Background Dynamic consent has been proposed as a process through which participants and patients can gain more control over how their data and samples, donated for biomedical research, are used, resulting in greater trust in researchers. It is also a way to respond to evolving data protection frameworks and new legislation. Others argue that the broad consent currently used in biobank research is ethically robust. Little empirical research with cohort study participants has been published. This research investigated the participants’ opinions (...) of adding a dynamic consent interface to their existing study. Methods Adult participants in the Extended Cohort for E-health, Environment and DNA longitudinal cohort study who are members of the EXCEED Public and Participant Engagement Group were recruited. Four focus groups were conducted and analysed for thematic content. Discussion topics were derived from a review of the current literature on dynamic consent. Results Participants were in favour of many aspects of a dynamic consent interface, such as being able to update their information, add additional data to their records and choose withdrawal options. They were supportive provided it was simple to use and not intrusive. Participants expressed a markedly high level of trust in the study and its investigators and were unanimously happy with their current participation. No strong support was found for adding a dynamic consent interface to EXCEED. Conclusions Trust in the study researchers was the strongest theme found. Openness and good data security were needed to retain their trust. While happy to discuss dynamic consent, participants were satisfied with the current study arrangements. There were indications that changing the study might unnecessarily disturb their trust. This raised the question of whether there are contexts where dynamic consent is more appropriate than others. This study was limited by the small number of participants who were committed to the study and biased towards it. More research is needed to fully understand the potential impact of adding a dynamic consent interface to an existing cohort study. (shrink)

Some time ago, Ian Kennedy asked whether consent wasthe great bulwark of “patient's rights”? Is it a necessary nuisance granted as a concession to modish thinking? Is it simply a figment of some lawyer's imagination which practitioners know is meaningless in practice? Is it just part of the rhetoric of “patient power”, sent to try doctors' patience and challenge their authority?

As the General Medical Council (GMC) is currently in the process of reviewing its ethical guidance on confidentiality, it is a prescient time to consider the legal and ethical issues inherent in it. This paper examines the question of anonymized data, and highlights the fact that the legal position regarding whether it should be classed as confidential is unclear, with the possibility of a change in the law being very real. Indeed, the article argues that the notion that anonymized data (...) is not confidential can be challenged on both legal and ethical grounds, and thus that the GMC should take this into account in its new guidance. Although identifying the fact that this might have implications for epidemiological research, the article highlights an alternative approach that would allow the conduct of such research while not infringing patients' legally protected human rights. (shrink)

Introduction -- Historical perspectives of medical ethics -- The medical ethics Renaissance: a brief assessment -- Risk disclosure/'informed consent' -- Consent, control and minors: Gillick and beyond -- Sterilisation/best interests: legislation intervenes -- The end of life: total abrogation -- Medical ethics in government-commissioned reports -- Conclusion.

In the United Kingdom, the question of how much information is required to be given to patients about the benefits and risks of proposed treatment remains extant. Issues about whether healthcare resources can accommodate extended shared decision-making processes are yet to be resolved. COVID-19 has now stepped into this arena of uncertainty, adding more complexity. U.K. public health responses to the pandemic raise important questions about professional standards regarding how the obtaining and recording of consent might change or be maintained (...) in such emergency conditions, particularly in settings where equipment, medicines, and appropriately trained or specialized staff are in short supply. Such conditions have important implications for the professional capacity and knowledge available to discuss the risks and benefits of and alternatives to proposed treatment with patients. The government’s drive to expedite the recruitment to wards of medical students nearing the end of their studies, as well as inviting retired practitioners back into practice, raises questions about the ability of such healthcare providers to engage fully in shared decision-making.This article explores whether the legal duty on healthcare practitioners to disclose the material risks of a proposed medical treatment to a patient should be upheld during pandemic conditions or whether the pre-eminence of patient autonomy should be partly sacrificed in such exceptional circumstances. We argue that measures to protect public health and to respect autonomous decision-making are not mutually exclusive and that there are good reasons to maintain professional standards in obtaining consent to treatment even during acute pressures on public health systems. (shrink)

Hard cases make bad law. In a matter of months, two such cases involving assisted reproduction have appeared before the U.K. High Court and legislation has been enacted. The common threads between them are consent and fatherhood. The first case concerns a ‘mistake’ resulting in sperm from the wrong man being used to create an embryo for a couple and the second the revocation of consent by a man to his former partner being allowed to use an embryo they created (...) together. Furthermore, Parliament has intervened, passing legislation which sets out when sperm from a dead man may be used by his former partner to generate an embryo. This note argues that the three developments cannot be reconciled with one another and that the cases in particular, decided on a narrow legal basis, convey contradictory messages, leading in at least one instance to a gross injustice. (shrink)

In 2014, Lord Saatchi launched his ultimately unsuccessful Medical Innovation Bill in the UK. Its laudable aim was to free doctors from the shackles that prevented them from providing responsible innovative treatment. Lord Saatchi’s principal contention was that current law was the unsurmountable barrier that prevented clinicians from delivering innovative treatments to cancer patients when conventional options had failed. This was because doctors feared that they might be sued or tried and convicted of gross negligence manslaughter if they deviated from (...) standard practice. Concerns about fear of the law and potential negative effects on medical practice are not new. Fear of litigation has been suggested as the reason for doctors practising “defensive medicine,” by opting for treatments regarded as “grievance-resistant,” rather than clinically indicated, for example, by ordering diagnostic tests or performing certain procedures, which are not strictly medically necessary. Whilst this claim is plausible and apparently accepted by the courts, there is limited empirical evidence in support of it so far as practitioners in the UK are concerned. In this paper, we report on our empirical research which provides a snapshot of medical opinion to begin to rectify this gap. We ran focus groups of different medical specialties, asking what these medical practitioners thought the barriers to medical innovation to be. We found that fear of the law was not the principal barrier to be lowered, and that the answer was far more multifaceted. (shrink)

This book explores the epistemic side of racial and sexual oppression. It elucidates how social insensitivities and imposed silences prevent members of different groups from listening to each other.

This article seeks to identify a 'problem' in the interaction between medical law and ethics, which is that neither fully appreciates how the other works. In particular, it argues that medical law has not only failed to formulate a consistent conception of the role that medical ethics performs, but it does not adequately differentiate between categories of medical ethics discourse. Consequently, the ethical content of a case, if identified at all, will not be dealt with in a consistent manner. The (...) article further argues that medical ethics does not recognize the power that law gives to it, and that the result is a regulatory vacuum. It then uses the findings of the Bristol Royal Infirmary Report to demonstrate, by analogy, how this may lead to problems. (shrink)

British Library MS Harley 7368 or The Book of Sir Thomas More presents a play by five hands in various states of revision. Scholars have identified Anthony Munday as the principal playwright and William Shakespeare as the author of three pages that portray Thomas More quelling a Mayday London riot against foreigners. Its manifold uncertainties notwithstanding, the playscript teaches us some things about Shakespeare and about Thomas More. It enables us to see the Bard in the act of creating and (...) revising, participating fully in the processes of collaboration typical in his time. Moreover, it presents More as a heroic wise man whom Protestants and Catholics can admire for his resolution, mirth and compassion, qualities that transcend confessional dispute. (shrink)

v. 1. Edad Media. 4. ed. -- v. 2. La época del Renacimiento. 2. ed. -- v. 3. El siglo del Barroco. 3. ed.

t. 1. La moral teológica y su acción en el paganismo. La moral teológica y su acción en el judaismo.--t. 2. La moral teológica y su acción en el cristianismo.

Until 2008, if doctors followed the General Medical Council's (GMC's) guidance on providing information prior to obtaining a patient's consent to treatment, they would be going beyond what was technically required by the law. It was hoped that the common law would catch up with this guidance and encourage respect for patients' autonomy by facilitating informed decision-making. Regrettably, this has not occurred. For once, the law's inability to keep up with changing medical practice and standards is not the problem. The (...) authors argue that while the common law has moved forward and started to recognise the importance of patient autonomy and informed decision-making, the GMC has taken a step back in their 2008 guidance on consent. Indeed, doctors are now required to tell their patients less than they were in 1998 when the last guidance was produced. This is an unfortunate development and the authors urge the GMC to revisit their guidance. (shrink)

José L. Zalabardo defends a pragmatist account of what grounds the meaning of central semantic discourses--ascriptions of truth, of propositional attitudes, and of meanings. He argues that it is the procedures that regulate acceptance and rejection that give the sentences of these discourses their meanings, and explores the application of the pragmatist template to ethical discourse. The pragmatist approach is presented as an alternative to representationalist accounts of the meaning grounds of declarative sentences, according to which a sentence has (...) the meaning it has as a result of links with the bits of the world that it purports to represent. Zalabardo develops a version of the open-question argument to support the claim that the meaning grounds of the discourses he focuses on cannot receive representationalist accounts. It is generally assumed that a declarative sentence cannot perform the function of representing the world unless it has a representationalist meaning ground. Zalabardo rejects this assumption, arguing that sentences with pragmatist meaning grounds can represent the world in exactly the same sense that sentences with representationalist meaning grounds do. This requires that there are states of affairs that the target sentences represent as obtaining, and Zalabardo develops an account of the nature of the states of affairs that can play this role for sentences with pragmatist meaning grounds. Pragmatist Semantics concludes by developing the suggestion that the meaning grounds of all our representational discourses might be ultimately pragmatist. (shrink)

. Introductory Remarks THEODOSIUS DOBZHANSKY The problems of reduction in biology are currently of considerable theoretical interest and practical ...

This paper offers an analysis of how the American criminal justice system sets unfair constraints on the epistemic agency of detained subjects and promotes unfair negative consequences on the exerc...

How precisely to understand and evaluate counterfactuals can be an intricate issue. The aim of this article is to examine a new set of difficulties for evaluating counterfactuals that arise in the context of the dynamical spacetimes described by the theory of general relativity (GR). The initial value formulation provides us with a methodology to pin down the specific combination of features of the theory at the origin of the difficulties, namely, non-linearity and certain non-local aspects (typically captured by ellipticity (...) at the analytical level), in particular when combined with the global and/or quasi-local character of physical quantities in GR. Finally, we connect the philosophical question about counterfactuals with concrete applied physical issues in GR about extracting meaningful predictions by constructing appropriate initial data sets, leading us to question the very suitability of the Cauchy approach to fully account for the explanatory power of the theory. (shrink)

Based on published works and unpublished materials, this article analyses how cybernetics was received by two Spanish thinkers exiled in Mexico: José Gaos (1900–1969) and Eduardo Nicol (1907–1990). This reception is particularly intriguing especially when considering the substantial presence and social impact that Norbert Wiener had in Mexican society because of his friendship with Arturo Rosenblueth. Gaos and Nicol are the first philosophers to develop a complex and original diagnosis of cybernetics in Mexico. It will be shown how the (...) exiled thinkers take on the philosophical implications of this science in the light of their respective theoretical projects, and finally, it will be defended how the critical perspective they develop is particularly significant for Mexico’s political and academic context since it illuminates some negative aspects of cybernetics that Wiener did not foresee and that had not been reported there until then. (shrink)

Reliabilist accounts of knowledge are widely seen as having the resources for blocking sceptical arguments, since these arguments appear to rely on assumptions about the nature of knowledge that are rendered illegitimate by reliabilist accounts. The goal of this book is to assess the main arguments against the possibility of knowledge, and its conclusions challenge this consensus. The book articulates and defends a theory of knowledge that belongs firmly in the truth-tracking tradition, and argues that although the theory has the (...) resources for blocking the main standard lines of sceptical reasoning, there is a sceptical argument against which the theory offers no defence, as it doesn’t rely on any assumptions that the theory would render illegitimate. The book ends with the suggestion that the problem might have a metaphysical solution—that although the sceptical argument may make no illegitimate epistemological assumptions, it does rest on a questionable account of the nature of cognition. (shrink)

Background The Regional Committee for Africa of the World Health Organization (WHO) in 2001 expressed concern that some health-related studies undertaken in the Region were not subjected to any form of ethics review. In 2003, the study reported in this paper was conducted to determine which Member country did not have a national research ethics committee (REC) with a view to guiding the WHO Regional Office in developing practical strategies for supporting those countries. Methods This is a descriptive study. The (...) questionnaire was prepared and sent by diplomatic pouch to all the 46 Member States in the WHO African Region, through the WHO country representatives, for facilitation and follow up. The data were entered in Excel spreadsheet and subsequently exported to STATA for analysis. A Chi-Squared test (χ 2) for independence was undertaken to test the relationship between presence/absence of Research Ethics Committee (REC) and selected individual socioeconomic and health variables. Results The main findings were as follows: the response rate was 61% (28/46); 64% (18/28) confirmed the existence of RECs; 36% (10/28) of the respondent countries did not have a REC (although 80% of them reported that they had in place an ad hoc ethical review mechanism); 85% (22/26) of the countries that responded to this question indicated that ethical approval of research proposals was, in principle, required; and although 59% of the countries that had a REC expected it to meet every month, only 44% of them reported that the REC actually met on a monthly basis. In the Chi-Squared test, only the average population in the group of countries with a REC was statistically different (at 5% level of significance) from that of the group of countries without a REC. Conclusion In the current era of globalized biomedical research, good ethics stewardship demands that every country, irrespective of its level of economic development, should have in place a functional research ethics review system in order to protect the dignity, integrity and safety of its citizens who participate in research. (shrink)