‘Doing good medical ethics’ involves attending to both the biomedical and existential aspects of illness. For this, we need to bring in a phenomenological perspective to the clinical encounter, adopt a virtue-based ethic and resolve to re-evaluate the goals of medicine, in particular the alleviation of suffering and the role of compassion in everyday ethics.

The maternal‐fetal HIV transmission trials, conducted in developing countries in the 1990s, undoubtedly generated one of the most intense, high profile controversies in international research ethics. They sparked off a prolonged acrimonious and public debate and deeply divided the scientific community. They also provided an impetus for the revision of the Declaration of Helsinki – the most widely known guideline for international research. In this paper, I provide a brief summary of the context, outline the arguments for and against the (...) controversial use of placebo controls, and focus on particular areas that I believe merit further discussion or clarification. On balance, I argue that the researchers failed in their duties to protect the best interests of their research subjects, and to promote distributive justice. I discuss the difficulties of obtaining valid consent in this research context, and argue that it is unethical to inform women of their HIV status without at least offering them prophylactic treatment for their unborn children. A global view of justice, which endorses international equity, cannot be squared with international research guidelines that allow ‘local conditions’ to define the scope of duty to the control group. Finally, I suggest that the heated debate reflects a tension, if not an outright war, between two conflicting meta‐ethical systems, or incommensurable paradigms, that underpin scientific research involving human subjects. (shrink)

Philosophical and scientific understandings of compassion converge, both stressing its necessity for the moral life and human flourishing. I conceptualise a dynamic and frangible account of professional virtues, including compassion, and propose that mechanistic organisational systems of care and the biomedical paradigm create a strong risk of dehumanisation and the obliteration of compassion in healthcare. Additionally, the neoliberal market ideology, with its instrumental approach to individuals and commodification of healthcare creates a corrosive influence that alienates clinicians from their patients and (...) severely curtails the scope for compassionate practice. The tension between efficiency and patient orientated care – although they need not be mutually exclusive – has become more acute in the current economic climate, at a time when the boundaries of medicine have broadened and expectations for healthcare have risen. This has created an unsustainable dynamic within which alienated healthcare professionals struggle to fulfil their healing roles and patients experience abandonment and more anxiety. (shrink)

Philosophical and scientific understandings of compassion converge, both stressing its necessity for the moral life and human flourishing. I conceptualise a dynamic and frangible account of professional virtues, including compassion, and propose that mechanistic organisational systems of care and the biomedical paradigm create a strong risk of dehumanisation and the obliteration of compassion in healthcare. Additionally, the neoliberal market ideology, with its instrumental approach to individuals and commodification of healthcare creates a corrosive influence that alienates clinicians from their patients and (...) severely curtails the scope for compassionate practice. The tension between efficiency and patient orientated care – although they need not be mutually exclusive – has become more acute in the current economic climate, at a time when the boundaries of medicine have broadened and expectations for healthcare have risen. This has created an unsustainable dynamic within which alienated healthcare professionals struggle to fulfil their healing roles and patients experience abandonment and more anxiety. (shrink)

“Anonymised screening is a research tool to inform policy and practice and individual decision making, but is not a tool to identify those at risk that could directly benefit from intervention.”1The assumption that the information acquired will be used to prioritise health care resources may prove false. A government, after weighing up the costs and benefits, may choose not to adopt appropriate interventions. Or, even if a policy is proposed,, it may not be adhered to. Even as I write, antenatal (...) clinics that serve populations with the highest concentration of refugees from sub-Saharan Africa, and therefore of those at risk, still do not have a policy of universal screening.Anonymised screening is a form of non-therapeutic research, and should comply with the Helsinki Declaration on Non-therapeutic Research involving Human Subjects. I have already argued that physicians who undertake anonymised screening have abrogated their duty, as outlined in article one, “... to remain the protector of the life and health of that person on whom biomedical research is being carried out”.2In addition, article four states: “In research on man, the interest of science and society should never take precedence over considerations related to the wellbeing of the subject.”2The desire for an outcome—perfect epidemiological figures—should not override the ethics of the process whereby this is achieved. The …. (shrink)

This qualitative cross-sectional survey, undertaken in the antenatal booking clinics of a hospital in central London, explores pregnant women’s responses to routine HIV testing, examines their reasons for declining or accepting the test, and assesses how far their responses fulfil standard criteria for informed consent. Of the 32 women interviewed, only 10 participants were prepared for HIV testing at their booking interview. None of the women viewed themselves as being particularly at risk for HIV infection. The minority of the participants (...) who declined testing differed from those who accepted, by interpreting test acceptance as risky behaviour, privileging the negative outcomes of HIV positivity and expressing an inability to cope with these, should they occur. Troublingly, only a minority of women had a broad understanding of the rationale for the test, and none fulfilled the standard criteria for informed consent. This study suggests that, although routine screening combined with professional recommendation may be successful in increasing uptake, this may be at the cost of eroding informed consent. Protecting third parties from a preventable disease may outweigh the moral duty of respecting autonomy, enshrined in Western bioethical tradition. Nevertheless, such a policy should be made transparent, debated in the public domain and negotiated with women seeking antenatal care. (shrink)

Seroprevalence monitoring of HIV in pregnant women by anonymised unlinked testing has been widely adopted in the UK and other countries. The scientific rationale is to eliminate participation and selection bias. The ethical justification is that the public good outweighs any harm to individuals. The assumption has been that individuals have had their autonomy respected by the offer of informed consent. In the light of new scientific evidence, it is doubtful that the public good is best served by the continuation (...) of anonymously testing women receiving antenatal care. It is submitted that it is no longer ethical for health professionals to refrain from informing pregnant women of the benefits of voluntary named testing, or to request their consent to anonymised testing. The legal and moral concept of duty of care is examined, and the abrogation of this duty through anonymisation is explained. (shrink)

Hoffmaster endeavours to enrich the dominant bioethical paradigm, based on abstract principles, with the lived experience of moral decision making. He proposes that bioethics involves not only the justifications for moral judgments, but also the understanding of the beliefs and values underpinning them. The “old” conventional bioethics, situated in “rationality and generality”, is to be replaced by a new “reoriented” bioethics, situated in the untidy world of “lived human experience”. In other words, context, in its widest sense, is to be (...) integrated into the bioethical framework. The relevance of social context in moral philosophy is not new, however. As MacIntyre tells us in After Virtue : “... it also follows that we have not yet fully understood the claims of any moral philosophy until we have spelled out what its social embodiment would be”. He reminds us that Plato and Aristotle, amongst others, undertook this project. MacIntyre, like Hoffmaster, laments the loss of social embodiment in the “narrow conception” of contemporary moral philosophy. I submit that we are now witnessing the rejection of Cartesian duality and the revival, or restoration, of an old paradigm—reintegrating the social milieu, narrative, and the emotions, in our conceptualisation of moral philosophy. Hoffmaster’s second goal is to raise the profile of social science research in the field of bioethics. He argues that the distinction between descriptive and normative ethics is artificial, and that the former is unfairly …. (shrink)

Any theory of information needs to comply with what we call the implementation, formalization, and representation constraints. These constraints are justified by basic considerations concerning scientific modelling and methodology. In the first part of this paper, we argue that the implementation and formalization constraints cannot be satisfied because the relation between Shannon information and IIT must be clarified. In the second part of the paper, we focus on the representation constraint. We argue that IIT cannot succeed in satisfying this constraint (...) for semantic contents without offering models for concepts, conceptual roles, and context sensitivity. In the final part of the paper, further complications are raised with respect to the distinction between consciousness and attention, which apply more specifically to the representation constraint. We conclude with some recommendations as to how IIT may succeed in solving these problems, highlighting the advantages and enormous potential of IIT as a scientific theory. (shrink)

To what degree has biology influenced and shaped the development of moral systems? One way to determine the extent to which human moral systems might be the product of natural selection is to explore behaviour in other species that is analogous and perhaps homologous to our own. Many non-human primates, for example, have similar methods to humans for resolving, managing, and preventing conflicts of interests within their groups. Such methods, which include reciprocity and food sharing, reconciliation, consolation, conflict intervention, and (...) mediation, are the very building blocks of moral systems in that they are based on and facilitate cohesion among individuals and reflect a concerted effort by community members to find shared solutions to social conflict. Furthermore, these methods of resource distribution and conflict resolution often require or make use of capacities for empathy, sympathy, and sometimes even community concern. Non-human primates in societies in which such mechanisms are present may not be exactly moral beings, but they do show signs of a sense of social regularity that -- just like the norms and rules underlying human moral conduct -- promotes a mutually satisfactory modus vivendi. (shrink)

The phenomenon of cheating in higher education is of overwhelming importance in that the students engaging in these acts are unlikely to have the skills necessary for their future professional life. Despite its relevance, the empirical evaluation of cheating in universities has been almost exclusively focused on the US context. Little is known about cheating at the European level, let alone in Portugal. Even less is explored at the regional level. In this paper we present evidence on the perception of (...) cheating by Portuguese undergraduate students of economics/business degrees. We undertake a large-scale survey, involving 2675 students from all Portuguese mainland public universities. We found that copying-favourable environments are associated with a higher propensity to cheat. Moreover, in universities where ‘codes of honour’ exist, this propensity tends to be lower. Finally, the propensity to copy seems to be highly influenced by the cultural systems and socially-related factors of different regions. (shrink)

This paper proposes that human expression of pain in the presence or absence of caregivers, and the detection of pain by observers, arises from evolved propensities. The function of pain is to demand attention and prioritise escape, recovery, and healing; where others can help achieve these goals, effective communication of pain is required. Evidence is reviewed of a distinct and specific facial expression of pain from infancy to old age, consistent across stimuli, and recognizable as pain by observers. Voluntary control (...) over amplitude is incomplete, and observers can better detect pain that the individual attempts to suppress rather than amplify or simulate. In many clinical and experimental settings, the facial expression of pain is incorporated with verbal and nonverbal vocal activity, posture, and movement in an overall category of pain behaviour. This is assumed by clinicians to be under operant control of social contingencies such as sympathy, caregiving, and practical help; thus, strong facial expression is presumed to constitute an attempt to manipulate these contingencies by amplification of the normal expression. Operant formulations support skepticism about the presence or extent of pain, judgments of malingering, and sometimes the withholding of caregiving and help. To the extent that pain expression is influenced by environmental contingencies, however, could equally plausibly constitute the release of suppression according to evolved contingent propensities that guide behaviour. Pain has been largely neglected in the evolutionary literature and the literature on expression of emotion, but an evolutionary account can generate improved assessment of pain and reactions to it. (shrink)

Research on cultural transmission among Americans has established a bias for transmitting stories that have disgusting elements. Conceived of as a cultural evolutionary force, this phenomenon is one type of emotional selection. In a series of online studies with Americans and Indians we investigate whether there are cultural differences in emotional selection, such that the transmission process favours different kinds of content in different countries. The first study found a bias for disgusting content among Americans but not among Indians. Four (...) subsequent studies focused on how country interacts with kind of emotional content in reactions to transmission of stories or information. Whereas Indian participants, compared to Americans, tended to be less interested in, and excited by, transmission of stories and news involving common disgust-elicitors, the opposite pattern held for transmission of happy surprises and good news. We discuss various possible explanations and implications. (shrink)

ABSTRACTThis article introduces the Hyperbole Identification Procedure, a first systematic method for identifying linguistic hyperbole in discourse. We start by comparing existing definitions of linguistic hyperbole. Based on the commonalities shared by these definitions, we provide our operational definition of hyperbole as “an expression that is more extreme than justified given its ontological referent.” The next section argues why it is useful to identify hyperbole, as with metaphor in Metaphor Identification Procedure Vrije Universiteit, at the level of lexical units, and (...) subsequently introduces the steps of HIP. We follow up with two sample analyses of HIP in practice. First, we show how to unitize and analyze one complete sample sentence. Second, we present sample analyses of a number of selected cases. Then we present data showing that HIP can be reliably applied to a sample corpus of Dutch news texts. We end with discussing applications and implications of using HIP in corpus research. (shrink)

Attentional bias has been suggested to contribute to the persistence of substance use behavior. However, the empirical evidence for its proposed role in addiction is inconsistent. This might be due to the inability of commonly used measures to differentiate between attentional engagement and attentional disengagement. Attesting to the importance of differentiating between both components of AB, a recent study using the odd-one-out task showed that substance use was differentially related to engagement and disengagement bias. However, the AB measures derived from (...) the OOOT showed insufficient reliability to be used as a solid measure of individual differences. Therefore, the current study aimed to improve the reliability of the AB measures derived from the OOOT by using more distinct contrast stimuli, adding practice trials, increasing the number of trials, and by having participants perform the task in an alcohol-relevant context. We contrasted the original OOOT with the adapted OOOT and assessed AB in low- and high-drinking individuals. Participants were 245 undergraduate students who typically tend to drink either low or high amounts of alcohol. In one condition, AB was measured with the original OOOT in a typical laboratory context, whereas in the other condition, AB was measured with the OOOT-adapt in a bar context. The OOOT-adapt showed superior internal consistency, especially for the high-drinking group. Further, specifically the OOOT-adapt differentiated between low- and high-drinking participants showing that high drinkers engaged faster with alcohol cues than did low drinkers. Thus, the OOOT-adapt was found to be a promising candidate to reliably index AB in the context of alcohol use. The OOOT-adapt further showed superior criterion validity as it could differentiate between low- and high-drinking individuals, thereby adding to the evidence that AB might be involved in substance use behavior. (shrink)

This 1999 volume takes a critical look at the current divide over immigration policies. It hopes to shed light on the debate by bringing together papers that investigate the link between trade and factor mobility, particularly labour migration, from theoretical and empirical perspectives. It examines the substitutability between trade and migration, the impact of regional integration on the location of economic activity, the role of public goods provisions, and the political economy of migration. Several papers quantify the link between trade, (...) trade policies, migration and income distribution in sending and receiving nations using econometric methods and general equilibrium simulations. Case studies of past and present migration episodes are also presented: the impact of NAFTA on migratory pressure and wage gaps; the trade-migration links between Eastern and Western Europe; and the historical experience with migration flows in the nineteenth century. (shrink)

A review of the chemical education research literature suggests that the term constructivism is used in two ways: experience-based constructivism and discipline-based constructivism. These two perspectives are examined as an epistemology in relation to the teaching and learning of the concept of idealization in chemistry. It is claimed that experience-based constructivism is powerless to inform the origin of such concepts in chemistry and while discipline-based constructivism can admit such theoretical concepts as idealization it does not offer any unique perspectives that (...) cannot be obtained from other models. Chemical education researchers do not consistently appeal to constructivism as an epistemology or as a teaching/learning perspective and it is shown that, while it draws attention to worthwhile teaching/learning strategies, it cannot be considered as foundational to chemical education research and tends to be used more as an educational label than as an undergirding theory. (shrink)

O trabalho pretende expor, em suas linhas gerais, a ligação, presente na teoria da consciência desenvolvida por Hegel, na Filosofia do Espírito de Jena, entre a formação da consciência, compreendida no bojo dos processos de individualização e desenvolvimento das capacidades práticocognitivas, e a pré-articulação linguística da cognição. Para isso, o ponto de partida é a exposição dos aspectos gerais da teoria hegeliana da consciência, nessa fase. Em seguida, interpreta-se essa teoria da consciência, relacionando-a a processos societários de desenvolvimento de capacidades (...) prático-cognitivas. A partir disso, procura-se então delinear os aspectos fundamentais da relação entre razão teórica e linguagem. Finalmente, discute-se a recuperação da consideração sobre a linguagem, no processo de formação da consciência. (shrink)

BackgroundIn gender-affirming medical care (GAMC), ethical challenges in decision-making are ubiquitous. These challenges are becoming more pressing due to exponentially increasing referrals, politico-legal contestation, and divergent normative views regarding decisional roles and models. Little is known, however, about what ethical challenges related to decision-making healthcare professionals (HCPs) themselves face in their daily work in GAMC and how these relate to, for example, the subjective nature of Gender Incongruence (GI), the multidisciplinary character of GAMC and the role HCPs play in assessing (...) GI and eligibility for interventions. Given the relevance and urgency of these questions, we conducted a qualitative study among HCPs providing GAMC to transgender adults in the Netherlands.MethodsIn this qualitative research, we conducted 11 semi-structured interviews between May 2020 and February 2021 with HCPs (six mental health professionals, two HCPs in endocrinology, two in plastic surgery, and one in nursing) working in two distinct GAMC settings. We purposively sampled for professional background and years of experience in GAMC. We analyzed our interview data using thematic analysis. As some respondents were more inclined to speak about what should or ought to be done to arrive at good or right decision-making, we identified both ethical challenges and norms. Furthermore, in our analysis, we differentiated between respondents’ explicit and implicit ethical challenges and norms and ascertained the specific context in which these challenges emerged.ResultsRespondents’ ethical challenges and norms centered on (1) dividing and defining decisional roles and bounds, (2) negotiating decision-making in a (multidisciplinary) team, and (3) navigating various decision-making temporalities. These themes arose in the context of uncertainties regarding (1) GAMC’s guidelines, evidence, and outcomes, as well as (2) the boundaries and assessment of GI.ConclusionsThis interview study provides detailed empirical insight into both the explicit and implicit ethical challenges that HCPs experience and their ethical norms regarding decision-making. It also describes how uncertainties and (implicit) normativities concerning GAMC and GI pre-structure the moral environment in which these challenges and norms manifest. We provide normative reflections and recommendations on handling these ethical challenges in a way that is sensitive to the context in which they arise. (shrink)

Este artículo investiga algunos pasajes de la _República_ de Platón para comprender algunos presupuestos y consecuencias de la argumentación del filósofo sobre el estatus de las pasiones, que culmina con la incisiva y radical afirmación, en el libro X, de que “es necesario secar las emociones” (Rep. 606d). Ello se debe a que, según Platón, ellas conducen a los hombres a actuar de forma irracional y cobarde, especialmente a aquellos ciudadanos que se acostumbran a la poesía, especialmente la dramática, que (...) incita a las pasiones. Frente a la crítica del filósofo al valor del teatro y a las expresiones de dolor (como el lamento y el llanto), propongo revalorizar el papel de la emoción en la formación del ciudadano y el fortalecimiento político de un grupo, tomando un caso contemporáneo: la ceremonia fúnebre realizada por el gobierno francés con motivo de la muerte del actor Jean-Paul Belmondo, en el contexto de la crisis pandémica de SARS-CoV-2. (shrink)