Research ethics guidelines grew out of several infamous episodes where research subjects were exploited. There is significant international synchronization of guidelines. However, indigenous groups in New Zealand, Canada and Australia have criticized these guidelines as being inadequate for research involving indigenous people and have developed guidelines from their own cultural perspectives. Whilst traditional research ethics guidelines place a lot of emphasis on informed consent, these indigenous guidelines put much greater emphasis on interdependence and trust. This article argues that traditional guidelines (...) are premised on relationships of equal power, and that often the researcher has more power that is not fully equalized by providing information. Where there is a relationship of unequal power, then focusing on interdependence and trust is more likely to achieve ethical safety. We illustrate this thesis by describing the detail of a research project looking at the use of interpreters, where we video-recorded live consultations and then interviewed the patient, interpreter and doctor. We conclude by suggesting that mainstream research ethics guidelines should pay more attention to the development of a trustworthy relationship between subject and researcher, and that, following the lead from clinical medicine, we should develop a culturally competent ethical framework for research on human subjects. (shrink)

Many clinical ethics support services do not involve patients. This is surprising because of the broad commitment to provide patient-centered healthcare. Clinical ethics support services are a component of the healthcare system and have an influence on patient care, and should therefore align with the regulatory and ethical requirements of patient-centered care, just process and cultural competence. First, in order to achieve good patient care, it is essential to involve patients in making their own healthcare decisions. Second, just ethical deliberation (...) requires that the deliberating parties have access to complete, accurate and unbiased information – this is best achieved through direct patient input. These arguments are especially compelling in the case of non-dominant cultural and ethnic groups. Here, we argue that when a clinician refers a case to a clinical ethics support services for consideration, and that case involves a conflict between the views or values of the clinician and the patient, the patient is entitled to, at a minimum: (a) be informed of the referral; (b) have the opportunity to speak directly to the clinical ethics support services prior to deliberation; (c) be provided with any opinion directly from the clinical ethics support services; and (d) have the opportunity to speak to a clinical ethics support services member after the deliberation. We use New Zealand as a case study to support and extrapolate the ethical principles and the minimum patient involvement requirements. We draw on our empirical research with senior doctors at a tertiary New Zealand hospital. Clinicians in our study indicated that they would feel bound by clinical ethics support service advice and that the clinical ethics support service has a significant impact on patient care in the case it reviews. (shrink)

We developed this study to examine the issue of parental refusal of treatment, looking at the issue through a cultural competence lens. Recent cases in Canada where courts have declined applications by clinicians for court orders to overrule parental refusal of treatment highlight the dispute in this area. This study analyses the 16 cases of a larger group of 24 cases that were selected by a literature review where cultural or religious beliefs or ethnic identity was described as important reasons (...) behind the refusal. The most significant finding was that nearly all of the cases cited unacceptable side effects as the main reason for declining treatment. We then analysed the detail of the cases and concluded that in the first instance a skilled clinical approach to develop an agreed management plan is by far the best approach. In the event that agreement cannot be reached we recommend engaging a mediator to help the clinician and parents/child to find an agreeable way forward. We argue that the option of se... (shrink)

This paper discusses the Saudi Arabian case by Abdallah Adlan and Henk ten Have, published in a 2012 issue of the Journal of Bioethical Inquiry, regarding a congenitally disabled child enrolled in a research project examining the genetics of her condition. During the course of the study, her father was found not to be genetically related, and the case discussed the dilemma between disclosing to the family all findings as promised in consent documents or withholding paternity information because of the (...) likely severe social repercussions. Using Adlan and ten Have’s example, this paper proposes a framework to consider cases outside of the conventional bioethics frame of reference, splitting the bioethical task into three elements: understanding the problem from the patient’s and the clinician’s perspective and then engaging in dialogue to decide what to do next. The process of dialogue between affected parties is vital. Presuming that there is a common morality undermines the effectiveness of the dialogue needed to find a resolution. (shrink)

Pickeringet al’s paper argues that the capacity of the decision-maker is the sole consideration in whether a decision should stand, and that the risk of the decision should not be considered. This argument ignores the existence of the player who is of the view that a decision is not wise. This paper argues that patient autonomy is not the sole determinant of whether a person is able to make an unwise decision, particularly in healthcare where there are always others affected (...) by the patient decision. Rather than asserting that patients have an unfettered autonomous choice on clinical decisions this paper argues that these decisions should be looked at through the lens of quality in health care that has proposed four parameters to be balanced; the patient experience, wise use of resources, the effect on public health and the clinician experience. (shrink)

ABSTRACTThis paper examines ideas of individual freedom in the Hellenistic city-states. It concentrates on the civic ideas expressed in the laws and decrees of Hellenistic cities, inscribed on stone, comparing them with Hellenistic historical and philosophical works. It places different Hellenistic approaches alongside modern liberal, neo-Roman republican and civic humanist theories of individual liberty, finding some overlaps with each of those modern approaches. The argument is that the Hellenistic Greeks developed innovative ways of combining demanding ideals of civic virtue and (...) the common good with equally robust ideals of individual freedom and ethical choice. They did so not least by adapting and developing traditional Greek approaches close to modern civic humanism, in ways very relevant to modern debates about how to reconcile civic duty, the common good and pluralism. (shrink)

The debate around the ethics of homeopathy in recent issues of the journal has been approached as a binary question; is homeopathy ethical or not? This paper suggests that this is an unhelpful question and instead discusses a framework to establish the extent to which the dominant culture should tolerate non-dominant health practices such as homeopathy. This requires a sophisticated understanding of the placebo effect, a critical evaluation of what evidence is available, a consideration of the harm that the non-dominant (...) practice might cause, and a consideration of how this might be affected by the culture of the patient. This is presented as a matter of cultural competence. At a clinical level clinicians need to respect the values and beliefs of their patients and communicate with all the practitioners involved in a patient’s care. At a societal level there are a number of factors to be considered when a community decides which practices to tolerate and to what extent. (shrink)

This article shows how the public inscriptions of Hellenistic poleis, especially decrees in honor of leading citizens, illuminate Greek ethical thinking, including wider debates about questions of central importance for Greek ethical philosophers. It does so by comparing decrees' rhetoric with the ethical language and doctrines of different ancient philosophical schools. Whereas some scholars identify ethical views comparable to Stoic ideas in Hellenistic decrees, this article argues that there are more significant overlaps, especially in decrees from Asia Minor dating to (...) after 150 BC, with fourth-century BC ethical philosophy, especially Aristotle's, and its Hellenistic continuators. The overlaps between decrees and philosophers' approaches had complex, diverse causes, probably sometimes including philosophical education and influence. Comparison of philosophy and epigraphy shows that, in the same way as the polis continued to flourish after Chaironeia, critical reflection about the ethical foundations of civic life also remained vibrant, among both philosophers and citizens. (shrink)

This paper examines the role of bioethics in the successful control of COVID-19 in New Zealand. After the severe acute respiratory syndrome coronavirus episode in Toronto researchers developed a framework of values and principles to articulate values that were already commonly accepted “in the community of its intended users,” to be used to inform decision-making. New Zealand subsequently developed its own framework that was embedded in its Pandemic Influenza Plan. These formed the basis of the New Zealand response to COVID-19. (...) This paper illustrates the ways in which the bioethical framework was reflected in the decisions and actions made by the government. (shrink)

SummaryThe conspicuous role of taxonomy and debates about taxonomy in the well‐established physical science of pedology throws into question the Popperian rejection of definition and classification.

This volume offers a history of the role of exile in the Greek city-state in the period c. 404-146 BC, from the end of the Peloponnesian War to the Roman conquest of the Greek world.

Consulting with a patient where there is a language barrier is unethical unless the barrier is overcome. Every patient with a language barrier should have this prominently documented on their file. Much of the literature relating to working with interpreters suggests that a professional interpreter should be used all the time, although in practice this is far from standard practice. In this paper we look at the issue using normative ethics, utilitarian ethics, an argument based on equality of health outcomes (...) before making an argument for an approach based on clinical judgement in each consultation of what form of language assistance is acceptable. (shrink)

Name der Zeitschrift: Klio Jahrgang: 98 Heft: 1 Seiten: 302-309.

The Higher Education and Employment strand of the Learning for Life project focused on exploring some of the values of 169 students and graduate employees (Arthur et al. 2009a , b ). A major theme suggested by participants, which arose naturally from the data and emerged from people’s accounts during in-depth interviews, involved the close relationship they felt existed between voluntary work and core values. It is this aspect of the project that is reported. There are several important and new (...) findings that will be highlighted, including: voluntary work as a dimension for the development of character, personal development and a venue for developing people’s skills (which universities and employers often seek in their processes of recruitment); the types of voluntary work conducted by students and graduate employees; the role of ethnic minorities; people’s moral motivations behind engaging in voluntary work; the rise of the gap year volunteer; and the link between voluntary work at university and Corporate Social Responsibility (CSR) in the working world. (shrink)