The randomised controlled trial (RCT) constitutes a quantitative, comparative, controlled study of a particular treatment, and provides invaluable evidence regarding its pharmacotherapeutic efficacy. These studies are generally predicated upon the ethical principle of clinical equipoise. However, this may be insufficient to justify withholding treatment from a control group while assessing drug therapy in a potentially fatal disease. Thus, the criteria for randomisation, informed consent methodology and timing, and consideration of treatment options in such a scenario remain the province of medical (...) ethics. This paper addresses the need for an RCT of ribavirin in the treatment of Crimean Congo haemorrhagic fever, and highlights underlying ethical concerns in light of the current medical, virological and ethical literature. (shrink)

This important volume explores alternative ways in which those involved in the field of speech communication have attempted to find a philosophical grounding for rhetoric. Recognizing that rhetoric can be supported in a wide variety of ways, this text examines eight different philosophies of rhetoric: realism, relativism, rationalism, idealism, materialism, existentialism, deconstructionism, and pragmatism. The value of this book lies in its pluralistic and comparative approach to rhetorical theory. Although rhetoric may be the more difficult road to philosophy, the fact (...) that it is being traversed by a group of authors largely from speech communication demonstrates important growth in this field. Ultimately, there is recognition that if different thinkers can have solid reasons to adhere to disparate philosophies, serious communication problems can be eliminated. _Rhetoric and Philosophy_ will assist scholars in choosing from among the many philosphical starting places for rhetoric. (shrink)

Weight-gain in psychiatric populations is a common clinical challenge. Many patients suffering from mental disorders, when exposed to psychotropic medications, gain significant weight with or without other side-effects. In addition to reducing the patients' willingness to comply with treatment, this weight-gain may create added psychological or physiological problems that need to be addressed. Thus, it is critical that clinicians take precautions to monitor and control weight-gain and take into account and treat all problems facing an individual. In this review, we (...) examine some of the key issues surrounding weight-gain in individuals suffering from mental disorders for contemporary practitioners in community clinics. We describe some factors known to make certain patients more susceptible to treatment-induced weight-gain and mechanisms implicated in this process. We also highlight a few psychological and pharmacological interventions that have proven effective in weight management. Importantly, we provide critical steps for management and prevention of weight-gain and related issues in the clinical practice of psychopharmacology. (shrink)

Medical tourism is a practice, whereby individuals travel across national borders with the intention of receiving medical care. Medical tourists are motivated to travel abroad by a number of factors, including the affordability of care abroad, access to treatments not available at home, and wait times for care at home. In this article, we share the findings of interviews conducted with 32 Canadian medical tourists with the aim of developing a better understanding of medical tourism, the ethical issues it raises (...) for public health within Canada and other source countries for medical tourists, and to identify research gaps and policy responses to this practice. While patient and academic perspectives overlap in several regards, we suggest areas in which academic consideration of the ethical issues raised by medical tourism can be informed by patient perspectives. (shrink)

Medical tourism—the practice where patients travel internationally to privately access medical care—may limit patients’ regular physicians’ abilities to contribute to the informed decision-making process. We address this issue by examining ways in which Canadian family doctors’ typical involvement in patients’ informed decision-making is challenged when their patients engage in medical tourism.

BackgroundMedical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists (...) may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism.MethodsThe methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists.ResultsThe final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service. (shrink)

Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists (...) may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism. The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists. The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service. (shrink)

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from (...) former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. (shrink)

In De Anima II.6, Aristotle divides the objects of perception into three kinds: “special perceptibles" (idia aisthêta) such as colours, sounds and flavours, which can be perceived in their own right by only one sense; “common perceptibles" (koina aisthêta) such as shapes, sizes and movements, which can be perceived in their own right by multiple senses; and “incidental perceptibles,” such as the son of Diares, which can be perceived only “incidentally” (kata sumbebêkos). In this paper, I examine this division of (...) perceptibles and consider what it amounts to. First, I argue that Aristotle’s distinction between perceiving something in its own right (kath' hauto) and perceiving it incidentally marks a causal distinction: what is perceived in its own right causes perception as such, whereas what is perceived incidentally coincides with what is perceived in its own right. Second, I argue that for Aristotle special perceptibles, unlike common perceptibles, belong to homogeneous bodies on account of their chemical composition. Finally, I explain the primacy Aristotle assigns to special perceptibles and his claim that perception of them alone is free from error. I conclude with some brief remarks on Aristotle and the primary/secondary quality distinction. (shrink)

Background: Medical tourism, thought of as patients seeking non-emergency medical care outside of their home countries, is a growing industry worldwide. Canadians are amongst those engaging in medical tourism, and many are helped in the process of accessing care abroad by medical tourism brokers - agents who specialize in making international medical care arrangements for patients. As a key source of information for these patients, brokers are likely to play an important role in communicating the risks and benefits of undergoing (...) surgery or other procedures abroad to their clientele. This raises important ethical concerns regarding processes such as informed consent and the liability of brokers in the event that complications arise from procedures. The purpose of this article is to examine the language, information, and online marketing of Canadian medical tourism brokers' websites in light of such ethical concerns. Methods: An exhaustive online search using multiple search engines and keywords was performed to compile a comprehensive directory of English-language Canadian medical tourism brokerage websites. These websites were examined using thematic content analysis, which included identifying informational themes, generating frequency counts of these themes, and comparing trends in these counts to the established literature. Results: Seventeen websites were identified for inclusion in this study. It was found that Canadian medical tourism broker websites varied widely in scope, content, professionalism and depth of information. Three themes emerged from the thematic content analysis: training and accreditation, risk communication, and business dimensions. Third party accreditation bodies of debatable regulatory value were regularly mentioned on the reviewed websites, and discussion of surgical risk was absent on 47% of the websites reviewed, with limited discussion of risk on the remaining ones. Terminology describing brokers' roles was somewhat inconsistent across the websites. Finally, brokers' roles in follow up care, their prices, and the speed of surgery were the most commonly included business dimensions on the reviewed websites. Conclusion: Canadian medical tourism brokers currently lack a common standard of care and accreditation, and are widely lacking in providing adequate risk communication for potential medical tourists. This has implications for the informed consent and consequent safety of Canadian medical tourists. (shrink)

People are motivated to acquire self-evaluative information that favours themselves or information that confirms their present self-views. We proposed that par...

We introduce the resurrection axioms, a new class of forcing axioms, and the uplifting cardinals, a new large cardinal notion, and prove that various instances of the resurrection axioms are equiconsistent over ZFC with the existence of an uplifting cardinal.

Revisiting the history of relativity Content Type Journal Article DOI 10.1007/s11016-010-9466-4 Authors Lewis Pyenson, Department of History, Western Michigan University, Kalamazoo, MI 49008-5242, USA Sean F. Johnston, School of Interdisciplinary Studies, University of Glasgow, Rutherford-McCowan Building, Dumfries, Glasgow, Scotland G2 0RB, UK Alberto A. Martínez, Department of History, University of Texas at Austin, 1 University Station B7000, Austin, TX 78712-0220, USA Richard Staley, Department of the History of Science, University of Wisconsin-Madison, 226 Bradley Memorial Building, 1225 Linden Drive, Madison, WI (...) 53706-1528, USA Journal Metascience Online ISSN 1467-9981 Print ISSN 0815-0796 Journal Volume Volume 20 Journal Issue Volume 20, Number 1. (shrink)

Finitary sketches, i.e., sketches with finite-limit and finite-colimit specifications, are proved to be as strong as geometric sketches, i.e., sketches with finite-limit and arbitrary colimit specifications. Categories sketchable by such sketches are fully characterized in the infinitary first-order logic: they are axiomatizable by σ-coherent theories, i.e., basic theories using finite conjunctions, countable disjunctions, and finite quantifications. The latter result is absolute; the equivalence of geometric and finitary sketches requires (in fact, is equivalent to) the non-existence of measurable cardinals.

Using the lottery preparation, we prove that any strongly unfoldable cardinal $\kappa$ can be made indestructible by all.

Objective Ethical standards state research participation must be voluntary and free of coercion and undue influence, but what if a third party appears to engage in research-relevant coercion, without the researchers’ knowledge? This case study describes this type of situation and its resolution. Methods We are engaged in a randomized clinical trial evaluating pedestrian safety with 7- and 8- years old. Depending on children's rate of learning, families receive up to $1275 for their time. We recently learned a third-party “talent (...) agency,” a firm placing children in modeling and acting jobs, was referring families to our research with the expectation that families would share 20% of study reimbursements. Results We sensed clear impropriety, but identified no ethical violations on our part as researchers. Once paid a study reimbursement, participants can spend funds how they wish. We were concerned, however, that the third-party was exploitatively coercing families to participate. Conclusions We pursued four avenues to resolve the issue. First, we documented the situation to our university Institutional Review Board. Second, we contacted the talent agency and requested they stop referring families to our research. They agreed. Third, we retained children engaged in our study who were referred from the talent agency; removing them partway through the clinical trial could impact study results. In doing so, we explained that we were unaware of the talent agency referral and that they were not obligated by us to offer a portion of the study reimbursement to the talent agency. Last, we asked newly enrolled families about their referral source. (shrink)

The prospect of using cell-based interventions to treat neurological conditions raises several important ethical and policy questions. In this target article, we focus on issues related to the unique constellation of traits that characterize CBIs targeted at the central nervous system. In particular, there is at least a theoretical prospect that these cells will alter the recipients' cognition, mood, and behavior—brain functions that are central to our concept of the self. The potential for such changes, although perhaps remote, is cause (...) for concern and careful ethical analysis. Both to enable better informed consent in the future and as an end in itself, we argue that early human trials of CBIs for neurological conditions must monitor subjects for changes in cognition, mood, and behavior; further, we recommend concrete steps for that monitoring. Such steps will help better characterize the potential risks and benefits of CBIs as they are tested and potentially used for treatment. (shrink)

Experiential evidence shows that pain is associated with common meanings. These include a meaning of threat or danger, which is experienced as immediately distressing or unpleasant; cognitive meanings, which are focused on the long-term consequences of having chronic pain; and existential meanings such as hopelessness, which are more about the person with chronic pain than the pain itself. This interdisciplinary book - the second in the three-volume Meanings of Pain series edited by Dr Simon van Rysewyk - aims to better (...) understand pain by describing experiences of pain and the meanings these experiences hold for the people living through them. The lived experiences of pain described here involve various types of chronic pain, including spinal pain, labour pain, rheumatic pain, diabetic peripheral neuropathic pain, fibromyalgia, complex regional pain syndrome, endometriosis-associated pain, and cancer-related pain. Two chapters provide narrative descriptions of pain, recounted and interpreted by people with pain. Language is important to understanding the meaning of pain since it is the primary tool human beings use to manipulate meaning. As discussed in the book, linguistic meaning may hold clues to understanding some pain-related experiences, including the stigmatisation of people with pain, the dynamics of patient-clinician communication, and other issues, such as relationships between pain, public policy and the law, and attempts to develop a taxonomy of pain that is meaningful for patients. Clinical implications are described in each chapter. This book is intended for people with pain, their family members or caregivers, clinicians, researchers, advocates, and policy makers. (shrink)

We introduce the strongly uplifting cardinals, which are equivalently characterized, we prove, as the superstrongly unfoldable cardinals and also as the almost-hugely unfoldable cardinals, and we show that their existence is equiconsistent over ZFC with natural instances of the boldface resurrection axiom, such as the boldface resurrection axiom for proper forcing.

Machine generated contents note: 1 Introduction 1 -- 2 Central themes and critical issues 10 -- Introduction 10 -- Core themes 11 -- Differences which have surfaced in the move from -- margins to mainstream 15 -- The claims of restorative justice: a brief examination 21 -- Some limitations of restorative justice 25 -- Some dangers of restorative justice 29 -- Debunking restorative justice 32 -- 3 Reviving restorative justice traditions 36 -- The rebirth of an ancient practice 36 -- (...) Pre-modem criminal justice 37 -- The renaissance of native justice traditions 43 -- Navajo peacemaking 44 -- Can one characterise ancient and indigenous -- justice as restorative? 47 -- Can one revive restorative justice traditions? 49 -- Conclusion: did restorative justice ever die? 59 -- 4 Healing the victim 62 -- Introduction 62 -- The experiences and needs of victims 64 -- The inadequacy of punitive justice for the victim 67 -- Victim reforms 70 -- Restitution from the offender 74 -- Beyond restitution: restoring victims 76 -- Restorative justice or 'clubbing together'? 78 -- Using victims to rehabilitate offenders 81 -- Paternalism towards victims 83 -- Balancing the needs of the victim with those of society 84 -- 5 A restorative approach to offenders 87 -- Introduction 87 -- Restorative justice as an alternative to retributive justice 88 -- Restorative justice as an alternative to treatment 94 -- The goals and methods of restorative justice in relation -- to offenders 95 -- An alternative to punishment or an alternative form of -- punishment? 106 -- An alternative to treatment? 111 -- 6 Shame, apology and forgiveness 114 -- Introduction 114 -- Restorative cautioning 115 -- The psychological routes of restorative conferencing 116 -- The idea of reintegrative shaming 118 -- Some questions about shaming 123 -- Apology and forgiveness 132 -- 7 Mediation, participation and the role of community 136 -- Introduction: handling criminal conflicts 136 -- The rationale for the restorative justice process 140 -- Achieving restorative goals 141 -- Moral development and the strengthening of community 144 -- The role of community 151 -- 8 The future of restorative justice 161 -- Introduction 161 -- Implementing restorative justice: the paths less likely 163 -- The implementation of restorative techniques 166 -- Restorative justice and the pattern of penal control 169 -- The future of restorative justice research 170 -- Appendix to chapter 3: the theological roots of judicial -- punishment 172. (shrink)

Background: Medical tourism involves patients travelling internationally to receive medical services. This practice raises a range of ethical issues, including potential harms to the patient's home and destination country and risks to the patient's own health. Medical tourists often engage the services of a facilitator who may book travel and accommodation and link the patient with a hospital abroad. Facilitators have the potential to exacerbate or mitigate the ethical concerns associated with medical tourism, but their roles are poorly understood. -/- (...) Methods: 12 facilitators were interviewed from 10 Canadian medical tourism companies. -/- Results: Three themes were identified: facilitators' roles towards the patient, health system and medical tourism industry. Facilitators' roles towards the patient were typically described in terms of advocacy and the provision of information, but limited by facilitators' legal liability. Facilitators felt they played a positive role in the lives of their patients and the Canadian health system and served as catalysts for reform, although they noted an adversarial relationship with some Canadian physicians. Many facilitators described personally visiting medical tourism sites and forming personal relationships with surgeons abroad, but noted the need for greater regulation of their industry. -/- Conclusion: Facilitators play a substantial and evolving role in the practice of medical tourism and may be entering a period of professionalisation. Because of the key role of facilitators in determining the effects of medical tourism on patients and public health, this paper recommends a planned conversation between medical tourism stakeholders to define and shape facilitators' roles. (shrink)

Aristotle sometimes claims that the perception of special perceptibles by their proper sense is unerring. This claim is striking, since it might seem that we quite often misperceive things like colours, sounds and smells. Aristotle also claims that the perception of common perceptibles is more prone to error than the perception of special perceptibles. This is puzzling in its own right, and also places constraints on the interpretation of. I argue that reading Alexander of Aphrodisias on perceptual error can help (...) to make good sense of both of Aristotle’s claims. (shrink)

Many scientists and doctors hope that affordable genome sequencing will lead to more personalized medical care and improve public health in ways that will benefit children, families, and society more broadly. One hope in particular is that all newborns could be sequenced at birth, thereby setting the stage for a lifetime of medical care and self‐directed preventive actions tailored to each child's genome. Indeed, commentators often suggest that universal genome sequencing is inevitable. Such optimism can come with the presumption that (...) discussing the potential limits, cost, and downsides of widespread application of genomic technologies is pointless, excessively pessimistic, or overly cautious. We disagree. Given the pragmatic challenges associated with determining what sequencing data mean for the health of individuals, the economic costs associated with interpreting and acting on such data, and the psychosocial costs of predicting one's own or one's child's future life plans based on uncertain testing results, we think this hope and optimism deserve to be tempered.In the analysis that follows, we distinguish between two reasons for using sequencing: to diagnose individual infants who have been identified as sick and to screen populations of infants who appear to be healthy. We also distinguish among three contexts in which sequencing for either diagnosis or screening could be deployed: in clinical medicine, in public health programs, and as a direct‐to‐consumer service. Each of these contexts comes with different professional norms, policy considerations, and public expectations. Finally, we distinguish between two main types of genome sequencing: targeted sequencing, where only specific genes are sequenced or analyzed, and whole‐exome or whole‐genome sequencing, where all the DNA or all the coding segments of all genes are sequenced and analyzed.In a symptomatic newborn, targeted or genome‐wide sequencing can help guide other tests for diagnosis or for specific treatment that is urgently needed. Clinicians use the infant's symptoms (or phenotype) to interrogate the sequencing data. These same complexities and uncertainties, however, limit the usefulness of genome‐wide sequencing as a population screening tool. While we recognize considerable benefit in using targeted sequencing to screen for or detect specific conditions that meet the criteria for inclusion in newborn screening panels, use of genome‐wide sequencing as a sole screening tool for newborns is at best premature. We conclude that sequencing technology can be beneficially used in newborns when that use is nuanced and attentive to context. (shrink)