A woman from the Republic of Ireland has successfully challenged the country's restrictive abortion legislation at the European Court of Human Rights. 1 The woman was in remission from cancer and believed that she was at increased risk of relapse due to her unintended pregnancy. She believed that continuing with the pregnancy would have put her life at risk. She travelled to England for an abortion in 2005 and subsequently experienced medical complications when she returned to Republic of Ireland. Abortion (...) in the Republic of Ireland is permitted if the life of the pregnant woman is at risk, but given the uncertainty around interpreting the legislation and the fear of criminal sanctions, the provision is not always effective in practice. The woman argued that her right to an abortion had been denied because there was no law or procedure through which she could have her clinical entitlement established. The ECtHR was unanimous that her right to private and family life had been violated but did not uphold her challenge under Articles 2, 3 and 14. The woman was joined by two other women in the challenge but the other women were unsuccessful as their circumstances differed; their lives had not been at risk if they had continued with their pregnancies. 2The Court concluded ‘that neither the medical consultation nor litigation options, relied on by the Irish government, constituted effective and accessible procedures which allowed [her] … to establish her right to lawful abortion in Ireland’.3At the time of writing, the Irish government was considering how to implement the judgement.Review of arm's-length bodiesAs previously reported here, in July 2010 the UK Government announced plans to reform and abolish a large number of arm's-length bodies. 4 …. (shrink)

House of Lords ruling on assisted dyingIn July 2009, the House of Lords ruled that the Director of Public Prosecutions must produce clear guidelines on the prosecution of those who help friends or relatives travel abroad for assisted suicide. 1 As previously reported here, both the High Court and Court of Appeal had rejected Debbie Purdy’s case before it reached the Lords.2 As a person with primary progressive multiple sclerosis, she had asked the court to rule that her husband would (...) not face prosecution if he accompanied her to Switzerland if she decides to end her life. 3By requiring the DPP to publish offence-specific guidelines about the circumstances in which a prosecution would be brought, the law lords did not go so far as to assert a right to assistance in dying by legalising assisted suicide. It was reiterated that any change to the criminal law against aiding and abetting suicide remained a political matter for Parliament. The Lords did, however, acknowledge that the right to privacy, and the associated right to autonomy, was potentially infringed by the absence of a transparent policy about those who are competent and terminally ill, or severely and incurably disabled, and who need help to travel abroad for assisted dying. The five law lords unanimously agreed that Ms Purdy’s right to a private life, as protected by article 8 of the European Convention on Human Rights, included the right to clarity regarding the exercise of the DPP’s discretion as to whether or not to prosecute.Following the Lords’ ruling, the DPP, Keir Starmer, confirmed that the new guidance would apply to all acts of assisted suicide, those taking place within and outside of the jurisdiction.4 He then published an interim policy for wide consultation in September 2009, and is expected to produce the final policy in …. (shrink)

In proposition 7 of the second part of the Ethics, Spinoza famously contends that the “order and connection of things is the same as the order and connection of ideas.” On this basis, Spinoza argues in the scholium that thought and extension are different ways of conceiving one and the same substance: “the thinking substance and the extended substance are one and the same substance, which is now comprehended under this attribute, now under that”. Less famously, in the same scholium, (...) Spinoza insists that the relation of thought and extension is not the only issue at stake. He notes that “certain Hebrews” saw, “as if through a cloud,” the unity of God and the world in knowing: “they maintained that God, God’s intellect, and the things understood by him are one and the same.” The cloud is the idea of divine transcendence. Commenting on this passage, Aviezer Ravitzky has observed that Spinoza’s mention of these “certain Hebrews” should inform us about “an inherent problem, about dynamite concealed in the teachings of the Jewish Aristotelians such as Maimonides.” If, as Aristotle argues in the De Anima and Metaphysics, the knower and the known are one in knowing, then the distinction between God and the objects of God’s knowing is undermined. Noetic union is ontological union, for the intellect is its ideas. Thus Aristotelian noesis undermines divine transcendence. E2p7 and its scholium, then, presage the most famous—or infamous—expression of the Ethics, Deus sive Natura. Maimonides qualifies his Aristotelianism with an hierarchical emanationist cosmology, thereby avoiding the implications of noetic union by differentiating between the creator and the creatures and between the agent intellect, the lowest of the celestial spheres and source of the human acquired intellect, and the divine intellect. Gersonides, the fourteenth century giant of the medieval Jewish tradition and its most consistent Aristotelian, endorses the Aristotelian formula, arguing consistently that the intelligible is an intellect and offering a meticulous explanation of “why it is said of non-material things that the intellect, the thinker, and the intelligible are all one.” In this article, I argue that Gersonides’ own highly Averroian position is evoked in E2p7s and that Spinoza extends and radicalizes the Gersonidean inheritance. Beginning from E2p7 and its scholium, I explore the implications of noetic union for the relationship of God and the world and that between thought and extension. (shrink)

Spinoza is often conceived as a highly intellectualist philosopher, and it is tempting to read human freedom without attention to its material basis. In this paper, I study Spinoza's claim that the more the body can undergo, the more the mind can know in order to establish Spinoza's view of freedom under the attribute of extension.

"Dreaming with open eyes" is a tagline for Spinoza's critique of Descartes; the dreams in question are principally those of volition and the active imagination. In this article, I compare the Cartesian theory of imagination as an active, but not fully rational, power of the mind and the Cartesian account of the volitional self to Spinoza's views. Descartes's own dreams and theories of dreaming are the focus of the first part of the article. Thereafter I examine Spinoza's critique of Descartes (...) and his alternative account of imagination. Finally, I argue that there is a positive sense of dreaming with open eyes to be recuperated in Spinoza's thought. Construed positively, to dream with open eyes is to understand dreams and imagination as natural phenomena and so to be able to respond constructively to them in ethical and political, as well as epistemological, life. (shrink)

In Ethics 4, Spinoza argues that “A free man thinks of nothing less than of death, and his wisdom is a meditation on life, not on death” (E4p67). Spinoza’s argument for this claim depends on his view of imagination, reason, and scientia intuitiva and on his notion of conatus. I explicate Spinoza’s view of life in terms of power (potentia) and show that Spinozan death amounts to reconfiguration rather than absolute annihilation. I then show that E4p67 reflects Spinoza’s well-known account (...) of the three kinds of knowing. Thinking of death is quintessentially imaginative and passive. The free person of E4p67 is in contrast a rational person. To reason, and as becomes especially clear E5, to experience scientia intuitiva, moreover is to think of things “without any relation to time, but [rather] sub specie aeternatitis”(E2p44c2) and to experience activity To the extent, then, that we are rational, free, and active, death is a non-issue. Indeed, to the extent that we are able to meditate on life sub specie aeternitatis, we actually experience joy, love (E5p20s, p32c), eternity (Sp23s), and “the greatest satisfaction of the Mind” (E5p27). (shrink)

This article discusses the impact of Descartes’s substance-dualism on his account of discursive reason. Taking the presentation of deduction in the Rules as a paradigmatic case of thought’s extension and movement in time, I analyze the relation between intuitive and discursive understanding and that between intellect and imagination. I focus specifically on the mediation of corporeal impressions and of intellectual ideas by ingenium. As intellectual, ingenium is a faculty of understanding; as joining with phantasia, ingenium has access to corporeal affections, (...) images, and memory. Deduction involves both of these aspects of ingenium, and Descartes’s dualism complicates efforts to clarify the operations and nature of ingenium. Thus the dynamics of dualistic psychology account for some of the limitations of deduction in particular and discursive rationality in general. (shrink)

Recent discussions have often associated the theme of political transformation in Spinoza with the phenomenon of revolution, which he analyzes as sometimes inevitable but generally undesirable. In this paper, I look more broadly at the theme of change in Spinoza’s political philosophy and focus the way he conceptualizes political formation as occurring in medias res. From this standpoint, there are isolated or pre-political individuals, and politics is subsumed within nature. Human beings always exist amidst other human beings and are always-already (...) interacting with them, thereby generating order. Thus would-be founders and sovereigns act in always-already formed situations; they are artisans, working with concrete actualities, namely, human beings already shaped in causal environments or networks and producing effects, not creators absolutely de novo. Nor is there some a- or post-political phase of life. The upshot is that Spinozan politics concerns only better and worse orders, not the existence per se of civic order. I explore Spinoza’s emphasis on the affective basis of politics in light of his account of the causal complexity of imagination and its affects, and I consider the ways the art of politics is concerned with managing and shaping imagination in accord with what reason counsel. (shrink)

This paper contributes to a special issue on methodology in the history of philosophy. I consider contemporary contextualism and reflect on prospects for an increasingly pluralistic, global, and decolonial historical scholarly practice.

Considered in its seventeenth-century context, Spinoza’s way of thinking about substance and nature is striking for its simultaneous refusal of Cartesian dualism and Hobbesian materialism. Spinoza knew both thinkers’ work well, yet sided with neither. Where Descartes divides substance into thinking and extended substance, and where Hobbes reduces all things to body, Spinoza espouses what is best called a double-aspect or non-reductive monism. The single substance of the Ethics is expressed as an infinity of modes in an infinity of attributes, (...) each infinite in kind. Thought and extension are two of the infinite attributes of substance, and the simultaneous sameness and difference of thought and extension constitutes a major theme of the Ethics. Using exactly parallel demonstrations, Spinoza argues in the second part of the Ethics that substance, or God, or nature is equally a thinking thing and an extended thing. Descartes’ account of matter and extension, in which passive matter is set in motion by God, inspires harsh criticism from Spinoza. (shrink)

Through a close analysis of texts from the Second Objections and Replies to the Meditations, this article addresses the tension between the pursuit of certainty and the preservation of divine transcendence in Descartes’s philosophy. Via a hypothetical “atheist geometer,” the Objectors charge Descartes with pantheism. While the Objectors’ motivations are not clear, the objection raises provocative questions about the relation of the divine and the human mind and about the being of created or dependent entities inDescartes’s metaphysics. Descartes contends that (...) there are real, eternal essences present in the human intellect as innate ideas. I argue that this claim implicates him in pantheism, not merely univocity. In the course of the analysis, I consider recent interpretations by Wells, Marion, and Hatfield. (shrink)

The Ethics of Joy offers reconstructive argument, careful engagement with select literature, and a big-picture presentation of Spinoza’s view of the well-lived human life. Not “convinced that Kantians in ethics are Kantians because of an argument that Kant or Korsgaard makes,” Andrew Youpa urges us to consider Spinoza’s view as “an alternative way of thinking about our lives—an alternative that is illuminating and insightful”. Since “the presentation of an illuminating alternative is arguably the best a philosopher can do”, this is (...) no small task. Youpa argues that Spinozan virtue—human excellence—is defined by our power to care for ourselves and others, not by our accountability. On his reading, power, and... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:720 Feminist Studies 42, no. 3. © 2016 by Feminist Studies, Inc. Julie R. Enszer “She Who Shouts Gets Heard!”: Counting and Accounting for Women Writers in Literary Grants and Norton Anthologies In 1979, the Coordinating Council of Literary Magazines (CCLM), a New York-based nonprofit that supported literary magazines through technical assistance and grant-making, announced a new program: CCLM editor fellowships.1 Editor fellowships came with a $5,000 grant. (...) Members of the literary community nominated editors to CCLM for the award. Adrienne Rich nominated Ellen Marie Bissert, editor of the feminist journal 13th Moon, and Mab Segrest, editor of Feminary: A Feminist Journal for the South Emphasizing the Lesbian Vision, for the editor fellowships. In 1979, the inaugural year of the prize, among the ten winners, not one was a woman. Bissert was one of three honorable mentions. Bissert rejected the distinction with a public letter to Maureen Owen, the only woman on the CCLM board of directors. Bissert deplored “the sexism inherent in the panelists’ decisions.”2 Several feminist publications reprinted Bissert’s letter while “the male small press gave it scant 1. The work of CCLM continues today, although now the organization is called the Council for Literary Magazines and Presses (CLMP). Under the leadership of Jeffrey Lependorf, the nonprofit organization continues to be a vital advocate for small magazines and publishers. 2. Open letter from Ellen Marie Bissert to Maureen Owen, June 28, 1980, CCLM Editors’ Grant 1980 folder, box 6, 13th Moon records, New York Public Library, Rare Books and Manuscripts Division (hereafter, CCLM folder). Julie R. Enszer 721 coverage.”3 As a result of Bissert’s objections, CCLM released the application statistics: 225 people were nominated, forty (18%) were women, and fifteen (7%) were non-white men. Of the 124 people who completed the applications, twenty-three (19%) were women and eleven (9%) were nonwhite men. There were thirty-three semifinalists, five (15%) women and four (12%) non-white men. These numbers shocked and outraged Bissert and other feminists. Adrienne Rich wrote to Maureen Owen, “I am appalled by the blatant sexism evidenced in the Council’s decision to fund ten male editors.”4 The attention that Bissert brought to the grant process resulted in a special meeting of the CCLM board to “discuss the controversy” and the awards.5 The next year, the CCLM editor fellowships went to five journals run by women and five run by men; one of the winners of the $5,000 award in 1980 was the editorial collective of Conditions, a magazine of writing by women with an emphasis on writing by lesbians.6 In a letter to readers of Conditions, the three editors, Elly Bulkin, Jan Clausen, and Rima Shore, noted that the “feminist protest following the announcement of the 1979 awards no doubt had an impact on the decision-making process” and that the award “represents the only substantial payment we have received, or seem likely to receive, for our editorial work, and we were greatly encouraged by it.”7 Maureen Owen acknowledged the importance of Bissert’s protests saying it “strengthened my position on the board at CCLM and the position of women editors and writers in general. She who shouts, get heard!”8 In 1979, Bissert, Rich, and other feminists demonstrated the importance of shouting about the inclusion of women in systems of literary appraisal; they recognized the important economic consequences of grants for feminist publishers and feminist authors. Thirty years later, in 2009, Cate Marvin and Erin Belieu founded VIDA: Women in Literary Arts to promote “conversations regarding the critical reception 3. Open letter from Bissert to Owen. 4. Rich to Owen, August 7, 1979, CCLM folder. 5. Open letter from Bissert to Owen. 6. Press release, June 11, 1980, CCLM folder. 7. Elly Bulkin, Jan Clausen, and Rima Shore, Conditions 7, unnumbered front matter. 8. Postcard from Owen to Bissert, undated, CCLM folder. 722 Julie R. Enszer of women’s creative writing in our current culture.”9 Each February or March since 2010, VIDA releases “the count”: a compilation of the gender breakdown of prizes, reviews, and literary journals in the United States. VIDA’s numbers demonstrate bias toward men in... (shrink)

This admirable volume treats the period from Montaigne to Kant. As the editor, Donald Rutherford, promises in his Introduction, the volume reflects the broadly contextualist consensus among scholars in the field over the last few decades. Neither intellectual history nor abstract conceptual analysis, contextualist scholarship looks at the way philosophical ideas develop in concrete settings, within intellectual horizons, and in response to specific philosophical problems. Thus this Cambridge Companion is committed to the idea that a philosopher’s published works must be (...) read in connection with both his or her correspondences, drafts, and other papers, as well as in connection with the thinkers whose works constitute that philosopher’s intellectual environment and matrix. Simply put, contextualist historians of philosophy deny that philosophical work takes place in a conceptual or historical vacuum. Second, this collection reflects the expanding list of important thinkers, works, and issues in the period. The familiar authors Rutherford terms the “canonical seven” —Descartes, Spinoza, Leibniz for the “rationalists” and Locke, Berkeley, Hume for the “empiricists,” all. (shrink)

In lieu of an abstract, here is a brief excerpt of the content: Mogens Lærke. Spinoza and the Freedom of Philosophizing. Oxford: Oxford University Press, 2021. Pp. xviii + 387. Hardback, $115.00. -/- Spinoza's political philosophy, always a subject of attention in Francophone scholarship, has been coming into sharper focus for Anglophone readers in recent years as well. Mogens Lærke—well known for his essays on metaphysics and cognition in Spinoza, for his invaluable book Leibniz lecteur de Spinoza (Paris: Honoré Champion, (...) 2008), and for bridging French and English scholarly communities—has now written a richly contextual treatment of Spinoza's conception of the freedom of philosophizing (libertas philosophandi). His book presents a thoroughly mid- to late seventeenth-century Dutch Spinoza. The expression libertas philosophandi appears in the full title of Spinoza's Theologico-Political Treatise (1670, hereafter TTP). Lærke argues that libertas philosophandi is the key to understanding "Spinoza's attempt to theorize a new republican public sphere" (5). As defined by Spinoza, "the freedom of philosophizing is not for Spinoza an individual right but a collective natural authority constitutive of a particular kind of public sphere" (5)—namely, one constituted by such recognizably republican notions as equality, integrity, virtue, and honor. It depends on citizens "having taken possession of their own free judgment and on their capability and willingness to engage with each other without prejudice and deceit" (234). Far from being "granted," libertas philosophandi is "achieved through civic education and mutual advising in the public sphere" (235). Rather than a formal permission or abstract right, libertas philosophandi is a socially mediated expression of power (or what the Ethics calls conatus, striving and expression): it emerges and is maintained through cultivation, regulation, and identification, and is communal—that is, political. Put another way, libertas philosophandi is a collective form of freedom enacted as a noncoercive exchange of views among equals who agree to search for truth and pursue well-being together. As distinct from the rational and intellectual freedom examined in the Ethics, libertas philosophandi reflects everyone's natural (and so inevitable) power of self-expression and does not depend on rational attainment. The task of politics is inducing as many people as possible to express themselves constructively. Thus, politics depends on motivating people to act as if they were rational. In practice, this means that citizens must commit themselves to friendly mutual advice and teaching rather than to coercive measures, to deliberative structures rather than to secrecy and partiality, and to acceptance of a unified sovereign, whatever the exact form of the government may be. Following the indications of TTP 5 and TTP 16-17, Lærke shows that this commitment can come about either imaginatively [End Page 523] or rationally. For those who do not or cannot—or cannot consistently—comprehend the usefulness of a well-constructed imperium, imaginative myths, such as the revelation at Mount Sinai or the social contract itself, are required. For those for whom the founding myths and codes, such as the principles of universal religion, prove insufficiently binding, state force intervenes. With characteristic erudition, Lærke situates Spinoza in the political, religious, sociocultural, and economic currents of mid- to late seventeenth-century Amsterdam. This contextualization leads to new ways of understanding Spinoza's place in the history of toleration and democratic thought. Lærke pairs this historical-philosophical sleuthing with close attention to Spinoza's exact language and argumentative structure. Most provocatively, Lærke insists on the fundamental continuity of Spinoza's political philosophy against influential readings that suppose a late-life change of heart. Chapters 2–5 explore the meaning of libertas philosophandi. Chapter 2, "Circles and Spheres of Free Philosophizing," retraces the history of the notion; chapter 3, "Philosophizing," presents philosophizing as a broad argumentative style encompassing reasoning from experience and practical or historical reasoning as well as more technical modes of inference and argument. What Spinoza calls the "natural light" and characterizes as "sound reason" is thus common to all, not restricted to intellectuals. Chapter 4, "The Apostolic Styles," studies Spinoza's analysis of the teaching methods exhibited in the Greek Scriptures. Chapter 5, "Authority," draws this part of the book to a... (shrink)

We argue that while presidential candidates have the right to medical privacy, the public nature and importance of the presidency generates a moral requirement that candidates waive those rights in certain circumstances. Specifically, candidates are required to disclose information about medical conditions that are likely to seriously undermine their ability to fulfill what we call the "core functions" of the office of the presidency. This requirement exists because (1) people have the right to be governed only with their consent, (2) (...) people's consent is meaningful only when they have access to information necessary for making informed voting decisions, (3) such information is necessary for making informed voting decisions, and (4) there are no countervailing reasons sufficiently strong to override this right. We also investigate alternative mechanisms for legally encouraging or requiring disclosure. Protecting the public's right to this information is of particular importance because of the documented history of deception and secrecy regarding the health of presidents and presidential candidates. (shrink)

The possibilities for collecting, storing, and processing of data have increased significantly over the last decades. It has been argued that an increasing demand for health data will de...

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority. Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and information (...) about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18. This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

Living organ donation in the UKThe prospect of new regulation is often met with reluctance and legitimate fears of additional bureaucracy for very little benefit. Changes to the approval procedure for living organ donation in the UK, however, appear to have made a real, and positive, difference to the practice. The Human Tissue Act 2004 abolished the Unrelated Live Transplants Regulatory Authority and handed responsibility for overseeing living donation to the newly established Human Tissue Authority. On paper, the new system (...) appeared to be a significant improvement on the old one. It removed the illogical disparity between related and unrelated donors. Previously only donations from unrelated individuals needed prior approval and evidence of a genetic link was a green light to proceed without further investigation, suggesting, erroneously, that donation within families was always voluntary and free from pressure and coercion. While the reasoning behind this distinction was obvious—coming as it did in the immediate aftermath of the uncovering of an international trade in human organs—the logic behind the distinction was lacking. Although the list of permitted relationships was broad, donation between spouses, long-term partners or friends was subject to the full and frequently drawn-out approval process designed to prevent surreptitious payment.Now all living organ donation needs prior approval but the system has been streamlined to avoid the long delays that became synonymous with the old system. Under the new regime: Applications are reviewed at a local level by a group of “independent assessors” who have been trained and accredited by the HTA.The independent assessor must be satisfied that the person consenting to the donation has been given and understood the necessary information and that there is no evidence of reward or coercion or evidence that the person has been subjected to pressure to consent. …. (shrink)

Ever so often in the UK, there is a flurry of activity around the information requirements of donor-conceived individuals. In April 2013, it was the launch of a report from the Nuffield Council on Bioethics that brought the issue back to public consciousness.1Since 1991, information about treatment with donor gametes or embryos has been collected by the Human Fertilisation and Embryology Authority . Since then, over 35 000 donor-conceived individuals have been born through treatment in licensed clinics. Medical information and (...) information about donors’ appearance are collected by clinics, and donors are encouraged to put together a ‘pen portrait’ giving information about themselves for any resulting children. One focus of the new report is on improving the quality and quantity of information available about donors.Traditionally, gamete and embryo donations were practised on an anonymous basis, so that those born as a result of such donation may receive only non-identifying information about the donor when they reach the age of 18 . This changed in 2005 when donor anonymity was removed so that anyone donating after that time could be identified to individuals born as a result of the treatment. Those who have donated in the past are also able to reregister as identifiable donors. Much concern was expressed at the time that this would exacerbate the shortage of donors although the Nuffield Council on Bioethics reports that, 8 years on, those clinics that actively recruit donors appear to be successful in finding sufficient donors. The report recommends that the option of anonymous donation should not be reintroduced.A big issue of debate in the UK has been, and continues to be, whether parents should tell their …. (shrink)

Phosphotyrosine phosphatases (PTPases) are the enzymes which remove phosphate groups from protein tyrosine residues. An enormous number of phosphatases have been cloned and sequenced during the past decade, many of which are expressed in haematopoietic cells. This review focuses on the biochemistry and cell biology of three phosphatases, the transmembrane CD45 and the cytosolic SH2‐domain‐containing PTPases SHP‐1 and SHP‐2, to illustrate the diverse ways in which PTPases regulate receptor signal transduction. The involvement of these and other PTPases has been demonstrated (...) in haematopoietic cell development, apoptosis, activation and non‐responsiveness. A common theme in the actions of many haematopoietic cell PTPases is the way in which they modulate the thresholds for receptor signalling, thereby regulating critical events in the positive and negative selection of lymphocytes. There is growing interest in haematopoietic PTPases and their associated regulatory proteins as targets for pharmaceutical intervention and in the involvement of these enzymes in human disease. (shrink)

Update on donation of bodily material in the UKIn March 2010, the Human Tissue Authority announced that the first pooled kidney transplants, each involving three living donors and three recipients, had been performed in the UK. 1 While the vast majority of living donor transplants take place between people who are genetically related or are otherwise emotionally close, the Human Tissue Act 2004 introduced greater flexibility, permitting, for example, altruistic, paired and pooled donation. The HTA commented that these types of (...) donation represent one in three of all kidney transplants in the UK. Under the system of paired and pooled donation, in which someone needs a donor organ and has a friend or relative willing to donate, but the two are not compatible with each other, they can pair up with one or more other incompatible donor and recipient pairs in an organ exchange. In paired donation, donor A gives an organ to recipient B and donor B gives to recipient A; in pooled donation, more than two donor–recipient pairs take part in an organ exchange, coordinated by the HTA . Under the human tissue legislation, all cases of paired and pooled donation need to be considered by an independent assessor and approved by a panel of at least three members of the HTA, to ensure that all parties fully understand the risks involved and the donors are not under any pressure to donate.The first pooled transplant took place late in 2009, and was followed shortly afterwards by a second. Several paired living kidney transplants, involving two couples, had already taken place, however, with 16 such transplants going ahead between 1 April 2008 and 31 March 2009. Also in March 2010, a …. (shrink)

Pragmatic clinical trials offer important benefits, such as generating evidence that is suited to inform real-world health care decisions and increasing research efficiency. However, PCTs also present ethical challenges. One such challenge involves the management of information that emerges in a PCT that is unrelated to the primary research question, yet may have implications for the individual patients, clinicians, or health care systems from whom or within which research data were collected. We term these findings as?pragmatic clinical trial collateral findings,? (...) or?PCT-CFs?. In this article, we explore the ethical considerations associated with the identification, assessment, and management of PCT-CFs, and how these considerations may vary based upon the attributes of a specific PCT. Our purpose is to map the terrain of PCT-CFs to serve as a foundation for future scholarship as well as policy-making and to facilitate careful deliberation about actual cases as they occur in practice. (shrink)

Because of the coronavirus pandemic, reminders of death are particularly salient. Although much terror management theory research demonstrates that people engage in defensive tactics to manage mortality awareness, other work shows that existential concerns can motivate growth-oriented actions to improve health. The present study explored the associative link between coronavirus anxieties, fear of death, and participants' well-being. Results, using structural equation modeling, found that increased mortality concerns stemming from COVID-19 were associated with heightened benefit finding from the pandemic. Increased benefit (...) finding, in turn, was related to higher life satisfaction, meaning in life, self-esteem, resilience, and vitality while also correlating negatively with depression and stress scores. There was no evidence for reverse mediation in that fear of mortality did not predict well-being through coronavirus worries. Overall, although many persons have experienced mental health concerns as a function of the COVID-19 pandemic, our findings demonstrate positive benefits that paradoxically follow in terms of an increased appreciation of life, improved relationships, and better health. (shrink)

In England, Wales and Scotland, the vast majority of abortions take place in the first trimester of pregnancy. In 2009, for example, 91% of abortions were carried out at under 13 weeks gestation for women resident in England and Wales. 1 Early abortion opens up the opportunity for a woman to have a medical abortion rather than a surgical abortion. Medical abortion is considered to be less invasive and less expensive than surgical abortion, and is increasingly becoming the preferred method. (...) 1 The proportion of medical abortions to surgical abortions has doubled in the last five years with 52% of abortions being medical abortions under 9 weeks gestation in 2009. A medical abortion typically involves taking mifepristone to block the hormones that help a pregnancy to continue, and then later on misoprostol, which makes the womb expel the embryo/fetus, usually within 4–6 h. Current legislation requires that both sets of drugs are administered in an NHS hospital or approved place, but women can go home after taking the second dose of drugs to complete the abortion. There has long been disagreement between the Department of Health and the British Pregnancy Advisory Services about what constitutes ‘any treatment for the termination of pregnancy’ under the Abortion Act 1967, specifically whether a woman taking the second set of drugs is considered to be undergoing the ‘treatment’ and is therefore required to be present in premises permitted under the Act. At the end of 2010, BPAS went to the High Court to challenge the Department of Health's view that the legislation requires women to take both sets of drugs in an approved place. BPAS argued that ‘treatment’ stops at the point of prescription and women should be able to go home, …. (shrink)