Background Increase in global health research undertaken in resource poor settings in the last decade though a positive development has raised ethical concerns relating to potential for exploitation. Some of the suggested strategies to address these concerns include calls for providing universal standards of care, reasonable availability of proven interventions and more recently, promoting the overall social value of research especially in clinical research. Promoting the social value of research has been closely associated with providing fair benefits to various stakeholders (...) involved in research. The debate over what constitutes fair benefits; whether those that addresses micro level issues of justice or those focusing on the key determinants of health at the macro level has continued. This debate has however not benefited from empirical work on what stakeholders consider fair benefits. This study explores practical experiences of stakeholders involved in global health research in Kenya, over what benefits are fair within a developing world context. Methods and results We conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups. The range of benefits articulated by stakeholders addresses both micro and macro level concerns for justice by for instance, seeking to engage with interests of those facilitating research, and the broader systemic issues that make resource poor settings vulnerable to exploitation. We interpret these views to suggest a need for global health research to engage with current crises that face people in these settings as well as the broader systemic issues that produce them. Conclusion Global health research should provide benefits that address both the micro and macro level issues of justice in order to forestall exploitation. Embracing the two is however challenging in terms of how the various competing interests/needs should be balanced ethically, especially in the absence of structures to guide the process. This challenge should point to the need for greater dialogue to facilitate value clarification among stakeholders. (shrink)

International health research in malaria-endemic settings may include screening for sickle cell disease, given the relationship between this important genetic condition and resistance to malaria, generating questions about whether and how findings should be disclosed. The literature on disclosing genetic findings in the context of research highlights the role of community consultation in understanding and balancing ethically important issues from participants’ perspectives, including social forms of benefit and harm, and the influence of access to care. To inform research practice locally, (...) and contribute to policy more widely, this study aimed to explore the views of local residents in Kilifi County in coastal Kenya on how researchers should manage study-generated information on sickle cell disease and carrier status. (shrink)

BackgroundCurrent guidelines do not clearly outline when assent should be attained from paediatric research participants, nor do they detail the necessary elements of the assent process. This stems from the fact that the fundamental justification behind the concept of assent is misunderstood. In this paper, we critically assess three widespread ethical arguments used for assent: children’s rights, the best interests of the child, and respect for a child’s developing autonomy. We then outline a newly-developed two-fold justification for the assent process: (...) respect for the parent’s pedagogical role in teaching their child to become an autonomous being and respect for the child’s moral worth.DiscussionWe argue that the ethical grounding for the involvement of young children in medical decision-making does not stem from children’s rights, the principle of best interests, or respect for developing autonomy. An alternative strategy is to examine the original motivation to engage with the child. In paediatric settings there are two obligations on the researcher: an obligation to the parents who are responsible for determining when and under what circumstances the child develops his capacity for autonomy and reasoning, and an obligation to the child himself. There is an important distinction between respecting a decision and encouraging a decision. This paper illustrates that the process of assent is an important way in which respect for the child as an individual can be demonstrated, however, the value lies not in the child’s response but the fact that his views were solicited in the first place.SummaryThis paper demonstrates that the common justifications for the process of assent are incomplete. Assent should be understood as playing a pedagogical role for the child, helping to teach him how specific decisions are made and therefore helping him to become a better decision-maker. How the researcher engages with the child supports his obligation to the child’s parents, yet why the researcher engages with the child stems from the child’s moral worth. Treating a child as having moral worth need not mean doing what they say but it may mean listening, considering, engaging or involving them in the decision. (shrink)

The practice of making datasets publicly available for use by the wider scientific community has become firmly integrated in genomic science. One significant gap in literature around data sharing concerns how it impacts on scientists’ ability to preserve values and ethical standards that form an essential component of scientific collaborations. We conducted a qualitative sociological study examining the potential for harm to ethnic groups, and implications of such ethical concerns for data sharing. We focused our empirical work on the MalariaGEN (...) Consortium, one of the first international collaborative genomics research projects in Africa. (shrink)

BackgroundPromoting the social value of global health research undertaken in resource poor settings has become a key concern in global research ethics. The consideration for benefit sharing, which concerns the elucidation of what if anything, is owed to participants, their communities and host nations that take part in such research, and the obligations of researchers involved, is one of the main strategies used for promoting social value of research. In the last decade however, there has been intense debate within academic (...) bioethics literature seeking to define the benefits, the beneficiaries, and the scope of obligations for providing these benefits. Although this debate may be indicative of willingness at the international level to engage with the responsibilities of researchers involved in global health research, it remains unclear which forms of benefits or beneficiaries should be considered. International and local research ethics guidelines are reviewed here to delineate the guidance they provide.MethodsWe reviewed documents selected from the international compilation of research ethics guidelines by the Office for Human Research Protections under the US Department of Health and Human Services.ResultsAccess to interventions being researched, the provision of unavailable health care, capacity building for individuals and institutions, support to health care systems and access to medical and public health interventions proven effective, are the commonly recommended forms of benefits. The beneficiaries are volunteers, disease or illness affected communities and the population in general. Interestingly however, there is a divide between "global opinion" and the views of particular countries within resource poor settings as made explicit by differences in emphasis regarding the potential benefits and the beneficiaries.ConclusionAlthough in theory benefit sharing is widely accepted as one of the means for promoting the social value of international collaborative health research, there is less agreement amongst major guidelines on the specific responsibilities of researchers over what is ethical in promoting the social value of research. Lack of consensus might have practical implications for efforts aimed at enhancing the social value of global health research undertaken in resource poor settings. Further developments in global research ethics require more reflection, paying attention to the practical realities of implementing the ethical principles in real world context. (shrink)

BackgroundThe concept of benefit sharing to enhance the social value of global health research in resource poor settings is now a key strategy for addressing moral issues of relevance to individuals, communities and host countries in resource poor settings when they participate in international collaborative health research.The influence of benefit sharing framework on the conduct of collaborative health research is for instance evidenced by the number of publications and research ethics guidelines that require prior engagement between stakeholders to determine the (...) social value of research to the host communities. While such efforts as the production of international guidance on how to promote the social value of research through such strategies as benefit sharing have been made, the extent to which these ideas and guidelines have been absorbed by those engaged in global health research especially in resource poor settings remains unclear. We examine this awareness among stakeholders involved in health related research in Kenya.MethodsWe conducted in-depth interviews with key informants drawn from within the broader health research system in Kenya including researchers from the mainstream health research institutions, networks and universities, teaching hospitals, policy makers, institutional review boards, civil society organisations and community representative groups.ResultsOur study suggests that although people have a sense of justice and the moral aspects of research, this was not articulated in terms used in the literature and the guidelines on the ethics of global health research.ConclusionThis study demonstrates that while in theory several efforts can be made to address the moral issues of concern to research participants and their communities in resource poor settings, quick fixes such as benefit sharing are not going to be straightforward. We suggest a need to pay closer attention to the processes through which ethical principles are enacted in practice and distil lessons on how best to involve individuals and communities in promoting ethical conduct of global health research in resource poor settings. (shrink)

This book explores how people's subjective, felt experiences of their bodies in action provide part of the fundamental grounding for human cognition and language. Cognition is what occurs when the body engages the physical and cultural world and must be studied in terms of the dynamical interactions between people and the environment. Human language and thought emerge from recurring patterns of embodied activity that constrain ongoing intelligent behavior. We must not assume cognition to be purely internal, symbolic, computational, and disembodied, (...) but seek out the gross and detailed ways that language and thought are inextricably shaped by embodied action. Embodiment and Cognitive Science describes the abundance of empirical evidence from many disciplines, including work on perception, concepts, imagery and reasoning, language and communication, cognitive development, and emotions and consciousness, that support the idea that the mind is embodied. (shrink)

This paper explores the ethical and conceptual implications of the findings from an empirical study (reported elsewhere) of decision-making capacity in anorexia nervosa. In the study, ten female patients aged thirteen to twenty-one years with a diagnosis of anorexia nervosa, and eight sets of parents, took part in semistructured interviews. The purpose of the interviews was to identify aspects of thinking that might be relevant to the issue of competence to refuse treatment. All the patient-participants were also tested using the (...) MacArthur Competence Assessment Tool—Treatment test of competence. This is a formalized, structured, interviewer-administered test of competence, which is a widely accepted clinical tool for determining capacity. The young women also completed five brief, self-administered questionnaires to assess their levels of psychopathology. The issues identified from the interviews are described under two headings: difficulties with thought processing and changes in values. The results suggest that competence to refuse treatment may be compromised in people with anorexia nervosa in ways that are not captured by traditional legal approaches. (shrink)

What is law? Does it have a purpose? What is its relationship with justice? Do we have a moral duty to obey the law? These sorts of questions lie at the heart of jurisprudence. Moreover, every substantive or 'black letter' branch of the law raises questions about its own meaning and function. The law of contract cannot be properly understood without an appreciation of the concepts of rights and duties. The law of tort is directly related to several economic theories (...) of compensation. The criminal law is inextricably linked to philosophies of punishment? Understanding Jurisprudence explores these problems and provides an engaging introduction to the central issues of legal theory. The book navigates the reader through legal philosophy's fundamental concepts, concerns, and controversies. An experienced teacher of jurisprudence and distinguished writer in the field, Professor Wacks adopts an approach that is easy to follow and understand without avoiding the complexities and subtleties of the subject. Students of law, politics, philosophy, and other social sciences will find this an ideal guide to the essential themes of contemporary jurisprudence. Online Resource Centre A free online resource accompanies the book and provides the following resources: Analysis of current controversies of a jurisprudential nature such as current legal and moral controversies and political debates An additional chapter providing guidance and advice on the study of jurisprudence An interactive glossary of key terms relating to legal theory Further reading, including links to full text journal articles Questions and answers Useful Web links to support learning. (shrink)

Raymond Geuss has been a distinctive contributor to the analysis and evaluation of German philosophy and to recent debates in ethics. In this new collection he treats a variety of topics in ethics, aesthetics, and the philosophy of history with special reference to the work of Hegel, Nietzsche, and Adorno. Two of the essays in the volume deal with central aspects of the philosophy of Nietzsche. The collection also contains an essay on the history of conceptions of 'culture' and (...) one on the ethics of Ernst Tugendhat. The remaining three essays focus on questions in aesthetics. The volume will be of interest to students of modern philosophy, German intellectual and cultural history, and literary theory. (shrink)

Human communities teem with a variety of social norms. In order to change unjust and harmful social norms, it is crucial to identify the psychological processes that give rise to them. Most researchers take it for granted that social norms are uniquely human. By contrast, we approach this matter from a comparative perspective, leveraging recent research on animal social behaviour. While there is currently only suggestive evidence for norms in nonhuman communities, we argue that human social norms are likely produced (...) by a wide range of mechanisms, many of which we share with nonhuman animals. Approaching this variability from a comparative perspective can help norm researchers expand and reframe the range of hypotheses they test when attempting to understand the causes of socially normative behaviours in humans. First, we diagnose some of the theoretical obstacles to developing a comparative science of social norms, and offer a few basic constructs and distinctions to help norm researchers overcome these obstacles. Then we develop a six-dimensional model of the psychological and social factors that contribute to variability in both human and potential nonhuman norms. -/- This article is part of the theme issue ‘Social norm change: drivers and consequences’. (shrink)

Facing up to the head -- The secreting head -- Being my head -- The head comes to -- Airhead : breathing and its variations -- Communicating with air -- Enjoying and suffering my head -- Communicating without air -- Notes on the red-cheeked animal : the geology of a blush -- The watchtower -- The sensory room -- Having and using my head -- Head traffic : eating, vomiting and smoking -- Head on head : notes on kissing -- (...) Headgear -- Caretaking my head -- In the wars -- The dwindles -- Knowing (and not knowing) my head -- Head and world -- The thinking head -- Epilogue: Heading off. (shrink)

_Foucault’s Law_ is the first book in almost fifteen years to address the question of Foucault’s position on law. Many readings of Foucault’s conception of law start from the proposition that he failed to consider the role of law in modernity, or indeed that he deliberately marginalized it. In canvassing a wealth of primary and secondary sources, Ben Golder and Peter Fitzpatrick rebut this argument. They argue that rather than marginalize law, Foucault develops a much more radical, nuanced and (...) coherent theory of law than his critics have acknowledged. For Golder and Fitzpatrick, Foucault’s law is not the contained creature of conventional accounts, but is uncontainable and illimitable. In their radical re-reading of Foucault, they show how Foucault outlines a concept of law which is not tied to any given form or subordinated to a particular source of power, but is critically oriented towards alterity, new possibilities and different ways of being. _Foucault’s Law_ is an important and original contribution to the ongoing debate on Foucault and law, engaging not only with Foucault’s diverse writings on law and legal theory, but also with the extensive interpretive literature on the topic. It will thus be of interest to students and scholars working in the fields of law and social theory, legal theory and law and philosophy, as well as to students of Foucault’s work generally. (shrink)

Grand specialiste de Ficin, Raymond Marcel expose ainsi les principes de son ambitieux programme: 1) resoudre un probleme dans l'evolution de la pensee europeenne, a savoir les relations entre les theologiens medievaux et les philosophes du XVIIe siecle. Ficin l'interesse en sa qualite de " point de repere " entre la philosophie medievale et moderne. Cette biographie est ainsi le travail d'un historien de la philosophie, historien au point de vue religieux, plus precisement thomiste. 2) livrer une introduction essentielle (...) a une serie de textes. Nous pouvons distinguer 2 grandes parties: 1) une introduction d'une centaine de pages " Renaissance et Platonisme " qui rappelle le probleme complexe et meconnu du platonisme dans la pensee occidentale de la Renaissance carolingienne a la moitie du XVe siecle. 2) La seconde partie, qui constitue le cur de l'ouvrage et s'appuie essentiellement sur la correspondance de Ficin, etudie plus specifiquement l'evolution intellectuelle de Ficin et la reception de ses ouvrages dans le contexte du platonisme du XVe siecle: les consequences du concile de Florence sur la pensee florentine, les rapports de Ficin avec Come de Medicis. (shrink)

Distinguished French sociologist Raymond Boudon presents here a critical theory history of the concept of ideology. His highly original and lucidly argued study addresses the core question of any account of ideology. How do individuals come to adhere to false or apparently irrational beliefs, and how do such beliefs become collectively accepted as true? Boudon begins by providing an exhaustive and subtle critique of sociological explanations of ideology from early conceptions to its current usage in the works of Barthes, (...) Foucault, Habermas, Sartre, and others. He then offers his own interpretation of the origins and emergence of ideological beliefs. In opposition to those views which associate ideology with irrationalism, Boudon shows that ideologies are a natural ingredient of social life; he develops a rationalist theory that helps to explain why certain ideas are believed by individuals and thereby effective in the social world. Finally, he examines case studies of two modern-day ideologies--developmentalism and Third Worldism. Moving easily across disciplinary boundaries, Boudon's provocative contribution to a subject of growing significance will be of great interest to scholars in sociology and social theory, as well as philosophy, political science, and development studies. (shrink)

This book traces the development of theories of the self and personal identity from the ancient Greeks to the present day. From Plato and Aristotle to Freud and Foucault, Raymond Martin and John Barresi explore the works of a wide range of thinkers and reveal the larger intellectual trends, controversies, and ideas that have revolutionized the way we think about ourselves. The authors open with ancient Greece, where the ideas of Plato, Aristotle, and the materialistic atomists laid the groundwork (...) for future theories. They then discuss the ideas of the church fathers and medieval and Renaissance philosophers, including St. Paul, Philo, Augustine, Aquinas, and Montaigne. In their coverage of the emergence of a new mechanistic conception of nature in the seventeenth century, Martin and Barresi note a shift away from religious and purely philosophical notions of self and personal identity to more scientific and social conceptions, a trend that has continued to the present day. They explore modern philosophy and psychology, including the origins of different traditions within each discipline, and explain both the theoretical relevance of feminism and gender and ethnic studies and also the ways that Derrida and other recent thinkers have challenged the very idea that a unified self or personal identity even exists. Martin and Barresi cover a number of issues broached by philosophers and psychologists, such as the existence of a fixed and unchanging self and whether the concept of the soul has a use outside of religious contexts. They address the question of whether notions of the soul and the self are still viable in today's world. Together, they reveal the fascinating ways in which great thinkers have grappled with these and other questions and the astounding impact their ideas have had on the development of self-understanding in the west. (shrink)

Acknowledged as perhaps _the_ masterpiece of materialist criticism in the English language, this omnibus ranges over British literary history from George Eliot to George Orwell to inquire about the complex ways economic reality shapes the imagination.

The question of the ethical life is arguably one of the most compelling, and urgent, questions of our time. As Peter Singer, among others, has pointed out, almost 10 million children die each year due to poverty, some of whom would not die if the amount of aid that we now offer increases significantly. As Singer has also pointed out, the exploitation of human beings and other animals is a major ethical and practical concern. There can be little reasonable doubt (...) that pain and suffering abound, in the world today, due to many causes such as poverty, disease, environmental degradation and destruction and anthropocentrism among others, just as there can be little reasonable doubt that some of the pain and suffering is preventable. So, what does it mean to live ethically today? Does it mean taking the point of view of the universe, as Sidgwick put it, memorably, rather than a narrow anthropocentric or speciesist view? Does it mean living in accordance with duties or obligations, or in light of recognised virtues, or with the minimisation of pain and suffering primarily in mind? Does it entail a consideration of the interests of other species and a rejection of the principle of the sanctity of human life? Does it mean not eating animals when other healthy alternatives are available, especially when those animals have been treated in ways that are inconsistent with their interests, whatever they may be? Does it mean taking active steps to reduce poverty on our part on a day to day basis? Is ethics exhausted in some sense today? And if we could reach some consensus on these questions, what difference would the ethical life make? Some argue that speciesism and the exploitation of human beings and other animals might diminish; that pain and suffering, especially gratuitous pain and suffering, would decrease, or at the very least, not increase; or that we will become more aware of the limitations of things such as "the traditional ethic of the sanctity of life", as Singer calls it. Some argue that the ethical life is closely related to a life of relationships, reflection and deliberation, all of which deepen our understanding and enrich us personally. Others argue that the ethical life is closely related to our search for a meaningful life - that the ethical life can help us to find meaning in a world in which "meaning", defined broadly, can seem elusive, enigmatic or unsubstantial. These and related issues and questions are explored in this collection, which illustrates the relevance, vitality and dynamism of ethics today. (shrink)

Social norms – rules governing which behaviours are deemed appropriate or inappropriate within a given community – are typically taken to be uniquely human. Recently, this position has been challenged by a number of philosophers, cognitive scientists, and ethologists, who have suggested that social norms may also be found in certain non-human animal communities. Such claims have elicited considerable scepticism from norm cognition researchers, who doubt that any non-human animals possess the psychological capacities necessary for normative cognition. However, there is (...) little agreement among these researchers about what these psychological prerequisites are. This makes empirical study of animal social norms difficult, since it is not clear what we are looking for and thus what should count as behavioural evidence for the presence (or absence) of social norms in animals. To break this impasse, we offer an approach that moves beyond contested psychological criteria for social norms. This approach is inspired by the animal culture research program, which has made a similar shift away from heavily psychological definitions of ‘culture’ and to become organized around a cluster of more empirically tractable concepts of culture. Here, we propose an analogous set of constructs built around the core notion of a normative regularity, which we define as a socially maintained pattern of behavioural conformity within a community. We suggest methods for studying potential normative regularities in wild and captive primates. We also discuss the broader scientific and philosophical implications of this research program with respect to questions of human uniqueness, animal welfare and conservation. (shrink)

We have identified a sample of 53 societies outside of the classical Himalayan and Marquesean area that permit polyandrous unions. Our goal is to broadly describe the demographic, social, marital, and economic characteristics of these societies and to evaluate some hypotheses of the causes of polyandry. We demonstrate that although polyandry is rare it is not as rare as commonly believed, is found worldwide, and is most common in egalitarian societies. We also argue that polyandry likely existed during early human (...) history and should be examined from an evolutionary perspective. Our analysis reveals that it may be a predictable response to a high operational sex ratio favoring males and may also be a response to high rates of male mortality and, possibly, male absenteeism. Other factors may contribute, but our within-polyandry sample limits analysis. (shrink)

Background Community advisory boards have expanded beyond high-income countries and play an increasing role in low- and middle-income country research. Much research has examined CABs in HICs, but less is known about CABs in LMICs. The purposes of this scoping review are to examine the creation and implementation of CABs in LMICs, including identifying frequently reported challenges, and to discuss implications for research ethics. Methods We searched five databases for publications describing or evaluating CABs in LMICs. Two researchers independently reviewed (...) articles for inclusion. Data related to the following aspects of CABs were extracted from included publications: time, country, financial support, research focus, responsibilities, and challenges. Thematic analyses were used to summarize textual data describing challenges. Results Our search yielded 2005 citations, 83 of which were deemed eligible for inclusion. Most studies were published between 2010 and 2017. Upper-middle-income countries were more likely to have studies describing CABs, with South Africa, China, and Thailand having the greatest numbers. The United States National Institutes of Health was the main source of financial support for CABs. Many CABs focused on HIV research. Thirty-four studies reported how CABs influenced the informed consent process for clinical trials or other aspects of research ethics. CAB responsibilities were related to clinical trials, including reviewing study protocols, educating local communities about research activities, and promoting the ethical conduct of research. Challenges faced by CABs included the following: incomplete ethical regulations and guidance; limited knowledge of science among members of communities and CABs; unstable and unbalanced power relationships between researchers and local communities; poor CAB management, including lack of formal participation structures and absence of CAB leadership; competing demands for time that limited participation in CAB activities; and language barriers between research staff and community members. Several challenges reflected shortcomings within the research team. Conclusions Our findings examine the formation and implementation of CABs in LMICs and identify several ethical challenges. These findings suggest the need for further ethics training among CAB members and researchers in LMICs. (shrink)

Training residents to become humanistic physicians capable of empathy, compassionate communication, and holistic patient care is among our most important tasks as physician educators. Narrative medicine aims to foster those highly desirable characteristics, and previous studies have shown it to be successful in fostering self-reflection, emotional processing, and preventing burnout. We aimed to evaluate pediatric residents’ perceptions of a novel narrative medicine curriculum. After the initiation of a longitudinal narrative medicine curriculum, focus groups were conducted with residents who participated in (...) at least one narrative medicine session. The curriculum was viewed positively, and residents found the sessions to be helpful in developing empathy, offering a space for reflection, and introducing new perspectives. Challenges noted were perception of relevance, timing of sessions, and interpretation by non-native English-speaking residents. With attention to linguistics and thematic undertones, narrative medicine is a feasible, replicable, and accepted teaching modality for pediatric residents to foster empathy, process emotions, and participate in self-reflection. (shrink)

In this paper we argue that the insistence by Fodor et. al. that the Language of Thought hypothesis must be true rests on mistakes about the kinds of explanations that must be provided of cognitive phenomena. After examining the canonical arguments for the LOT, we identify a weak version of the LOT hypothesis which we think accounts for some of the intuitions that there must be a LOT. We then consider what kinds of explanation cognitive phenomena require, and conclude that (...) three main confusions lead to the invalid inference of the truth of a stronger LOT hypothesis from the weak and trivial version. These confusions concern the relationship between syntax and semantics, the nature of higher-level causation in cognitive science, and differing roles of explanations invoking intrinsic structures of minds on the one hand, and aetiological or evolutionary accounts of their properties on the other. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Studying Penguins to Understand BirdsJacinta O. A. Tan (bio), Anne Stewart (bio), Ray Fitzpatrick (bio), and Tony Hope (bio)Keywordsanorexia nervosa, treatment decision-making, competence, valuesWe are grateful to Grisso, Appelbaum, Charland, and Vollmann for their thoughtful commentaries on our paper. We would like to respond by picking up on some of the points they make, although we do not address all the issues raised.Our general aims in the paper (...) are less immediately pragmatic than are the central concerns of Grisso and Appelbaum. Our interest is primarily in a number of ethical, and related conceptual, issues that arise from empirical data. In the long run, of course, we believe that these ethical and conceptual issues are important to the care of people with mental disorders, but our focus is philosophical.Our central interest is what justifies overriding treatment refusal. We are unhappy with a "status" approach according to which, for example, the mere fact that a person suffers a mental disorder provides grounds for overriding her wishes. Such an approach, it seems to us, fails to identify reasons, and discriminates against those with mental disorder, a view shared by the Law Commission (The Law Commission 1995). We are, on the other hand, attracted by the approach that grounds any overriding of treatment refusal on lack of capacity (or competence) to make treatment decisions. The concept of capacity has been well developed through legal cases and conceptual analysis, not least by Grisso and Appelbaum themselves. We were struck, however, first through clinical experience, and subsequently from the pilot study reported in our paper, that many patients with anorexia nervosa who refuse treatment do not necessarily lack capacity, using the current criteria, and yet show features or give reasons that raise serious doubts as to whether it is right to respect their refusal of treatment.To avoid reliance on a "status" approach, the issue with which we are grappling is whether the concept of capacity (and therefore lack of capacity) can be developed to encompass some of our findings, and whether it is ethically right to do so. Charland makes the important point that the concept of competence, or capacity, has both a descriptive and a prescriptive component. It is for this reason that the question of whether, for example, we should extend the criteria for capacity is part of the question of when it is morally right to override treatment refusal.Grisso and Appelbaum suggest that our work advances "our thinking about appreciation, rather than requiring that we add new elements" (2006, 297). From our perspective, and at this stage, it is a secondary issue whether we are suggesting a development of appreciation, or a new element (e.g., "pathological values"). The primary issue for us is whether the reasons for refusal to which we draw attention provide grounds for overriding refusal, and if they do how they can be characterized in [End Page 299] such a way as to avoid the ever-present danger of simply overriding autonomy in a patient's best interests.We chose to study anorexia nervosa for various reasons, but we expect that the issues raised have a more general relevance (such as to substance abuse and impulse control disorders as Grisso and Appelbaum and Charland suggest). We do not expect the results to be relevant to all, or even most, mental disorders. Our main interest is not the specific management of people with anorexia, but how the data challenge, and help to develop, the concept of capacity, and the ethical analysis of overriding patient refusal of treatment. Our paper aims to address what we understand Charland to be referring to by the "pretheoretical desiderata" (2006, 283) of the concept of capacity. One reason why we chose anorexia as the focus of this work is because it is different from many mental disorders in the issues that it raises. In this it is, perhaps, rather like studying penguins to better understand the concept of bird just because penguins, although clearly birds, have unusual features.We agree, therefore, with Grisso and Appelbaum's caution that it would be unwise to jump in and change the MacCAT-T on the basis of the results... (shrink)

Belliotti unravels the paradoxes of human existence to reveal paths for crafting meaningful, significant, valuable, even important lives. He argues that human life is not inherently absurd; examines the implications of mortality; contrasts subjective and objective meaning, and evaluates contemporary renderings of meaningful human lives.

Sous l'égide de l'Institut Frédérick R. Bull, un collectif d'auteurs s'interroge sur les conséquences économiques, sociales et humaines de l'emploi généralisé des techniques nouvelles innovées par le traitement de l'information et notamment le secret professionnel, la déontologie médicale, la justice et la morale policière, la déontologie de l'ingénieur, les pouvoirs et systèmes médiatiques.

Ethics of Health Care: A Guide for Clinical Practice, 3E is designed to guide health care students and practitioners through a wide variety of areas involving ethical controversies. It provides a background in value development and ethical theories, including numerous real-life examples to stimulate discussion and thought.