In June 2020, Gilead agreed to provide the USA with 500 000 doses of remdesivir—an antiviral drug which at that time was percieved to show promise in reducing the recovery time for patients with COVID-19. This quantity represented Gilead’s then full production capacity for July and 90% of its capacity for August and September. Similar deals are evident around access to proposed vaccines for COVID-19, and such deals are only likely to increase. These attempts to secure preferential access to medicines (...) and vaccines, so-called vaccine/treatment nationalism, jeopardise supplies of life-saving treatments and vaccines available elsewhere, and jeopardise global equitable distribution of such vaccines/treatments more generally. Much of the focus to date has been on States’ role in negotiating such deals. However, such developments also demonstrate the power patent holders have in controlling access to life-saving healthcare, determining who obtains access first and at what price. This article argues that the extent of control currently given to patent holders for COVID-19 must be questioned. This article demonstrates that patents have significant implications for healthcare acting as private governance tools over patented inventions. It is only by greater probing of patent holders’ role in delivering access to medicines, diagnostics and vaccines for COVID-19 that equitable global equitable access can be achieved. (shrink)

This article outlines and compares current and proposed global institutional mechanisms to increase equitable access to COVID-19 vaccines, focusing on their institutional and operational complementarities and overlaps. It specifically considers the World Health Organization's (WHO’s) COVAX (COVID-19 Vaccines Global Access) model as part of the Access to COVID-19 Tools Accelerator (ACT-A) initiative, the WHO’s COVID-19 Technology Access Pool (C-TAP) initiative, the proposed TRIPS (Trade-Related Aspects of Intellectual Property Agreement) intellectual property waiver and other proposed WHO and World Trade Organization technology (...) transfer proposals. We argue that while various individual mechanisms each have their specific individual merits—and in some cases weaknesses—overall, many of these current and proposed mechanisms could be highly complementary if used together to deliver equitable global access to vaccines. Nonetheless, we also argue that there are risks posed by the proliferation of proposals in this context, including the potential to disperse stakeholder attention or to delay decisive action. Therefore, we argue that there is now a clear need for concerted global multilateral action to recognise the complementarities of specific models and to provide a pathway for collaboration in attaining global equitable access to vaccines. The institutional infrastructure or proposals to achieve this amply exist at this point in time—but much greater cooperation from industry and clear, decisive and coordinated action from states and international organisations are urgently needed. (shrink)

Genome editing enables very accurate alterations to DNA. It promises profound and potentially disruptive changes in healthcare, agriculture, industry, and the environment. This paper presents a multidisciplinary analysis of the contemporary development of genome editing and the tension between continuity and change. It draws on the idea that actors involved in innovation are guided by “sociotechnical regimes” composed of practices, institutions, norms, and cultural beliefs. The analysis focuses on how genome editing is emerging in different domains and whether this marks (...) continuity or disruption of the established biotechnology regime. In conclusion, it will be argued that genome editing is best understood as a technology platform that is being powerfully shaped by this existing regime but is starting to disrupt the governance of biotechnology. In the longer term is it set to converge with other powerful technology platforms, which together will fundamentally transform the capacity to engineer life. (shrink)

Our editorial introduces this Special Issue devoted to exploring the ethics of youth work practice in the twenty-first century. The call for papers for this Special Issue went out in October 2022 w...

Background Over the last decade, the return of results (ROR) in precision medicine research (PMR) has become increasingly routine. Calls for individual rights to research results have extended the “duty to report” from clinically useful genetic information to traits and ancestry results. ROR has thus been reframed as inherently beneficial to research participants, without a needed focus on who benefits and how. This paper addresses this gap, particularly in the context of PMR aimed at increasing participant diversity, by providing investigator (...) and researcher perspectives on and questions about the assumed value of ROR in PMR.Methods Semi-structured interviews with a purposive sample of investigators and researchers across federally funded PMR studies in three national consortia, as well as observations of study activities, focused on how PM researchers conceptualize diversity and implement inclusive practices across research stages, including navigating ROR.Results Interviewees (1) validated the value of ROR as a benefit of PMR, while others (2) questioned the benefit of clinically actionable results to individuals in the absence of sufficient resources for translating findings into health care for diverse and disadvantaged populations; (3) expressed uncertainties in applying the presumed value of ROR as a benefit for non-clinical results; and (4) and debated when the promise of the value of ROR may undermine trust in PMR, and divert efforts to return value beyond ROR.Conclusions Conceptualizations of diversity and inclusion among PM researchers and investigators raise unique ethical questions where unexamined assumptions of the value of ROR inform study recruitment efforts to enroll minoritized and under-represented populations. A lack of consideration for resources and infrastructure necessary to translate ROR into actionable information may hinder trustworthy community-research relationships. Thus, we argue for a more intentional interrogation of ROR practices as an offer of benefit and for whom. (shrink)

Abstract: We examine how trustworthy behaviour can be achieved in the financial sector. The task is to ensure that firms are motivated to pursue long-term interests of customers rather than pursuing short-term profits. Firms’ self-interested pursuit of reputation, combined with regulation, is often not sufficient to ensure that this happens. We argue that trustworthy behaviour requires that at least some actors show a concern for the wellbeing of clients, or a respect for imposed standards, and that the behaviour of these (...) actors is copied in such a way that it becomes a behavioural norm. We briefly suggest what such behavioural norms might need to be if trustworthy behaviour is to be achieved, and consider how they might be supported; we describe the research that is necessary in order to understand these norms in more detail. We argue that the norms of traders are different from the norms of those engaged in other activities, since they are inevitably self-interested, and we consider the risk that traders’ norms might undermine those of other actors. We analyse the task for governance in dealing with this problem, and the role which leadership by a corporate board and management might play in doing this. We describe the need for further research in to describe how this might be done. (shrink)

This paper sets up and then solves a puzzle for the sceptical realist interpretation of Hume. The puzzle takes off when the sceptical realist attributes to Hume the following metaphysical theses: Causal powers grounding necessary connections in nature exist. Causal powers grounding necessary connections in nature are what make things happen.It then attributes an epistemological thesis to him: We have no knowledge of causal powers in nature nor of the necessary connections in nature which these powers ground.But putting these three (...) theses together seems to yield a problematic result. The epistemological thesis seems to have two corollaries as its upshot. We cannot know that causal powers grounding necessary connections in nature exist. We cannot know that causal powers grounding necessary connections in nature are what make things happen.That is, we cannot know and. New Hume’s position, the sceptical realist interpretation, seems to make Hume out to be arguing for a view that is self-undermining or dialectically unstable by his own empiricist lights. I argue that there is an overlooked externalist dimension to Hume’s epistemology and draw on this to solve the puzzle. (shrink)

Rights, justice, and power raise many interesting questions. Why do such basic concepts as rights and justice have such differentpoints of concern—equality, proportionality, medium rei? Why are there such different perspectives in philosophy, theology, and law? Why is the notion of power in business ethics so isolated from the general discussion of applied justice in treatises on business contracts, employee relations, and in other related topics? Discussions of power seemed parallel with discussions of justice. The two did not seem to (...) intersect. In this paper I shall argue that rights, power, and justice are interrelated. While natural rights are the basis for justice, rights cannotbe realized nor justice become operative without power. I shall call this relationship and the theory underlying it “Transforming Justice.”One of the basic concerns of this article is to notice the lack of interaction between rights and power in the traditional theories ofjustice. Granted that for many philosophers it is sufficient to determine what is just. But the notion of justice as an active virtue that persons are to exercise in their dealings with others goes further. It touches the realities of life that every person experiences. Life doesnot separate rights from power. Reflection upon the current separation of rights from power both in theory and in action is analogous to the separation of the “sensory” from the “imaginative” in art and in life. The urge to devise a framework of justice that brings out thewholeness of its existential being is the underlying rationale for developing a theory of transforming justice. Another purpose fordeveloping a theory of transforming justice is to suggest a conceptual framework of business ethics and corporate social responsibility that incorporates values, rights, power, and virtue. Authors and teachers approach these issues either from a value perspective or from the view that institutions respond only to those who exercise power. Thus, it isnecessary for a conceptual framework to incorporate the dynamics of power and the qualifying aspects of rights or claims.A natural law approach to justice and rights argues that humans have certain basic rights that others, whether humans or institutions, are required to respect. Natural rights theory places the burden or duty on each individual to respect the rights ofevery other person. In addition, justice is usually defined by natural law theorists as “giving each person his or her due,” what is requiredby natural rights, what is owed, earned, or deserved. But its applications fall short of reality. It raises other questions. How does one person get another to give him what is “his due”? How are duties and claims entailed by natural rights enforced in practice? The notionof transforming justice attempts to answer these questions. (shrink)

In this paper I suggest ways in which vision theory and psychology of perception may illuminate our understanding of beauty. I identify beauty as a phenomenon which is (i) ineffable, (ii) subjectively universal (intersubjective), and (iii) manifested in objects as formal structure. I present a model of perception by which I can identify a representation whose underlying principles would explain these features of beauty. The fact that these principles underlie the representation rather than constitute the content of representation, provides an (...) explanation for the ineffability and subjective universality of the perception of beauty in the form of objects. In part one, I set out two models of perception conducive to this approach. In part two, I suggest how such theories can offer a way of explaining and understanding the experience of beauty. (shrink)

This paper explores how transformative experience generates decision-making problems of particular seriousness in medical settings. Potentially transformative experiences are especially likely to be encountered in medicine, and the associated decisions are confronted jointly by patients and clinicians in the context of an imbalance of power and expertise. However in such scenarios the principle of informed consent, which plays a central role in guiding clinicians, is unequal to the task. We detail how the principle’s assumptions about autonomy, rationality and information handle (...) transformative experiences poorly, appealing to several difficult cases for medical decision-making to illustrate the resulting problem, and we consider how the existing literature on complications with consent fails to offer a resolution. We argue that recognition of the problem has a role to play in achieving a more effective response to transformative decisions. In Sect. 1 we introduce several representative cases of challenging patient decision-making that clinicians might face. In Sect. 2 we detail how transformative experience has been analysed in the recent literature, before outlining in Sect. 3 the theoretical basis of the principle of informed consent, which plays a central role in how clinicians are expected to support decision-making. In Sect. 4, having laid the groundwork for a clear description, we return to the cases given in Sect. 1 to confirm how their transformative nature presents a problem: either clinicians treat the decisions faced by these patients as ‘normal’, encouraging them to focus on information provision that patients may be unable to act on, or they treat them as transformative, in which case they lack the resources to recognise whether they are helping patients make (subjectively) good decisions. In Sect. 5 we argue that the existing literature does not offer any escape from this problem. We close in Sect. 6 by noting the significant impact that appreciating the problem of transformative experience could have on supporting transformative decisions in medicine and briefly suggesting how we might aim to develop new approaches to dealing with these. (shrink)

Ideals of democratic participation and rational self-government have long informed modern political theory. As a recent elaboration of these ideals, the concept of deliberative democracy is based on the principle that legitimate democracy issues from the public deliberation of citizens. This remarkably fruitful concept has spawned investigations along a number of lines. Areas of inquiry include the nature and value of deliberation, the feasibility and desirability of consensus on contentious issues, the implications of institutional complexity and cultural diversity for democratic (...) decision making, and the significance of voting and majority rule in deliberative arrangements.The anthology opens with four key essays--by Jon Elster, Jürgen Habermas, Joshua Cohen, and John Rawls--that helped establish the current inquiry into deliberative models of democracy. The nine essays that follow represent the latest efforts of leading democratic theorists to tackle various problems of deliberative democracy. All the contributions address tensions that arise between reason and politics in a democracy inspired by the ideal of achieving reasoned agreement among free and equal citizens. Although the authors approach the topic of deliberation from different perspectives, they all aim to provide a theoretical basis for a more robust democratic practice.Contributors : James Bohman, Thomas Christiano, Joshua Cohen, Jon Elster, David Estlund, Gerald F. Gaus, Jürgen Habermas, James Johnson, Jack Knight, Frank I. Michelman, John Rawls, Henry S. Richardson, Iris Marion Young. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.1 (2003) 64-76 [Access article in PDF] The Sign System in Chinese Landscape Paintings Cliff G. Mcmahon Paintings emerge from a culture field and must be interpreted in relation to the net of culture. A given culture will be implicated by the sign system used by the painter. Everyone agrees that in Chinese landscape paintings, the most important cultural bond is to ancient (...) Chinese Taoism, and to a lesser degree, to Confucianism. Obviously, then, the key for these landscapes is an alert understanding of Taoism, and the primary source is the book the Tao Tê Ching.Some of the most crucial elements in Taoist beliefs are often ignored in the analysis of the Taoist landscapes, and this deserves more attention. The core of Taoism lies in a philosophic and religious guess, and the guess is made as an effort to reach a high-order explanatory theory of the origin of the universe, the structure of the universe, and the best path for human life. The guess of the ancient Chinese sages goes something like this: The universe is created by an Ultimate One whose nature remains mysterious, beyond the power of words, an Absolute pervaded by the spirit of motherhood, and thus moved to the acts of creation, using two agents of creation. These two agents are invisible but real forces that operate by the tension of polarity, the dynamic interplay of negative and positive energies, much like male and female forces. The female power is called Yin, the male power Yang. The female power is seen wherever there is fluidity, softness, openness, receiving, emptiness, or darkness. The male power is at work in hardness, assertiveness, force, and light. Everything that is made is a blending of the Yin and Yang polarities, and the dynamism and flux of reality is based on the tendency of Yin and Yang to advance and retreat, the tendency of one to become the other, just as summer changes into winter, and day changes into night. In order for a man to be complete, he must learn to put on the way of woman, to be receptive. This is a very intelligent principle. [End Page 64] When we take in all our impressions of nature, and take in all the books we have read, we are in the receptive mode. The Yin female principle of emptiness has a priority over Yang in that there must be an empty space before any concrete thing comes to occupy the space. The Yin female force is seen in the low and quiet valley, and in the fluid receptivity of water. Yang is in the bold assertive mountains and in the hardness of stone. Yin appears in the graceful and flexible bending of bamboo, while Yang is in the hardness and strength of bamboo. Since Yin is associated with water, all forms of cloud and mist are symbols of Yin. Yang is action, Yin is wisdom.One of the most important aspects of Taoism is the principle that the mysterious Absolute One has permeated all of reality and serves the good of all creatures in every passing minute, asking nothing in return and offering no favoritism to any age or any group. This is obviously a sophisticated and intelligent principle for a theology. On this point, Taoism is superior to Buddhism, Christianity, and Islam. Christianity might have taken a similar stand in that the gospel of John declares that the eternal logos dwells in all created things in a timeless manner, and was fully embedded in the world before the coming of the historical Jesus, but so far, Christians have almost totally ignored the opening lines of John.This philosophic core of Taoist belief compares to the great Western idea that Godhead creates by the use of cosmic agents. In the gospel of John, the logos is the agent. In chapter eight of Proverbs, Wisdom is the agent. In Plotinus, Nous is the agent. In Heraclitus, the polarities of love and hate are this agent. Sometimes the idea of cosmic agent is used to protect... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.1 (2003) 64-76 [Access article in PDF] The Sign System in Chinese Landscape Paintings Cliff G. Mcmahon Paintings emerge from a culture field and must be interpreted in relation to the net of culture. A given culture will be implicated by the sign system used by the painter. Everyone agrees that in Chinese landscape paintings, the most important cultural bond is to ancient (...) Chinese Taoism, and to a lesser degree, to Confucianism. Obviously, then, the key for these landscapes is an alert understanding of Taoism, and the primary source is the book the Tao Tê Ching.Some of the most crucial elements in Taoist beliefs are often ignored in the analysis of the Taoist landscapes, and this deserves more attention. The core of Taoism lies in a philosophic and religious guess, and the guess is made as an effort to reach a high-order explanatory theory of the origin of the universe, the structure of the universe, and the best path for human life. The guess of the ancient Chinese sages goes something like this: The universe is created by an Ultimate One whose nature remains mysterious, beyond the power of words, an Absolute pervaded by the spirit of motherhood, and thus moved to the acts of creation, using two agents of creation. These two agents are invisible but real forces that operate by the tension of polarity, the dynamic interplay of negative and positive energies, much like male and female forces. The female power is called Yin, the male power Yang. The female power is seen wherever there is fluidity, softness, openness, receiving, emptiness, or darkness. The male power is at work in hardness, assertiveness, force, and light. Everything that is made is a blending of the Yin and Yang polarities, and the dynamism and flux of reality is based on the tendency of Yin and Yang to advance and retreat, the tendency of one to become the other, just as summer changes into winter, and day changes into night. In order for a man to be complete, he must learn to put on the way of woman, to be receptive. This is a very intelligent principle. [End Page 64] When we take in all our impressions of nature, and take in all the books we have read, we are in the receptive mode. The Yin female principle of emptiness has a priority over Yang in that there must be an empty space before any concrete thing comes to occupy the space. The Yin female force is seen in the low and quiet valley, and in the fluid receptivity of water. Yang is in the bold assertive mountains and in the hardness of stone. Yin appears in the graceful and flexible bending of bamboo, while Yang is in the hardness and strength of bamboo. Since Yin is associated with water, all forms of cloud and mist are symbols of Yin. Yang is action, Yin is wisdom.One of the most important aspects of Taoism is the principle that the mysterious Absolute One has permeated all of reality and serves the good of all creatures in every passing minute, asking nothing in return and offering no favoritism to any age or any group. This is obviously a sophisticated and intelligent principle for a theology. On this point, Taoism is superior to Buddhism, Christianity, and Islam. Christianity might have taken a similar stand in that the gospel of John declares that the eternal logos dwells in all created things in a timeless manner, and was fully embedded in the world before the coming of the historical Jesus, but so far, Christians have almost totally ignored the opening lines of John.This philosophic core of Taoist belief compares to the great Western idea that Godhead creates by the use of cosmic agents. In the gospel of John, the logos is the agent. In chapter eight of Proverbs, Wisdom is the agent. In Plotinus, Nous is the agent. In Heraclitus, the polarities of love and hate are this agent. Sometimes the idea of cosmic agent is used to protect... (shrink)

This study examines values and value types as well as scores in levels of moral reasoning for␣students enrolled in a business program. These two factors are measured using the Schwartz Personal Values␣Questionnaire and the Defining Issues Test 2. No statistically significant differences in levels of moral␣reasoning, rankings of values, and value types could be attributed to gender. However, eight significant correlations between value types and levels of moral reasoning provide evidence that a systematic relationship exists. The relationships are not only (...) internally consistent but also consistent with the model of values based on motivational goals (Schwartz S. H. and K. Boenke: 2004, Journal of Research in Personality , 38 230–255). (shrink)

The science and technology of genetic testing is rapidly advancing with the consequences that genetic testing may well offer the prospect of being able to detect the onset of future disabilities. Some recent research also indicates that certain behavioural profiles may have a strong genetic basis, such as the determination to succeed and win or the propensity for risk-taking, which may be of interest to third parties. However, as this technology becomes more prevalent there is a danger that the genetic (...) information may be misused by entities such as employers, insurance companies, educational facilities, and finance companies and that people with particular genetic profiles may be discriminated against.This book explores the different types and the potential uses of genetic testing. The book highlights the ethical and legal dilemmas and the challenges arising as a result of emerging and rapidly advancing genetic science. Chapters in the book assess the importance and impact of the US Genetic Information Non-Discrimination Act (GINA) in the employment and health insurance contexts asking whether it is proving to be an effective tool in addressing the issue of genetic discrimination and alleviating individuals' fears of discrimination. The book then goes on to make the case for regulation at the European Union level in order to protect the privacy of genetic information and to prevent the discriminatory use of genetic information in Europe. It considers what can be learnt from the experience of the US in addressing ethical and legal issues as well as the impact that the UN Convention on the Rights of Persons with Disabilities is having on this debate within the EU. (shrink)

The application of machine learning and artificial intelligence in healthcare domains has received much attention in recent years, yet significant questions remain about how these new tools integrate into frontline user workflow, and how their design will impact implementation. Lack of acceptance among clinicians is a major barrier to the translation of healthcare innovations into clinical practice. In this systematic review, we examine when and how clinicians are consulted about their needs and desires for clinical AI tools. Forty-five articles met (...) criteria for inclusion, of which 24 were considered design studies. The design studies used a variety of methods to solicit and gather user feedback, with interviews, surveys, and user evaluations. Our findings show that tool designers consult clinicians at various but inconsistent points during the design process, and most typically at later stages in the design cycle. We also observed a smaller amount of studies adopting a human-centered approach and where clinician input was solicited throughout the design process. A third of all studies reported on clinician trust in clinical AI algorithms and tools. The surveyed articles did not universally report validation against the “gold standard” of clinical expertise or provide detailed descriptions of the algorithms or computational methods used in their work. To realize the full potential of AI tools within healthcare settings, our review suggests there are opportunities to more thoroughly integrate frontline users’ needs and feedback in the design process. (shrink)

Anti-selection occurs when information asymmetry exists between insurers and applicants. When an applicant knows they are at high risk of loss, but the insurer does not, the applicant may try to use this knowledge differential to secure insurance at a lower premium that does not match risk.

This study examines values and value types as well as scores in levels of moral reasoning for␣students enrolled in a business program. These two factors are measured using the Schwartz Personal Values␣Questionnaire and the Defining Issues Test 2. No statistically significant differences in levels of moral␣reasoning, rankings of values, and value types could be attributed to gender. However, eight significant correlations between value types and levels of moral reasoning provide evidence that a systematic relationship exists. The relationships are not only (...) internally consistent but also consistent with the model of values based on motivational goals (Schwartz S. H. and K. Boenke: 2004, Journal of Research in Personality, 38 230–255). (shrink)

This study investigates the use of musical intelligence to improve the English pronunciation of Chinese third level students. It is relevant for a human-centred systems engineering approach to cross-cultural interaction. Language learning is important as valid communication can help interactions and cultural understanding between countries, this also may benefit international stability. There are natural barriers between the English and Chinese language which are reflected in teaching approaches. The teaching of English in Chinese classrooms is removed from real-world English learning environments. (...) The academic environments and approaches focus on the learning of grammar, spelling and writing with little real-life conversation and interaction with native English speakers. English language learning in China is from a more academic perspective rather than practical utilisation. Correct pronunciation and accent is therefore diminished. This study demonstrates that a musical intelligence e-Learning approach can benefit Chinese English language students. (shrink)

To be an effective teacher, a combination of specific professional skills and psychological attributes are required. With increasingly fluid employment conditions, particularly in the international context, recruiters and schools are under considerable pressure to quickly differentiate candidates and make successful placements, which involves more than just determining if a candidate holds an appropriate qualification. Therefore, the aim of this cross-sectional study was to measure theoretically and empirically valuable psychological attributes in an international sample of schoolteachers to determine the most valuable (...) correlates of satisfaction and position duration. An international sample (N= 335) of elementary, middle and high school teachers completed an online survey to capture their workplace satisfaction, position duration and measure 15 psychological attributes using validated instruments. Linear associations were estimated using hierarchical regression with this analysis complemented and compared with follow-up non-linear neural network models. Using regression, lower agreeableness (less people-oriented) emerged as the strongest correlate of longer position duration throughout the cohort. In elementary school teachers, lower impulsivity and higher organizational commitment emerged as the strongest correlates of longer position duration. In high school teachers, better stress tolerance and higher organizational commitment emerged as the strongest correlates of longer position duration. Using neural networks to suggest predictive models, low levels of neuroticism and impulsivity were the strongest predictors of longer position duration in elementary school teachers. High stress tolerance also predicted high work satisfaction in elementary teachers, whereas it was lower impulsivity that most strongly predicted higher work satisfaction in high school teachers. Innovation tendencies, perhaps surprisingly, appeared as a consistent predictor of lower levels of workplace satisfaction across teaching levels. Honesty-humility also emerged as a predictor of shorter position duration, particularly for primary/elementary teachers scoring above the mean. Taken together the results suggest an interesting balancing act that needs to be struck between hiring people-oriented and innovative teachers who may be more effective and adaptable but also at greater risk of changing position, possibly due to an increased interest and ability to transition into new social environments. (shrink)

Background: Due to the important role of depression in major illnesses, screening measures for depression are commonly used in medical research. The protocol for managing participants with positive screens is unclear and raises ethical concerns. The aim of this article is to identify and critically discuss the ethical issues that arise when a positive screen for depression is detected, and offer some guidance on managing these issues.DiscussionDeciding on whether to report positive screens to healthcare practitioners is both an ethical and (...) a pragmatic dilemma. Evidence suggests that reporting positive depression screens should only be considered in the context of collaborative care. Possible adverse effects, such as the impact of false-positive results, potentially inappropriate labelling, and potentially inappropriate treatment also need to be considered. If possible, the psychometric properties of the selected screening measure should be determined in the target population, and a threshold for depression that minimises the rate of false-positive results should be chosen. It should be clearly communicated to practitioners that screening scores are not diagnostic for depression, and they should be informed about the diagnostic accuracy of the measure. Research participants need to be made aware of the consequences of the detection of high scores on screening measures, and to be fully informed about the implications of the research protocol.SummaryFurther research is needed and the experiences of researchers, participants, and practitioners need to be collated before the value of reporting positive screens for depression can be ascertained. In developing research protocols, the ethical challenges highlighted should be considered. Participants must be agreeable to the agreed protocol and efforts should be made to minimise potentially adverse effects. (shrink)