Pragmatic clinical trials (PCTs) seek to show the effectiveness of treatments in routine, clinical practice (MacPherson 2004). However, a number of ethical challenges come to the fore when collater...

Volume 20, Issue 2, February 2020, Page 38-41.

The introduction of Western healthcare, via colonialism, into Africa facilitated a confrontation of indigenous and exogenous “medical” knowledge as well as the attendant praxis. Although colonialism has been expunged from the shores of Africa, the epistemic and ideological frictions it introduced into the sphere of healthcare linger and raise different dilemmas. Against this background, this paper explores pragmatic and ethical approaches that may help engage these tensions in the context of drug development based on validated traditional phytomedicines.

Many drugs used in paediatric medicine are off-label. There is a rising call for the use of adaptive clinical trial designs in responding to the need for safe and effective drugs given their potential to offer efficiency and cost-effective benefits compared with traditional clinical trials. ADs have a strong appeal in paediatric clinical trials given the small number of available participants, limited understanding of age-related variability and the desire to limit exposure to futile or unsafe interventions. Although the ethical value (...) of adaptive trials has increasingly come under scrutiny, there is a paucity of literature on the ethical dilemmas that may be associated with paediatric adaptive designs. This paper highlights some of these ethical concerns around safety, scientific/social value and caregiver/guardian comprehension of the trial design. Against this background, the paper develops a non-static conceptual lens for understanding PADs. It shows that ADs are epistemically open and reduce some of the knowledge-associated uncertainties inherent in clinical trials as well as fast-track the time to draw conclusions about the value of evaluated drugs/treatments. On this note, the authors argue that PADs are ethically justifiable given they have multiple layers of safety, exposing enrolled children to lesser potential risks, create social/scientific value generally and for paediatric populations in particular, specifically foster the flourishing of paediatric populations and can significantly improve paediatric trial efficiency when properly designed and implemented. However, because PADs are relatively new and their regulatory, ethical and logistical characteristics are yet to be clarified in some jurisdictions, the cooperation of various public and private stakeholders is required to ensure that the interests of children, their caregivers and parents/guardians are best served while exposing paediatric research subjects to the most minimal of risks when they are enrolled in paediatric trials that use ADs. Data sharing not applicable as no datasets generated and/or analysed for this study. Not applicable. (shrink)

Volume 19, Issue 7, July 2019, Page 53-55.

The power of the scientific enterprise presents multiple avenues for harnessing and increasingly controlling biological phenomena and instituting interventions in different areas of biomedicine (Af...

Funding broadly connotes the notion of an institution and/or institutions making money and other resources available to individual researchers and organizations to accomplish specific projects. Whi...

COVID‐19, caused by a novel coronavirus named SARS‐CoV‐2, was identified in December 2019, in Wuhan, China. It was first confirmed in sub‐Saharan Africa in Nigeria on 27 February 2020 and has since spread quickly to all sub‐Saharan African countries, causing more than 111,309 confirmed cases and 2,498 deaths as of 03 June 2020. The lessons learned during the recent Ebola virus disease (EVD) outbreaks in some sub‐Saharan African countries were expected to shape and influence the region’s responses to COVID‐19 pandemic. (...) However, some of the challenges associated with the management of the EVD outbreaks persist and create obstacles for the effective management of the COVID‐19 pandemic. This article describes the commonalities between the EVD epidemics and COVID‐19 pandemic, with a view to draw on lessons learned to effectively tackle the ongoing pandemic. Key successes, failures and lessons learned from previous EVD outbreaks are discussed. Recommendations on how these lessons can be translated to strengthen the COVID‐19 response in sub‐Saharan Africa are provided. (shrink)

I read with great bewilderment the unconvincing arguments of Peter F. Omonzejele in his article “Ethical Challenges Posed by the Ebola Virus Epidemic in West Africa” published in the 11 issue of the Journal of Bioethical Inquiry. While the author glaringly mixed up anthropological issues concerning the hygiene of hand-washing and safe burials in an article with a title clearly focused on ethical challenges, he failed to establish how the current Ebola epidemic ravaging some West Africa countries made these human (...) practices ethical challenges. Anecdotal examples cited in the article fit entirely into the realm of anthropological and sociological issues fuelling the spread of Ebola but are not in any way related to ethical challenges. The title was either misleading or the author deliberately discussed anthropological/sociological issues tangentially in an article supposedly written on ethical issues.The author also contradicted himself, having categorized as a compelling need t .. (shrink)

Contexts where the same clinician with an ongoing physician-patient relationship seeks to enroll his or her own patient(s) into a clinical research are ethically tricky due to the associated role c...

One of the central characteristics of public health disasters is the rapid overlapping of different needs and priorities that require making critical choices that inevitably elicit conflicti...

Community engagement in research, including public health related research, is acknowledged as an ethical imperative. While medical care and public health action take priority over research during infectious disease outbreaks, research is still required in order to learn from epidemic responses. The World Health Organisation developed a guide for community engagement during infectious disease epidemics called the Good Participatory Practice for Trials of Emerging (and Re‐emerging) Pathogens that are Likely to Cause Severe Outbreaks in the Near Future and for which (...) Few or No Medical Counter‐Measures Exist (GPP‐EP). This paper identified priorities for community engagement for research conducted during infectious disease outbreaks drawing on discussions held with a purposive sample of bioethicists, social scientists, researchers, policy makers and laypersons who work with ethics committees in West Africa. These perspectives were considered in the light of the GPP‐EP, which adds further depth and dimension to discussions on community engagement frameworks. It concludes that there is no presumptive justification for the exclusion of communities in the design, implementation and monitoring of clinical trials conducted during an infectious disease outbreak. Engagement that facilitates collaboration rather than partnership between researchers and the community during epidemics is acceptable. (shrink)

This book presents the first critical examination of the overlapping ethical, sociocultural, and policy-related issues surrounding disasters, global bioethics, and public health ethics. These issues are elucidated under the conceptual rubric: Public health disasters. The book defines PHDs as public health issues with devastating social consequences, the attendant public health impacts of natural or man-made disasters, and latent or low prevalence public health issues with the potential to rapidly acquire pandemic capacities. This notion is illustrated using Ebola and pandemic influenza (...) outbreaks, atypical drug-resistant tuberculosis, and the health emergencies of earthquakes as focal points. Drawing on an approach that reckons with microbial, existential, and anthropological realities; the book develops a relational-based global ethical framework that can help address the local, anthropological, ecological, and transnational dynamics of the ethical issues engendered by public health disasters. The book also charts some of the critical roles that relevant local and transnational stakeholders may play in translating the proposed global ethical framework from the sphere of concept to the arena of action. This title is of immense benefit to bioethics scholars, public and global health policy experts, as well as graduate students working in the area of global health, public health ethics, and disaster bioethics. (shrink)

A large and important part of social relations is gender relations between men and women. Over time, the manifestation of such relations has often been one of violence, particularly violence against women. Different approaches have been deployed to deal with the experience of gender-based violence (GBV). One popular approach is the human rights framework that suggest that GBV can be addressed by granting certain rights to women. We argue that while a human rights framework holds some promise in resolving GBV, (...) it is limited in some ways because it does not take the cultural perceptions of gender relations that envision gender duties into account. As part of our argument, we show that social relations in African communities ought to be primarily based on the principle of duty to the other, rather than an emphasis on rights. We conclude that there is a need to complement the rights-based approach with a duty-based approach to effectively address GBV. (shrink)

Psychological assessment has long been reported as a key component of clinical psychology. This paper examined and shed light on the complexities surrounding the clinical significance of therapeutic approach to treatment Planning. To achieve this objective, the paper searched and used the PsycINFO and PubMed databases and the reference sections of chapters and journal articles to analysed the underlying themes: 1) a strong basis for the usage of therapeutic approach to psychological assessment in treatment plans, 2) explained the conceptual meaning (...) of clinical significant change in therapeutic assessment, 3) used initial theory to explain the therapeutic mechanisms of change in clinical practice, 4) analysed the empirically documenting clinically significant change in therapeutic assessment. Finally, the study suggested that though therapeutic assessment is not sufficient for the systematic study of psychotherapy outcome and process, it is still consistent with both the lay-man and professional expectations regarding treatment outcome and also provides a precise method for classifying clients as “changed” or “unchanged” on the basis of clinical significance criteria. (shrink)

While most business ethics texts focus exclusively on individual decision making--what should an individual do--this resource presents the whole business ethics story. Highly realistic, readable, and down-to-earth, it moves from the individual to the managerial to the organizational level, focusing on business ethics in an organizational context to promote an understanding of complex influences on behavior. The new Fifth Edition is the perfect text for students entering the workplace, those seeking to become professionals in training, communications, compliance, in addition to (...) chief ethics officers, corporate counsel, heads of human resources, and senior executives. (shrink)

Providing a vibrant four-color design, market-leading BUSINESS ETHICS: ETHICAL DECISION MAKING AND CASES, Ninth Edition, thoroughly covers the complex environment in which managers confront ethical decision making. Using a proven managerial framework, this accessible, applied text addresses the overall concepts, processes, and best practices associated with successful business ethics programs--helping readers see how ethics can be integrated into key strategic business decisions. Thoroughly revised, the new ninth edition incorporates coverage of new legislation affecting business ethics, the most up-to-date examples, and (...) the best practices of high-profile organizations. It also includes 20 all-new or updated original case studies. (shrink)

The Language Dynamic identifies a number of mechanisms that enable the meaning potential of language from the phoneme through grammar and discourse and onto ideological systems. This book, which underpins functional theories of language with concepts from biological and cultural evolution, social semiotics and systems theory, is relevant to all who are interested in how and why we can mean and what it means for us as humans to be semiotic agents.

This volume is a collection of 16 essays, old and new, relating history and exegesis in the writings of Bede and Adomnán, and in the lives of Thomas Becket. The first part consists of seven studies of Bede's writings, notably his biblical commentaries and his Ecclesiastical History. Two of the essays are published here for the first time. The five studies in the second part, devoted to Adomnán, discuss his life of Saint Columba (the Vita Columbae) and his guide to (...) the Holy Places (De locis sanctis). One essay ('The Bible as Map'), published posthumously, compares his presentation of a major theme, the earthly and heavenly Jerusalem, with the approach adopted by Bede. The third section consists of two essays on the lives of Thomas Becket that were composed shortly after his death. They examine, in the context of patristic exegesis, the biblical images invoked in the texts in order to show how the saint's biographers understood the complex relationship between hagiography and history. With the exception of the Jarrow Lecture on Bede and the essays on Becket, the studies in both parts were published originally in edited books, some of them now hard to come by. (shrink)

Conventional wisdom suggests that the Platonist philosophers of Late Antiquity, from Plotinus (third century) to the sixth-century schools in Athens and Alexandria, neglected the political dimension of their Platonic heritage in their concentration on an otherworldly life. Dominic O'Meara presents a revelatory reappraisal of these thinkers, arguing that their otherworldliness involved rather than excluded political ideas, and he reconstructs for the first time a coherent political philosophy of Late Platonism.

'Two things', wrote Kant, 'fill the mind with ever new and increasing admiration and awe: the starry heavens above and the moral law within'. Many would argue that since Kant's day, the study of the starry heavens has advanced while ethics has stagnated, and in particular that Kant's ethics offers an empty formalism that tells us nothing about how we should live. In Acting on Principle Onora O'Neill shows that Kantian ethics has practical as well as philosophical importance. First published (...) in 1975, the book is regarded as a classic account and defence of the Kantian ethical position. It addresses Kant's account of reasoning about action, in particular his controversial claim that the Categorical Imperative guides action and is basic to ethics and justice. This second edition offers a substantial new introduction and updated bibliography, and will be valuable for a wide readership in Kant studies and those studying ethics. (shrink)

A globe-spanning investigation into the Transhumanist movement, considering the tech billionaires, scientific luminaries, and DIY body-hackers attempting to prolong, improve, and ultimately transcend the limits of human life.

'Two things', wrote Kant, 'fill the mind with ever new and increasing admiration and awe: the starry heavens above and the moral law within'. Many would argue that since Kant's day, the study of the starry heavens has advanced while ethics has stagnated, and in particular that Kant's ethics offers an empty formalism that tells us nothing about how we should live. In Acting on Principle Onora O'Neill shows that Kantian ethics has practical as well as philosophical importance. First published (...) in 1975, the book is regarded as a classic account and defence of the Kantian ethical position. It addresses Kant's account of reasoning about action, in particular his controversial claim that the Categorical Imperative guides action and is basic to ethics and justice. This second edition offers a substantial new introduction and updated bibliography, and will be valuable for a wide readership in Kant studies and those studying ethics. (shrink)

This book is available either individually, or as part of the specially-priced Arguments of the Philosphers Collection.

Over the course of the past twenty-five years, feminist theory has had a forceful impact upon the history of Western philosophy. The present collection of essays has as its primary aim to evaluate past women’s published philosophical work, and to introduce readers to newly recovered female figures; the collection will also make contributions to the history of the philosophy of gender, and to the history of feminist social and political philosophy, insofar as the collection will discuss women’s views on these (...) issues. The volume contains contributions by an international group of leading historians of philosophy and political thought, whose scholarship represents some of the very best work being done in North and Central America, Canada, Europe and Australia. (shrink)

Assesses critically the work of Rawls, Walzer, and Habermas and presents a theory of justice that responds to two senses of pluralism.

It is widely accepted that we are answerable in a special way for our intentional actions. And it is also widely accepted that we are thus answerable because we perform intentional actions for reasons. The aim of this chapter is to argue against this ‘reasons’ view of such answerability. First, reasons are distinguished from practical standards. Then, it is argued that the best interpretation of the practices in which we treat agents as answerable is that they fundamentally concern practical standards (...) rather than reasons. This view shows that we are answerable, not just because we are deliberators, but because we are executive agents whose complex executive capacities open us to criticism. (shrink)

This piece explicates some chief modes of consciousness in phenomenology in order to show that a very significant challenge of virtuality surfaces both within, as well as outside of, the discipline. This issue is of no small importance today, where the difference between perception and imagination, real and irreal, as well as presence and absence, are all becoming increasingly vague because of new technologies and the intrinsic virtualities involved therein. In this context, the question is: Where does virtuality fit in (...) such a picture? I will argue that phenomenology can start to account for such developments, although much more explicative work will be required in the future. With this in mind, sections two to four will articulate an initial phenomenology of perception, phantasy, and image-consciousness, as found chiefly in works by Husserl and Sartre. Then, section five will question the preceding phenomenological theory through some phenomenological and non-phenomenological thinkers, who all seem to have a concept of virtuality at the heart of their work. Lastly, in the final two sections I will suggest a difference between real and irreal virtualities, and briefly mention some current virtual technologies in order to show that there is a constant and complex interplay between the real, irreal, and the virtual in many of our everyday experiences—an interplay that needs to be investigated much further if we are to make sense of how it is changing how we think and behave. (shrink)

In this paper, I examine some main threads of the identification stage of Scotus's project in the fourth chapter of De Primo, where he tries to show that a first efficient cause must have the attributes of simplicity, intellect, will, and infinity. Many philosophers are favorably disposed towards one or another argument such as Scotus's (e.g., the cosmological argument from contingency) purporting to show that there is an absolutely first efficient cause. How far can Scotus take us from this starting (...) point towards the ultimate aim of establishing the existence of a being more recognizably identifiable as God? (shrink)