The human microbiome is the bacteria, viruses, and fungi that cover our skin, line our intestines, and flourish in our body cavities. Work on the human microbiome is new, but it is quickly becoming a leading area of biomedical research. What scientists are learning about humans and our microbiomes could change medical practice by introducing new treatment modalities. This new knowledge redefines us as superorganisms comprised of the human body and the collection of microbes that inhabit it and reveals how (...) much we are a part of our environment. The understanding that microbes are not only beneficial but sometimes necessary for survival recasts our interaction with microbes from adversarial to neighborly. This volume explores some of the science that makes human microbiome research possible. It then considers ethical, legal, and social concerns raised by microbiome research. Chapters explore issues related to personal identity, property rights, and privacy. The authors reflect on how human microbiome research challenges reigning views on public health and research ethics. They also address the need for thoughtful policies and procedures to guide the use of the biobanked human samples required for advancing this new domain of research. In the course of these explorations, they introduce examples from the history of biomedical science and recent legal cases that shed light on the issues and inform the policy recommendations they offer at the end of each topic's discussion.This volume is the product of an NIH Human Microbiome Project grant. It represents three years of conversations focused on consensus formation by the twenty-seven members of the interdisciplinary Microbiome Working Group. (shrink)

In this article the authors reflect on regulations which have been developed to protect research subjects and data in research which uses human subjects. They suggest that regulations related to informed consent and privacy protection are burdensome in research which uses human subjects. They argue that a new category of research risk must be established which informs research subjects of the level of risk that they will be exposed to by participating in the research.

From the beginning, a code of ethics for bioethicists has been conceived of as part of a movement to professionalise the field. In advocating for such a code, Baker repeatedly identifies 'having a code of ethics' with 'professionalization'. The American Society of Bioethics and Humanities echoes this view in their code of ethics for healthcare ethics consultants 1 and the subsequent publication in the American Journal of Bioethics.2 Taking for granted that a code of ethics could be a valuable asset (...) for HCECs, this essay has two aims. First, there are good reasons to doubt that the label 'profession' has significant meaning for HCECs. Attempts to accurately conceive of a profession fall into two broad camps: substantive and formal. Substantive conceptions should be rejected. Specifically, substantive conceptions beg the question about what it means to be a profession, which produces devastating problems for practical application. Formal conceptions of profession avoid begging the question, but do so at the cost of identifying the responsibilities of a profession. Using the term 'professional responsibilities', then, requires additional explication and classifying HCECs as professionals requires the identification of their role-specific responsibilities.i Second, this essay will critique the ASBH code of ethics for HCECs as a first articulation of these responsibilities. As written, this code of ethics has limited value for HCECs because most of the responsibilities identified in this code do not identify HCEC-specific responsibilities. In closing, some important strategies to improve upon this initial attempt to define the responsibilities of HCECs are identified. (shrink)

The American Journal of Bioethics, Volume 11, Issue 11, Page 44-45, November 2011.

Conflicts of interest represent one of the defining problems of our time, and yet a clear definition of what constitutes a conflict of interest remains elusive. To move us closer to resolving this problem, this article first reviews and critiques attempts to define conflicts of interest, and, second, uses these critiques to ground a more conceptually consistent and practically useful definition. This definition builds on, but also breaks away from Michael Davis’s definition of conflicts of interest. Specifically, it articulates and (...) defends defining conflicts of interest in terms of their threat to good judgment but does so in the broadest terms. Defining it in this way expands the domain of conflicts of interest, but also avoids unnecessary conceptual distractions and practical difficulties. (shrink)

Using four examples of cost-effectiveness analyses, I argue that discussions of and research on cost-effectiveness in medical practice should clearly delineate between protocol and practice cost-effectiveness analyses. Failure to do so risks confusing conclusions that warrant substantial confidence and limited applicability with conclusions with broader applicability but more limited confidence. Further, these different types of analyses incorporate different sets of values. I argue that some favor should be shown for those analyses that include a wider array of values.

This paper is split into two parts. The first half analyzes conflicts of interests’ effects on judgment, the harms these effects threaten, and our current policies and practices for handling conflicts of interest. This analysis relies on scholarship in several fields, most prominently psychology, all of which have reasons to worry about conflicts of interest. This analysis will show that our current classifications of conflicts of interest and our current strategies for handling conflicts of interest are confusing, of dubious benefit, (...) or both. The second half provides some tools for helping us to limit or avoid the harms of conflicts of interest. These simple tools focus on how we think about and classify conflicts of interest. Specifically, I recommend beginning to classify conflicts of interest in a new way: as either severable or systemic. These new classifications are not intended to be heavy conceptual machinery, but simple and valuable tools. These new classifications, even though they are not meant to be exhaustive or comprehensive, help delineate tractable strategies and help determine the distribution of responsibilities for addressing specific conflicts of interest. (shrink)

The article reviews the article "The Pitfalls of Deducing Ethics From Behavioral Economics: Why the Association of American Medical Colleges Is Wrong About Pharmaceutical Detailing," by T. S. Huddle in the January 1, 2010 issue of "American Journal of Bioethics.".

1The opinions contained in this article are those of the authors and should not be construed as policies of the American Medical Association.

Active shooter incidents have unfortunately become a common occurrence the world over. There is no country, city, or venue that is safe from these tragedies, and healthcare institutions are no exception. Healthcare facilities have been the targets of active shooters over the last several decades, with increasing incidents occurring over the last decade. People who work in healthcare have a professional and moral obligation to help patients. As concerns about the possibility of such incidents increase, how should healthcare institutions and (...) healthcare professionals understand their responsibilities in preparation for and during ASI? (shrink)

Patients and family members (N = 671) were surveyed in five Mid-Atlantic U.S. hospitals to ascertain the number and kinds of ethical concerns they are presently experiencing or have previously experienced while being sick or receiving medical care. Seventy percent of participants had at least one (range 0–14) type of ethical concern or question. The most commonly experienced concerns pertained to being unsure how to plan ahead or complete an advance directive (29.4%), being unsure whether someone in the family was (...) able to make their own decisions (29.2%), deciding about limiting life-sustaining treatments (28.6%), wondering about disclosing personal medical information to others in the family (26.4%) and not being sure whether to undergo treatment because of cost (26.2%). Most were interested to some degree in getting help from ethics consultants in the future (76.6%). Given this prevalence, common concerns might usefully be addressed systematically, rather than exclusively on a case-by-case basis. (shrink)

Die vor allem unter der Bezeichnung Gestalt-Psychologie bekanntgewordeneGestalttheorie der Berliner Schule war lange Zeit vielen zu Unrecht nur für ihreBeiträge zur Wahrnehmungspsychologie ein Begriff. In letzter Zeit werden jedochdiesseits und jenseits des Atlantiks zunehmend die frühen gestalttheoretischenAnsätze für eine psychotherapierelevante Lehre des gesunden und gestörtenmenschlichen Erlebens und Verhaltens wiederentdeckt und neu aufgegriffen. Dervorliegende Sammelband stellt drei exemplarische frühe Beiträge zurPsychopathologie vor, die noch vom Begründer der Gestalttheorie MaxWertheimer geprägt wurden. Anhand der Analyse der paranoischenEigenbeziehung und Wahnbildung, der Manie und der (...) schizophrenen Denkstörungdemonstrieren sie eindrucksvoll die spezifische Herangehensweise undFruchtbarkeit des ganzheitlichen systemtheoretischen Ansatzes der Gestalttheorieauf dem Gebiet psychischer Störungen. Im Anschluß diskutierenPsychotherapeuten und Psychiater aus Deutschland, Österreich und den USA dieAktualität und Relevanz dieser Ansätze für die psychotherapeutischeKrankheitslehre und Praxis. (shrink)

Paul usually ends his letters with salutations to believers who meet in someone else’s house. Far from being individualistic, these greetings also include people from different house churches. Considered from a functional angle, these greetings cement relationships between house churches. Within an ubuntu worldview, the oral praxis of sereto (Sepedi) or isiduko (IsiXhosa) (praise-poetry) establishes and confirms relationships between members of the same community (family, clan or tribe). The question is how such praxes affect women who belong to such (...) communities. Contribution: This article is a comparative analysis of how some of the salutations used at the end of some of Paul’s epistles touch on gender relations in the same way as the ubuntu oral praxis of sereto or isiduko touches on gender relations among members of a community (family, clan or tribe). (shrink)

How far can one ascribe a spatial meaning to pain? When I have a pain, for instance, in my leg, how should one understand the “in” in the “pain in my leg”? I argue (contrary to Noordhof) that pain does have a spatial meaning, but (contrary to Tye) that the spatiality of pain is not to be understood in the standard sense of spatial enclosure. Instead, spatiality has a special meaning with regard to pain. By defining pain in phenomenological terms (...) as a disturbed form of bodily perception, I contend that the “in” in “pain in my body” has a dual spatial meaning: firstly, it signifies my internal perceptual relation to a disturbing part of my body; secondly, it denotes the external perceptual relation to my environment that the disturbance forces me to take. Once the spatiality of pain is understood in terms of such a perceptual relation, it is not restricted to localisable hurts, but pertains to all forms of pain, such as affliction and agony. South African Journal of Philosophy Vol. 25 (4) 2006: pp. 336-349. (shrink)

Biological psychiatry has been dominated by a psychopharmacologically-driven neurotransmitter dysfunction paradigm. The objective of this paper is to explore a reductionist assumption underlying this paradigm, and to suggest an improvement on it. The methods used are conceptual analysis with a comparative approach, particularly using illustrations from the history of both biological psychiatry and molecular biology. The results are that complete reduction to physicochemical explanations is not fruitful, at least in the initial stages of research in the medical and life sciences, (...) and that an appropriate (non-reducible) integrative principle - addressing a property of the whole system under study - is required for each domain of research. This is illustrated in Pauling's use of a topological integrative principle for the discovery of the functioning of proteins and in Watson and Crick's use of the notion of a genetic code as an integrative principle for the discovery of the structure of genes. The neurotransmitter dysfunction paradigm addresses single molecules and their neural pathways, yet their interactions within the CNS as a whole seem most pertinent to mental disorders such as schizophrenia. The lack within biological psychiatry of an integrative principle addressing a property of the CNS as a whole may be responsible for the empirical failure of orthomolecular psychiatry, as well as for the central role that serendipity has played in the study of mental disorders, which is dominated by the neurotransmitter paradigm. The conclusion is that research in biological psychiatry may benefit from using, at least initially, some integrative principle(s) addressing a property of the CNS as a whole, such as connectionism or a hierarchical notion. (shrink)

Like nature itself, modern economic life is driven by relentless competition and unbridled selfishness. Or is it? Drawing on converging evidence from neuroscience, social science, biology, law, and philosophy, Moral Markets makes the case that modern market exchange works only because most people, most of the time, act virtuously. Competition and greed are certainly part of economics, but Moral Markets shows how the rules of market exchange have evolved to promote moral behavior and how exchange itself may make us more (...) virtuous. Examining the biological basis of economic morality, tracing the connections between morality and markets, and exploring the profound implications of both, Moral Markets provides a surprising and fundamentally new view of economics--one that also reconnects the field to Adam Smith's position that morality has a biological basis. Moral Markets, the result of an extensive collaboration between leading social and natural scientists, includes contributions by neuroeconomist Paul Zak; economists Robert H. Frank, Herbert Gintis, Vernon Smith, and Bart Wilson; law professors Oliver Goodenough, Erin O'Hara, and Lynn Stout; philosophers William Casebeer and Robert Solomon; primatologists Sarah Brosnan and Frans de Waal; biologists Carl Bergstrom, Ben Kerr, and Peter Richerson; anthropologists Robert Boyd and Michael Lachmann; political scientists Elinor Ostrom and David Schwab; management professor Rakesh Khurana; computational science and informatics doctoral candidate Erik Kimbrough; and business writer Charles Handy. (shrink)

It considers the epistemology of theology and features 42 chapters, divided into 4 sections on 'Theology Relative Epistemic Concepts' and 'General Epistemic Concepts as Related to Theology', and on studies of individual theologians from St Paul through to Hans Urs von Balthasar and of contemporary movements such as Liberation Theology and Feminism.