. I was startled to learn how philosophically complex Wakefield’s position actually is, and how shallow my own understanding of it has been. It emerges as a far more nuanced and sophisticated account than I had given it credit for, and one that deserves serious reevaluation. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Medical Tourism:Crossing Borders to Access Health CareHarriet Hutson Gray (bio) and Susan Cartier Poland (bio)Traveling abroad for one's health has a long history for the upper social classes who sought spas, mineral baths, innovative therapies, and the fair climate of the Mediterranean as destinations to improve their health. The newest trend in the first decade of the twenty-first century has the middle class traveling from developed countries to those (...) with emerging economies to avoid treatment delays, prohibitive costs for life-saving procedures, or simply high costs for elective surgery. Others leave to have access to assisted suicide in countries that have legalized it: Belgium, The Netherlands, and Switzerland. This new era of globalization in health care has arrived without the benefit of international standards, government oversight, or ethical and legal review.Howard Staab, a self-employed carpenter from North Carolina, flew to India for his medically necessary heart surgery, scheduled a side trip to the Taj Mahal, and returned home to work in North Carolina. He spent a total of less than $10,000, instead of the $200,000 required from the local hospital (I, Milstein and Smith 2006).At first blush, the outsourcing of medical care to India seems to be a particular solution for a particular problem. However, the particularity of Mr. Staab is not unique. His experience is emblematic of those patients in the United States with a medical need for major and elective procedures, but who also must bear the total cost of these procedures. These middle-class, under-insured Americans go abroad.In tandem with increasingly aggressive marketing campaigns, American hospitals and companies have begun to leverage their connections in Asia to grow the medical tourism business into a major economic force. What are the consequences of this?Several authors point to the effect on the host country's population, particularly the poor, to be pushed farther down the queue to receive adequate, affordable care. Resources are applied to the foreign trade instead of building the local [End Page 193] medical infrastructure. Another potential problem is the obligation of the home-country physician to provide follow-up care. What are the legal ramifications when the procedure was illegal to begin with? Are there opportunities for redress for medical errors?These factors may be converging into a "perfect storm" for health care in the U.S., in which the potential participation of the major insurance companies in promoting offshore care will be the tipping point in the precarious structure that represents the economic currents in health care. Third-party administrators and self-funded employers may be on the cutting edge in 2009 by providing incentives to employees to travel overseas for care.I. Economic ConsiderationsConnell, John. Medical Tourism: Sea, Sun, Sand and... Surgery. Tourism Management 27: 1093–1100, 2006.As evidence of the interest of traditional tour operators in this newer twist on the industry, the author explores medical tourism as an element of the growth of world tourism. In promoting medical tourism, he urges consideration of such issues as the privatization of health care, the foundational role of technology, and uneven access to health resources.Dunn, Philip. Medical Tourism Takes Flight. H and HN: Hospitals and Health Networks: 40–44, November 2007.Writing for U.S. health care executives, Dunn emphasizes that the reality of medical tourism competes with the local medical center for patients and their insurance dollars in a significant way. He examines the possibility that U.S. insurance plans soon may offer to pay for what is currently a cash only business and that the economic impact to the local medical center could be significant or even devastating.Frontiers of Health Services Management [Selected Articles] 24 (2), Winter 2007.In "Managing Healthcare Services in the Global Marketplace" (pp. 3–18), Bruce J. Fried and Dean M. Harris consider legal, ethical, and financial implications of the international workforce. In "Globalization of Health Care" (pp. 19–30), Lynn Schroth and Ruthy Khawahja point out that the transfer of comprehensive management expertise and intellectual property from U.S. medical centers to international sites is driving the success of collaboration between U.S. and foreign health care centers. In "Is... (shrink)

At first blush, the notion a “feminist epistemology” appears, at best, peculiar—not, as Sandra Harding suggests, because “‘woman the knower’ appears to be a contradiction in terms” but because it is hard to see how an epistemology, a philosophical theory of knowledge, can be either feminist or anti-feminist since it is not clear how such a theory might benefit or harm women.

Background This pilot study evaluated the speaking book ‘What it means to be part of a clinical trial’. The book aims at empowering populations with information on their rights and responsibilities when enrolled in clinical research. Wide publication of the book—at significant cost—is anticipated. It is important that the book is evaluated within the communities for whom it is intended, and the necessary changes (if any) are made, before translation and large-scale publication takes place. Objective The objective of the study (...) was to measure the efficacy and ease of use of the book. Methods Participants were recruited from a catering company. Participants were questioned on their knowledge of clinical trials and were then given the book. Instructions for use of the book were given to one group (‘experimental’ group). The other group (‘control’ group) was not given any instructions. A week later, the investigators returned, repeated the knowledge questions and asked ‘ease of use’ questions. Results A two-way repeated measure of covariants showed a statistically significant positive increase in knowledge of clinical trials among the intervention group (p=0.02). Results for the control group displayed trends that were not statistically significant. Percentage analysis of ‘ease of use’ questions proved that the book is easy to use, although some changes would be beneficial. Conclusion This study revealed that the speaking book is easy to use. It significantly increased knowledge of clinical trials among the study sample if instructions on use of the book were provided. (shrink)

There is a mystery, present from conception, namely, how the human person, who transcends the individual elements of sperm and ovum, can nevertheless come to exist at the first instant of the sperm’s interaction with the ovum, an event marked by the formation of an “embryonic skin,” or wall. In this essay, the author holds that the full complexity of the human person implies such a profound unity-in-diversity of human being that we must, in the end, let the dialogue between (...) reason and revelation lead us to conclude that the first instant of embryonic life is the first instant that the person comes to exist: that the first sign of embryonic life is a “natural sacrament” of the internal act of God which brings the person to exist, one in soul and body. National Catholic Bioethics Quarterly 12.3 (Autumn 2012): 421–430. (shrink)

During the past four decades the governance of environmental problems – the definition of issues and their political and practical resolution – has evolved to include a wider range of stakeholders in more extensive open discussions. In the introduction to this issue of Environmental Values on ‘Environment, Policy and Participation’, we outline some features of these recent developments in participatory environmental governance, indicate some key questions that arise, and give an overview of the collection of papers in this special issue.

All authors in this symposium use a food regime perspective to ask questions about the present which—as these articles demonstrate—have several possible answers. History suggests a time perspective of 25–40 year cycles so far—a food regime 1870–1914, an experimental and chaotic era 1914–1947, and a food regime 1947–1973. It has been less than 40 years since 1973, when food regime analysts agree that a contested and experimental period began. There is no consensus on whether it has already ended or how (...) it might issue into a new food regime. The conversation is more fruitful than the conclusions. I intend these comments as an invitation to join in. (shrink)

This reflection item provides an edited account of human rights lawyer Harriet Wistrich’s conversation with Manvir Grewal, Visiting Lecturer and Ph.D. student, and Harriet Samuels, Reader in Law at the University of Westminster. It summarises the exchange which focused on Harriet Wistrich’s career trajectory and the many public interest law cases that she has brought on behalf her clients, mainly women, in both domestic and international forums. It also includes a condensed version of the question and answer (...) session with the audience. Questions included the broader issues around domestic violence, rape, coercive control, sex work and the nature of feminism. (shrink)

The Perceived Role of Ethics and Social Responsibility (PRESOR) instrument was developed in the United States by Singhapakdi et al. (1996b) as a reliable and valid scale to measure the perceived role of ethics and social responsibility in achieving organizational effectiveness. This study was carried out to confirm the factorial structure of the instrument and to assess its reliability and validity for use in Hong Kong, the finance and service heart of the Asia-Pacific region and a culture with clear differences (...) in ethical attitudes and perceptions from those of the United States. Constructive replication of the exploratory factor analytic procedure of the original study with a representative sample of Hong Kong managers failed to support the hypothesized scale structure but instead suggested a different, two-factor, structure. Confirmatory factor analysis defined the alternative model which comprised two interpretable, negatively intercorrelated factorial scales, "Importance of ethics and social responsibility" and "Subordination of ethics and social responsibility in the achievement of organizational effectiveness". The model showed a high level of goodness-of-fit for the population and the two subscales, comprised of five items and four items respectively, were shown to have acceptable internal consistency reliability. Correlational and multiple regression analysis showed highly significant levels of association with the ethical ideology dimensions of the EPQ (Forsyth, 1980), used in the validation of the original scale, and with two ethical philosophy subscales derived from the ATBEQ (Preble and Reichel, 1988). The instrument is short, easily administered, is psychometrically sound and has considerable potential in the study of the perceived role of ethics and social responsibility in the achievement of organizational effectiveness. (shrink)

This paper presents four arguments in favour of respecting Ulysses Contracts in the case of individuals who suffer with severe chronic episodic mental illnesses, and who have experienced spiralling and relapse before. First, competence comes in degrees. As such, even if a person meets the usual standard for competence at the point when they wish to refuse treatment, they may still be less competent than they were when they signed the Ulysses Contract. As such, even if competent at time 1 (...) and time 2, there can still be a disparity between the levels of competence at each time. Second, Ulysses Contracts are important to protect people’s most meaningful concerns. Third, on the approach defended, the restrictions to people’s liberty would be temporary, and would be consistent with soft paternalism, rather than hard paternalism: the contracts would be designed in such a way that individuals would be free to change their minds, and to change or cancel their Ulysses Contracts later. Finally, even if one rejects the equivalence thesis, this is still consistent with the claim that, in particular cases, it can be as wrong to allow a harm as to do a harm. Nevertheless, controversies remain. This paper also highlights several safeguards to minimise risks. Ultimately, we argue that people who are vulnerable to spiralling deserve a way to protect their autonomy as far as possible, using Ulysses Contracts when necessary. (shrink)