Recent reports published by the United Nations and the World Health Organization suggest that the brain drain of healthcare professionals from the developing to the developed world is decimating the provision of healthcare in poor countries. The migration of these key workers is driven by a combination of economic inequalities and the recruitment policies of governments in the rich world. This article assesses the impact of the healthcare brain drain and argues that wealthy countries have a moral obligation to reduce (...) the flow of healthcare workers from the developing to the developed world. (shrink)

Ancillary care is care that research participants need that is not essential to make the research safe or scientifically valid and is not needed to remedy injuries that eventuate as a result of the research project itself. Ancillary care duties have recently been defended on the grounds of beneficence, entrustment, utility and consent. Justice has also been mentioned as a possible basis of ancillary care duties, but little attention has been paid to this approach. In this paper, the author seeks (...) to rectify this omission by arguing that ancillary care duties can be based on a principle of justice as rectification. (shrink)

Over the past few decades, “Big Tobacco” has spread its tentacles across the developing world with devastating results. The global incidence of smoking has increased exponentially in Africa, Asia and South America and it is leading to an equally rapid increase in the incidence of smoking-induced morbidity and mortality on these continents. The World Health Organization (WHO) has tried to respond to this crisis by devising a set of regulations to limit the spread of smoking, and many countries have bound (...) themselves to follow the WHO’s guidelines. This article provides an overview of these regulatory measures and the authors attempt to defend them from the perspective of liberty and autonomy. Their motivation is to countermand any attempt by the tobacco industry to attack the regulations on the grounds that they infringe the liberty rights of producers and consumers. It is also argued, however, that a blanket ban of the production, sale and consumption of tobacco cannot be justified on the grounds of autonomy alone. (shrink)

The authors were involved in developing an ethical framework to assist the Queens Region Board (Prince Edward Island, Canada) set priorities in health and health care. Two and one half years after the adoption of this framework, the authors undertook an evaluation of the framework. This paper will discuss: a) the historical background of regionalization in Canada, and in particular the circumstances leading up to the institution of regional boards in Prince Edward Island; b) the sorts of ethical issues facing (...) the Queens Regional Board; c) issues arising in connection with the use and development of ethics frameworks for managing ethical issues in priority setting; d) the framework adopted by the Queens Board and the process that led to its development; e) issues arising as concerns implementation of the framework; f) questions and issues pertinent to other boards and bodies considering similar initiatives. (shrink)

BackgroundThe increased risk of developing attention-deficit hyperactivity disorder (ADHD) in extremely preterm infants is well-documented. Better understanding of perinatal risk factors, particularly those that are modifiable, can inform prevention efforts.MethodsWe examined data from the Extremely Low Gestational Age Newborns (ELGAN) Study. Participants were screened for ADHD at age 10 with the Child Symptom Inventory-4 (N = 734) and assessed at age 15 with a structured diagnostic interview (MINI-KID) to evaluate for the diagnosis of ADHD (N = 575). We studied associations (...) of pre-pregnancy maternal body mass index (BMI), pregestational and/or gestational diabetes, maternal smoking during pregnancy (MSDP), and hypertensive disorders of pregnancy (HDP) with 10-year and 15-year ADHD outcomes. Relative risks were calculated using Poisson regression models with robust error variance, adjusted for maternal age, maternal educational status, use of food stamps, public insurance status, marital status at birth, and family history of ADHD. We defined ADHD as a positive screen on the CSI-4 at age 10 and/or meeting DSM-5 criteria at age 15 on the MINI-KID. We evaluated the robustness of the associations to broadening or restricting the definition of ADHD. We limited the analysis to individuals with IQ ≥ 70 to decrease confounding by cognitive functioning. We evaluated interactions between maternal BMI and diabetes status. We assessed for mediation of risk increase by alterations in inflammatory or neurotrophic protein levels in the first week of life.ResultsElevated maternal BMI and maternal diabetes were each associated with a 55–65% increase in risk of ADHD, with evidence of both additive and multiplicative interactions between the two exposures. MSDP and HDP were not associated with the risk of ADHD outcomes. There was some evidence for association of ADHD outcomes with high levels of inflammatory proteins or moderate levels of neurotrophic proteins, but there was no evidence that these mediated the risk associated with maternal BMI or diabetes.ConclusionContrary to previous population-based studies, MSDP and HDP did not predict ADHD outcomes in this extremely preterm cohort, but elevated maternal pre-pregnancy BMI, maternal diabetes, and perinatal inflammatory markers were associated with increased risk of ADHD at age 10 and/or 15, with positive interaction between pre-pregnancy BMI and maternal diabetes. (shrink)

Neuroscientists are searching for the engram within the conceptual framework established by John Locke's theory of mind. This framework was elaborated before the development of information theory, before the development of information processing machines and the science of computation, before the discovery that molecules carry hereditary information, before the discovery of the codon code and the molecular machinery for editing the messages written in this code and translating it into transcription factors that mark abstract features of organic structure such as (...) anterior and distal. The search for the engram needs to abandon Locke's conceptual framework and work within a framework informed by these developments. The engram is the medium by which information extracted from past experience is transmitted to the computations that inform future behavior. The information-conveying symbols in the engram are rapidly generated in the course of computations, which implies that they are molecules. (shrink)

The title may be understood in three ways. Firstly, the truth under study is the truth about freedom. We speak of the truth of something, in as much as we presume that there are many misconceptions about that something, and it stands in need of clarification. Thus, the many misconceptions about freedom will have to be divested, if freedom is to be rightly grasped. Secondly, in the sense that there is a truth in the core of freedom, indeed, truth is (...) the essence of freedom. If truth is to be rightly grasped, its core has to be penetrated. Thirdly, there is a deeper relation between truth and freedom. Freedom cannot be understood, much less rightly practised, if we do not comprehend the necessary relation that freedom bears to truth. This essay purports to study all three senses, not quite generally, but with special reference to Ratzinger, the German theologian-cum-phenomenologist of religion, who also happens to be the current pope Benedict XVI of the Catholic Christianity. The study proceeds in three stages. First of all, I will give the statement of the problem. Secondly, I will briefly dwell on the modern Western history of freedom. Thirdly, I will study the interface between freedom and truth, highlighting the nature of human freedom, the relation between freedom and responsibility, and the relation between freedom and the truth of human existence itself. The essay is more interpretive than evaluative, with an eye to be as close to the insightful thoughts of Ratzinger as possible. (shrink)

Statisticians in medicine can disagree on appropriate methodology applicable to the design and analysis of clinical trials. So called Bayesians and frequentists both claim ethical superiority. This paper, by defining and then linking together various dichotomies, argues there is a place for both statistical camps. The choice between them depends on the phase of clinical trial, disease prevalence and severity, but supremely on the ethics underlying the particular trial. There is always a tension present between physicians primarily obligated to their (...) own patients (the weight of 'individual ethics') and ethical committees responsible for the scientific merit of the trial and its long-term implications ('collective ethics'). Individual ethics, it is proposed, favour the Bayesian approach; collective ethics, the frequentist. Though in some situations the choice appears clear-cut, there remain other where both methodologies can be appropriate. (shrink)