The notion of “cultural competency” in healthcare has gained currency in recent years. Health professionals are expected to be sensitive to the cultural backgrounds and language of their patients. Courses on cultural competency are now routinely offered to physicians, nurses, and others working in health fields. Although the rhetoric of cultural competency has been applied to clinical contexts, little attention has been given to its applicability in health research generally or, more specifically, in international health research. In this paper, I (...) briefly explore the relevance and limitations of cultural competency for informed consent to international health research, particularly in the context of low-resource settings. (shrink)

Studies on informed consent to medical research conducted in low or middle-income settings have increased, including empirical investigations of consent to genetic research. We investigated voluntary participation and comprehension of informed consent among women involved in a genetic epidemiological study on breast cancer in an urban setting of Nigeria comparing women in the case and control groups.

As we look to the future in a world with porous borders and boundaries transgressed by technologies, an inevitable question is:Can there be a single, global bioethics? Intimately intertwined with this question is a second one: How might a global bioethics account for profound - and constantly transforming - sources of cultural difference? Can a uniform, global bioethics be relevant cross-culturally? These are not simple questions, rather, a multi-dimensional answer is required. It is important to distinguish between two meanings of (...) bioethics: the academic discipline of bioethics as opposed to bioethics as a set of practices governing clinical care and scientific research. There is growing evidence to support the notion of a shared global understanding of bioethics as a field of inquiry focused on the moral dimensions of science and biomedicine. (shrink)

The severe shortage of organs for transplantation and the continual reluctance of the public to voluntarily donate has prompted consideration of alternative strategies for organ procurement. This paper explores the development of market approaches for procuring human organs for transplantation and considers the social and moral implications of organ donation as both a gift of life and a commodity exchange. The problematic and paradoxical articulation of individual autonomy in relation to property rights and marketing human body parts is addressed. We (...) argue that beliefs about proprietorship over human body parts and the capacity to provide consent for organ donation are culturally constructed. We contend that the political and economic framework of biomedicine, in western and non-western nations, influences access to transplantation technology and shapes the form and development of specific market approaches. Finally, we suggest that marketing approaches for organ procurement are and will be negotiated within cultural parameters constrained by several factors: beliefs about the physical body and personhood, religious traditions, economic conditions, and the availability of technological resources. (shrink)

As we look to the future in a world with porous borders and boundaries transgressed by technologies, an inevitable question is:Can there be a single, global bioethics? Intimately intertwined with this question is a second one: How might a global bioethics account for profound - and constantly transforming - sources of cultural difference? Can a uniform, global bioethics be relevant cross-culturally? These are not simple questions, rather, a multi-dimensional answer is required. It is important to distinguish between two meanings of (...) bioethics: the academic discipline of bioethics as opposed to bioethics as a set of practices governing clinical care and scientific research. There is growing evidence to support the notion of a shared global understanding of bioethics as a field of inquiry focused on the moral dimensions of science and biomedicine. (shrink)

In the field of bioethics, scholars have begun to consider carefully the impact of structural issues on global population health, including socioeconomic and political factors influencing the disproportionate burden of disease throughout the world. Human rights and social justice are key considerations for both population health and biomedical research. In this paper, I will briefly explore approaches to human rights in bioethics and review guidelines for ethical conduct in international health research, focusing specifically on health research conducted in resource-poor settings. (...) I will demonstrate the potential for addressing human rights considerations in international health research with special attention to the importance of collaborative partnerships, capacity building, and respect for cultural traditions. Strengthening professional knowledge about international research ethics increases awareness of ethical concerns associated with study design and informed consent among researchers working in resource-poor settings. But this is not enough. Technological and financial resources are also necessary to build capacity for local communities to ensure that research results are integrated into existing health systems. Problematic issues surrounding the application of ethical guidelines in resource-poor settings are embedded in social history, cultural context, and the global political economy. Resolving the moral complexities requires a commitment to engaged dialogue and action among investigators, funding agencies, policy makers, governmental institutions, and private industry. (shrink)

The exportation of Western biomedicine throughout the world has not resulted in a systematic homogenization of scientific ideology but rather in the proliferation of many forms and practices of biomedicine. Similarly, in the last decade, bioethics has become increasingly an international enterprise. Although there may be consensus regarding the inherent value of ethical discourse as it relates to health and medical care, there are disagreements about the nature and parameters of medical morality. This lack of consensus exists because our beliefs (...) about morality are culturally constituted, embedded in social, religious, and political ideologies that influence particular individuals and communities at specific historical moments. (shrink)

The exportation of Western biomedicine throughout the world has not resulted in a systematic homogenization of scientific ideology but rather in the proliferation of many forms and practices of biomedicine. Similarly, in the last decade, bioethics has become increasingly an international enterprise. Although there may be consensus regarding the inherent value of ethical discourse as it relates to health and medical care, there are disagreements about the nature and parameters of medical morality. This lack of consensus exists because our beliefs (...) about morality are culturally constituted, embedded in social, religious, and political ideologies that influence particular individuals and communities at specific historical moments. (shrink)

Most writing on informed consent in Africa highlights different cultural and social attributes that influence informed consent practices, especially in research settings. This review presents a composite picture of informed consent in Nigeria using empirical studies and legal and regulatory prescriptions, as well as clinical experience. It shows that Nigeria, like most other nations in Africa, is a mixture of sociocultural entities, and, notwithstanding the multitude of factors affecting it, informed consent is evolving along a purely Western model.Empirical studies show (...) that 70–95% of Nigerian patients report giving consent for their surgical treatments. Regulatory prescriptions and adjudicated cases in Nigeria follow the Western model of informed consent. However, adversarial legal proceedings, for a multiplicity of reasons, do not play significant roles in enforcing good medical practice in Nigeria. Gender prejudices are evident, but not a norm. Individual autonomy is recognized even when decisions are made within the family. Consent practices are influenced by the level of education, extended family system, urbanization, religious practices, and health care financing options available. All limitations notwithstanding, consent discussions improved with increasing level of education of the patients, suggesting that improved physician's knowledge and increasing awareness and education of patients can override other influences.Nigerian medical schools should restructure their teaching of medical ethics to improve the knowledge and practices of physicians. More research is needed on the preferences of the Nigerian people regarding informed consent so as to adequately train physicians and positively influence physicians’ behaviors. (shrink)

This review considers ethical challenges to research design and informed consent in biomedical and behavioral studies conducted in resource-poor settings. A review of the literature explores relevant social, cultural, and ethical issues in the conduct of biomedical and social health research in developing countries. Ten case vignettes illustrate ethical challenges that arise in international research with culturally diverse populations. Recommendations for researchers and policy-makers concerned about ethical practices in multinational studies conducted in resource-poor settings are also listed.

The use of nonhuman animals in research has long been a source of bioethical and scientific debate. We consider the oversight and use of nonhuman animals in chimeric research. We conducted interviews with twelve members of embryonic stem cell research oversight committees, nine members of institutional animal care and use committees, and fourteen scientists involved in human–nonhuman‐animal chimeric research in different areas of the United States. Interviews addressed animal welfare and conceptual issues associated with moral status and humanization of nonhuman (...) animals that contain human cells. Our findings suggest that concepts of enhanced moral status and consciousness are not very useful in human–nonhuman‐animal chimeric research in part because their meanings are not easily defined, which presents challenges to applying the concepts in research. Instead, scientists and oversight committee members we interviewed seemed to rely on standard assessments of changes in animal welfare when focusing on the ethics of human‐animal chimeric research. (shrink)

Background The rise in genomic and biobanking research worldwide has led to the development of different informed consent models for use in such research. This study analyses consent documents used by investigators in the H3Africa (Human Heredity and Health in Africa) Consortium. Methods A qualitative method for text analysis was used to analyse consent documents used in the collection of samples and data in H3Africa projects. Thematic domains included type of consent model, explanations of genetics/genomics, data sharing and feedback of (...) test results. Results Informed consent documents for 13 of the 19 H3Africa projects were analysed. Seven projects used broad consent, five projects used tiered consent and one used specific consent. Genetics was mostly explained in terms of inherited characteristics, heredity and health, genes and disease causation, or disease susceptibility. Only one project made provisions for the feedback of individual genetic results. Conclusion H3Africa research makes use of three consent models—specific, tiered and broad consent. We outlined different strategies used by H3Africa investigators to explain concepts in genomics to potential research participants. To further ensure that the decision to participate in genomic research is informed and meaningful, we recommend that innovative approaches to the informed consent process be developed, preferably in consultation with research participants, research ethics committees and researchers in Africa. (shrink)

Most writing on informed consent in Africa highlights different cultural and social attributes that influence informed consent practices, especially in research settings. This review presents a composite picture of informed consent in Nigeria using empirical studies and legal and regulatory prescriptions, as well as clinical experience. It shows that Nigeria, like most other nations in Africa, is a mixture of sociocultural entities, and, notwithstanding the multitude of factors affecting it, informed consent is evolving along a purely Western model. Empirical studies (...) show that 70–95% of Nigerian patients report giving consent for their surgical treatments. Regulatory prescriptions and adjudicated cases in Nigeria follow the Western model of informed consent. However, adversarial legal proceedings, for a multiplicity of reasons, do not play significant roles in enforcing good medical practice in Nigeria. Gender prejudices are evident, but not a norm. Individual autonomy is recognized even when decisions are made within the family. Consent practices are influenced by the level of education, extended family system, urbanization, religious practices, and health care financing options available. All limitations notwithstanding, consent discussions improved with increasing level of education of the patients, suggesting that improved physician's knowledge and increasing awareness and education of patients can override other influences. Nigerian medical schools should restructure their teaching of medical ethics to improve the knowledge and practices of physicians. More research is needed on the preferences of the Nigerian people regarding informed consent so as to adequately train physicians and positively influence physicians' behaviors. (shrink)

The emergence of new obstetrical and neonatal technologies, as well as more aggressive clinical management, has significantly improved the survival of extremely low birth weight infants. This development has heightened concerns about the limits of viability. ELBW infants, weighing less than 1,000 grams and no larger than the palm of one's hand, are often described as of late twentieth century technology. Improved survivability of ELBW infants has provided opportunities for long-term follow-up. Information on their physical and emotional development contributes to (...) developing standards of practice regarding their care. (shrink)

Cultural difference has been largely ignored within bioethics, particularly within the end-of-life discourses and practices that have developed over the past two decades in the U.S. healthcare system. Yet how should culturebe taken into account?

This article is the lead piece in a special report that presents the results of a bioethical investigation into chimeric research, which involves the insertion of human cells into nonhuman animals and nonhuman animal embryos, including into their brains. Rapid scientific developments in this field may advance knowledge and could lead to new therapies for humans. They also reveal the conceptual, ethical, and procedural limitations of existing ethics guidance for human‐nonhuman chimeric research. Led by bioethics researchers working closely with an (...) interdisciplinary work group, the investigation focused on generating conceptual clarity and identifying improvements to governance approaches, with the goal of helping scholars, funders, scientists, institutional leaders, and oversight bodies (embryonic stem cell research oversight [ESCRO] committees and institutional animal care and use committees [IACUCs]) deliver principled and trustworthy oversight of this area of science. The article, which focuses on human‐nonhuman animal chimeric research that is stem cell based, identifies key ethical issues in and offers ten recommendations regarding the ethics and oversight of this research. Turning from bioethics’ previous focus on human‐centered questions about the ethics of “humanization” and this research's potential impact on concepts like human dignity, this article emphasizes the importance of nonhuman animal welfare concerns in chimeric research and argues for less‐siloed governance and oversight and more‐comprehensive public communication. (shrink)

In June 1993, conjoined twins Amy and Angela Lakeberg became the focus of national attention. They shared a complex six‐chambered heart and one liver; only one could survive separation surgery, and even her chances were slim. The medical challenge was great and the ethical challenges were even greater.

The rise of genomic studies in Africa – not least due to projects funded under H3Africa – is associated with the development of a small number of biorepositories across Africa. For the ultimate success of these biorepositories, the creation of cell lines including those from selected H3Africa samples would be beneficial. In this paper, we map ethical challenges in the creation of cell lines.

Community engagement has been recognised as an important aspect of the ethical conduct of biomedical research, especially when research is focused on ethnically or culturally distinct populations. While this is a generally accepted tenet of biomedical research, it is unclear what components are necessary for effective community engagement, particularly in the context of genomic research in Africa.

Presents a plethora of approaches to developing human potential in areas not conventionally addressed. Organized in two parts, this international collection of essays provides viable educational alternatives to those currently holding sway in an era of high-stakes accountability.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The World According to Kant: Appearances and Things in Themselves in Critical Idealism by Anja JauernigPatricia KitcherAnja Jauernig. The World According to Kant: Appearances and Things in Themselves in Critical Idealism. Oxford: Oxford University Press, 2021. Pp. 400. Hardback, $105.00.After Peter Strawson's withering criticisms of the "Metaphysics of Transcendental Idealism" in The Bounds of Sense (London: Methuen, 1966), many Kant scholars devoted their labors to explaining and expanding (...) his project of transcendental epistemology. Recently, however, the tide has turned, and major Kant scholars have tried to fathom the intricacies of his metaphysical doctrines. With its new, systematic, and boldly idealistic interpretation of transcendental idealism, Anja Jauernig's The World According to Kant is an important contribution to this literature.Jauernig casts her reading of Kantian metaphysics in relation to two traditional accounts: the two-world interpretation that seemed obvious to Kant's first readers, and the two-aspect interpretation offered by Gerald Prauss (Kant und das Problem der Dinge an sich [Bonn: Bouvier Verlag, 1974]) and Henry Allison (Kant's Transcendental Idealism: An Interpretation and Defense [New Haven, CT: Yale University Press, 1983]). On the second reading, there are not two sets of objects, one phenomenal and one noumenal, but just one set that can be regarded in two different ways. Jauernig effectively demolishes the original two-aspect reading, noting that it has the consequence that contradictory properties (being F and not being F) are attributed to the same thing (164). The serious competitor to her interpretation is a more recent reading that makes an analogy with secondary qualities. Rae Langton introduces this strategy in Kantian Humility (Oxford: Oxford University Press, 1998), and Lucy Allais offers a new version of it in Manifest Reality (Oxford: Oxford University Press, 2015). On Allais's version, the properties of empirical objects are real, but unusual. As the redness of a rose depends not just on the existence of the rose, but also on the existence of perceivers with retinal cones, the properties of empirical objects depend on cognitive subjects as well on as things in themselves. Jauernig takes Allais's secondary quality analogy and a closely [End Page 160] related view of Tobias Rosefeldt's as her principal foils and marshals many texts to support her new view. To my mind, however, some of the cited texts seem ambiguous, for example, "our sensible representation is in no way a representation of things in themselves, but merely of the manner in which they appear to us" (Ak. 4:287, cited on 256n22). The second part of the citation seems to imply that sensible representations are how things in themselves are "manifest" to us, as Allais would put it.Jauernig would focus on the first part of the citation: a sensible representation in no way represents the thing in itself. In her view, empirical objects or appearances are fully mind-dependent: each of their "ontological ingredients" (elements that make up an object) is mind-dependent. Since empirical objects are fully mind-dependent and things in themselves are mind-independent, they have no "ontological overlap" (32). Phenomena and noumena are therefore numerically distinct things (32). Appearances or empirical objects are "empirically real" (as opposed to illusory), not merely because they agree with the formal conditions of reality, but because cognition begins with the receipt of sensations through the affection of human sensibility by things in themselves. (Here Jauernig's appearances that are grounded in real things but have properties that are "fully" mind-dependent seem similar to Allais's appearances.) Because objects of empirical cognition involve sensations caused by things in themselves, they should be understood as existents, even though they are not part of "fundamental ontology," whose denizens are mind-independent. Appearances exist or perhaps "in-exist" only as "intentional objects" of representations (33). On Kant's theory, as on Leibniz's, there are different levels of reality (39–40).Jauernig energetically engages challenges confronting her strongly idealistic reading. If empirical objects are fully mind-dependent, how do they differ from illusions and fictions? Since Kant anchors empirical reality to empirical intuition, the question becomes, how are appearances or empirical objects the referents of empirical intuitions? Appearances are... (shrink)

Brian Lleiter : Leiter reports -- Jason Stanley : philosophy as the great naïveté -- Eric Schwitzgebel : the splintered skeptic -- Mark Rowlands : hour of the wolf -- Eric T. olson : the philosopher with no hands -- Craig Callender : time lord -- Kieran Setiya : what Anscombe intended and other puzzles -- Kit Fine : metaphysical kit -- Patricia Churchland : causal machines -- Valerie Tiberius : mostly elephant, ergo -- Peter Carruthers : mind reader (...) -- Joshua Knobe : indie rock virtues -- Alfred R. Mele : the four million dollar philosopher -- Graham Priest : logically speaking -- Ursula Renz: after Spinoza : wiser, freer, happier -- Cecile Fabre: on the intrinsic value of each of us -- Hilde Lindemann : no ethics without feminism -- Elizabeth S. Anderson : the new leveller -- Christine Korsgaard: treating people as end in themselves -- Michael Lynch : truth, reason and democracy -- Timothy Williamson : classical investigations -- Ernie Lepore : meaning, truth, language, reality -- Jerry Fodor : meaningful words without sense, and other revolutions -- Huw Price : without mirrors -- Gary Gutting : what philosophers know. (shrink)

This book was inspired originally by the debates at the turn of the century about placebo controlled trials of antiretrovirals in HIV positive pregnant women in developing countries. Moving forward from this one limited example, the book includes several additional controversial cases of clinical research conducted in developing countries, and asks probing philosophical questions about the ethics of such trials. All clinical research by its very nature uses people to acquire generalizable knowledge to help future people. But what sorts of (...) "use" are morally permissible? What is it to exploit people? Suppose that a trial conducted in a developing country would not be ethically permissible in the developed world. Can we automatically conclude from this that the trial is unethical, that some sort of morally problematic double standard is in operation? Or might the differences in the two settings justify differences in trial design? This collection of philosophical essays examines these important questions about what exploitation is and when clinical research counts as exploitative. -/- "This is an outstanding contribution to the growing literature on the ethics of research with human subjects and a fine example of what bioethics can offer at its best. Anyone with a serious interest in these issues will need to read this book from start to finish." -Daniel Wikler, Harvard School of Public Health "This book contributes significantly to the literature on exploitation in clinical research conducted in the developing world."--Patricia Marshall, Case Western Reserve University . (shrink)

This paper takes a critical look at the rise of the practice of philosophy in the market place in late modernity. Two main forms of such practice are identified: the practice of Socratic Dialogue in small groups in organisations and one-to-one philosophical counselling of individual 'clients'. The relevance of professionalism for commercialised applied practical philosophy is discussed. Philosophical counsellors in particular may be at risk of engaging with vulnerable individuals who are in need of protection from practitioners who are not (...) trained to deal with their problems. Psychology is the discipline which is most related to practical philosophy and it is growing in ethical awareness. This paper emphasises the importance of ethics for philosophy in practice. There is a pressing need for eternal vigilance by practitioners from such disciplines, whether professionalised or not, in the complex modern'runaway world'. (shrink)

This paper takes a critical look at the rise of the practice of philosophy in the market place in late modernity. Two main forms of such practice are identified: the practice of Socratic Dialogue in small groups in organisations and one-to-one philosophical counselling of individual 'clients'. The relevance of professionalism for commercialised applied practical philosophy is discussed. Philosophical counsellors in particular may be at risk of engaging with vulnerable individuals who are in need of protection from practitioners who are not (...) trained to deal with their problems. Psychology is the discipline which is most related to practical philosophy and it is growing in ethical awareness. This paper emphasises the importance of ethics for philosophy in practice. There is a pressing need for eternal vigilance by practitioners from such disciplines, whether professionalised or not, in the complex modern'runaway world'. (shrink)

Ruth Millikan and others advocate theories which attempt to naturalize wide mental content (e.g. beliefs.

We describe and analyze 13 cases handled by our ethics consultation service (ECS) in which families requested continuation of physiological support for loved ones after death by neurological criteria (DNC) had been declared. These ethics consultations took place between 2005 and 2013. Patients’ ages ranged from 14 to 85. Continued mechanical ventilation was the focal intervention sought by all families. The ECS’s advice and recommendations generally promoted “reasonable accommodation” of the requests, balancing compassion for grieving families with other ethical and (...) moral concerns such as stewardship of resources, professional integrity, and moral distress. In cases we characterized as finitegoal accommodation, a “reasonable accommodation” strategy proved effective in balancing stakeholders’ interests and goals, enabling steady progress toward resolution. When a family objected outright to a declaration of DNC and asked for an indefinite accommodation, the “reasonable accommodation” approach offered clinicians little practical direction, and resolution required definitive action by either the family or the clinical team. Based on our analysis and reflections on these 13 cases, we propose ethically justified and practical guidelines to assist healthcare professionals, administrators, and ECSs faced with similar cases. (shrink)

This paper regards the plausibility of rejecting the scholastic claim that the “good” is a transcendental property of being—that ens et bonum convertuntur—onthe basis of two claims: Stephen Cahn’s claim that evil worlds created by an evil God are intrinsically plausible—i.e., that it is plausible to think of evil as a positive and instantiable property; and the claim that “evil is a primitive”—that is, that evil is a primary or basic ontological property. It argues that if an “ontological primitive” must (...) be a property which has no basic constituents other than itself—or whose definition cannot invoke concepts or constituents other than the primitive itself—evil itself cannot be considered a primitive. Nor can it be considered a positive property. (shrink)

Intellectual receptivity is both the prerequisite for objective human knowledge and the condition of possibility for all human knowledge. My arguments are cast in Thomistic terms. In the first part, I review the most important arguments with which Aquinas defends the receptivity of the human intellect, especially the argument from intellectual media and the argument from actualization. In the second part, I attempt to resolve the apparent contradictions involved in the claim that the intellect is receptive, contradictions that stem from (...) the fact that the intellect is an active potency (since its proper act is to reason) and receptivity is the act of a passive potency. In the final part,I argue that knowledge of the proper object of the human intellect (material singulars) is possible if and only if the human intellect is receptive. (shrink)