Background: One of the ethical imperatives for a valid consent process in clinical medication trials is that the process be guided by and recorded in an informed consent document (ICD). Concerns have been expressed, however, about readability and participant understanding of ICDs, which are often 10–20 pages long. Objective measures of readability and understanding have been used to support these concerns in several articles, but surprisingly the voice of trial participants on ICDs has not been heard in previous studies. Hence, (...) this study compares participants' subjective views on readability and their understanding of ICDs with those ICDs' objective readability scores. It also evaluates whether family, friends, and additional aids would foster better understanding of the ICD. Methods: Sixty current trial participants rated the readability and their understanding of deidentified standard ICDs. These had been sourced from two multicenter international Phase III trials on medication for diabetes mellitus and cancer. Results: Less than 10% of participants considered the ICDs difficult to read or difficult to understand in spite of objective readability scores at levels of about 12th grade education, but about a quarter considered the ICDs to be too technical. Participants gave mixed responses about friends or family members helping or the need for videos, pictures, additional reading material, and frequently answered questions (FAQ) sheets as an aid to their understanding. Conclusions: These findings suggest individual clinical trial participants should be engaged on their views of an ICD, for doing so is part of informed consent as a process rather than consent being merely focused on written information. Such participant-specific engagement should guide whether family and friends, videos, pictures, additional reading material, and FAQ sheets would be of assistance in improving understanding. (shrink)

What renders some mentally disordered patients incapable of informed consent to medical interventions? It is argued that a patient is incapable of giving informed consent owing to mental disorder, if a mental disorder prevents a patient from understanding what s/he consents to; if a mental disorder prevents a patient from choosing decisively; if a mental disorder prevents a patient from communicating his/her consent; or if a mental disorder prevents a patient from accepting the need for a medical intervention. This paper (...) holds that a patient's capacity to give informed consent should be assessed clinically by using these conditions necessary for informed consent, and should be assessed specifically for each intervention and specifically at the time when the consent has to be given. The paper considers patients' incapacity to give informed consent to treatment, to give informed consent to be examined clinically, and to give informed consent to participate in research. (shrink)

The book discusses different models of world order, traditional and modern. Any practical application of the concept at issue will be affected by the prevailing power structure, and to some degree, reflect it. The reality of American preeminence in the world today needs to be reconciled with the demand for international legitimacy.

This paper presents the philosophical theory underpinning an empirical study that found changes in the semantic usage of first person pronouns by recovering psychotherapy patients. The philosophical theory provided semantic variables that could serve as markers of recovery. It derived from the semantic theory by Gottlob Frege and the logic of relations, and accounts for the meaning expressed by the first person pronouns as distinct from their syntax and pragmatic symbolization. This distinction is worthwhile because empirical evidence was found for (...) change in the meaning expressed by these pronouns during recovery, but not for change in their syntax or pragmatic symbolization. Philosophical work on the concepts of illness and recovery was used to deduce that the semantic variables are markers of recovery in general rather than in psychotherapy only. As with the empirical study, the semantic variables were shown to change as follows when someone recovers: occupancy of alpha positions is taken up and occupancy of omega positions is relinquished. Potential applications of these findings were examined by which the tracking of the semantic variables may serve to improve the clinician's understanding of a patient, monitor a patient's progress, and enhance recovery. (shrink)

THE FIRST PART OF MY RESPONSE to the commentaries on my earlier paper is about the place of language and logical systems in the understanding of the personal positions that recovering patients occupy in their life experiences. It includes the main reasons for using Frege's philosophy. Thereafter, I make the point that relational positions in recovery extend broader than positions of actor and patient.

In lieu of an abstract, here is a brief excerpt of the content:Philosophy, Psychiatry, & Psychology 12.1 (2005) 77-78 [Access article in PDF] Language, Mind, and World Werdie (C. W.) Van Staden Keywords psychotherapy, linguistics, semantics, references, speech The paper by Mcconnell and Gillett touches, in a Lacanian way, on the connections between language, world, and the conscious and unconscious mind. Their paper brings together the influential ideas of Freud, philosophical phenomenology, existentialism, and structuralism in describing Lacan's approach to (...) these connections. Going further than Lacan's concerns in psychotherapy, their paper calls on us to consider the importance of these connections more generally in philosophy, psychiatry, and psychology.These connections matter substantially in the practice of psychiatry and psychology, for there we need to understand as much as possible of the ways in which language is intimately involved with the minds and brains of people and their biological and interpersonal worlds. Even at first glance, we can easily concede that people use language to express their troubled minds and their past, present, and anticipated relations with their biological and interpersonal worlds; that language use depends inescapably on brain functions (of the Broca and the Wernicke areas, for example); and that practitioners use language receptively and exploratively to access and examine the minds as well as the biological and interpersonal worlds of the people.Cognizant of the connections between language, mind, and world, language has received considerable attention in the psychotherapy literature and practice (e.g., Russell 1987), including from Lacan and his followers. In addition to these practices and theoretical expositions, empirical linguistic studies in psychotherapy have also been published recently (e.g., Van Staden in press; Van Staden and Fulford 2004; Spence 1995; Spence, Mayes, and Dahl 1994).There has been, furthermore, a growing interest in defining linguistic variables for empirical research in general psychiatry and psychology (Van Staden 2002; Thomas and Fraser 1994). The necessary and intimate role of language has also been reviewed recently in coming to a diagnostic understanding of people's difficulties (Van Staden 2003) and in conducting ethically sound assessments of mentally disordered people's capacity to give informed consent (Van Staden and Krüger 2003). Furthermore, the underlying connections between language, mind, and world, for example, have brought about the expectation that genetic factors in the etiology of schizophrenia would be related to the far-reaching capacity of human beings to use language (Crow 1997).A philosophical interest in the connections between language, mind, and world can be traced back to Plato. More recently, it has been taking a central place in analytic philosophy. The vast and sophisticated philosophical literature on this topic suggests that these connections are very [End Page 77] intricate and that we probably have an inchoate understanding of them. These connections are about theories of reference; theories of descriptions; semantic theories of truth; Kant's distinction between form and content; meaning; contextual content; linguistic pragmatism and speech act theories—all elaborate topics, of course, intertwined with various ontological commitments (cf. Luntley 1999).Lacan's contribution, driven by practical need albeit in the constrained area of psychotherapy, has not yet been taken up in analytic philosophy circles. The paper by McConnell and Gillett sets the scene for further philosophical examination that could determine whether Lacan's work does advance contemporary analytic philosophy on this topic. The most potential for such advance concerns probably, as indicated by McConnell and Gillet, insights about the unconscious mind.Notwithstanding a worthy philosophical examination of whether Lacan's work advances contemporary analytic philosophy on the connections between language, mind, and world, it may prove to be a challenging undertaking—probably even more challenging than the admirable groundwork done in the paper by McConnell and Gillett. The reason is, in my opinion, that the depth of Lacan's work is difficult to penetrate, in part because of the abundance of his esoteric terms, some of which are prima facie incommensurable with ordinary analytic language. The philosophical cogency of his work, moreover, is difficult to verify, because he often simply made conjectures, true as they might be, without explicating (sufficiently) the justification thereof.Lacan's work is commendable, however, even if... (shrink)

The purpose of this article is to problematise a particular social transparency and disclosure regulation in the UK, that transcend national boundaries in order to control slavery in supply chains operating in the developing world. Drawing on notions from the regulatory and sociology literature, i.e. transparency and normativity, and by interviewing anti-slavery activists and experts, this study explores the limitations of the disclosure and transparency requirements of the UK Modern Slavery Act and, more specifically, how anti-slavery activists experience and interpret (...) the new regulations and the regulators’ implementation of the regulation. This research found limited confidence among anti-slavery activists regarding the Act’s call for transparency in relation to the elimination of slavery from global supply chains. The research also found that the limits of the transparency provisions within the Act appear to hinder the attainment of normativity. This study provides new and unique insights into the critical role that social activists play in exposing the lack of corporate transparency and failures of responsibility to protect workers within global supply chains. (shrink)

According to widespread opinion, the meaning of body part terms is determined by salient discontinuities in the visual image; such that hands, feet, arms, and legs, are natural parts. If so, one would expect these parts to have distinct names which correspond in meaning across languages. To test this proposal, we compared three unrelated languages—Dutch, Japanese, and Indonesian—and found both naming systems and boundaries of even basic body part terms display variation across languages. Bottom‐up cues alone cannot explain natural language (...) semantic systems; there simply is not a one‐to‐one mapping of the body semantic system to the body structural description. Although body parts are flexibly construed across languages, body parts semantics are, nevertheless, constrained by non‐linguistic representations in the body structural description, suggesting these are necessary, although not sufficient, in accounting for aspects of the body lexicon. (shrink)

Distributional fairness of corporate distributions is an important social issue linked to accounting for equality. Value added and the information contained in the value added statement can conceptually be regarded as a reflection of how the company is managed for all stakeholders. We investigate value added information published in sustainability reports to determine if the information provided is useful for assessing distributional fairness between stakeholders. We find that the value added information disclosed lack conciseness, comparability and understandability. The divergence is (...) considerable and the explanations of the disclosed information so limited that the usefulness of the value added disclosures must be questioned. Our results suggest several obfuscating techniques in the disclosure of value added information, including disclosing information that is conceptually compromised, resulting in comparability issues and disclosing information that can’t be verified by reconciling back to the financial statements. Our findings have clear ethical and moral implications as they stress the societal issue of distributional fairness. It seems that companies are either reluctant to provide value added information that is useful, or deliberately use value added disclosures to obfuscate. Information reflecting distributional fairness is therefore compromised. (shrink)

The Oxford Handbook of Psychiatric Ethics is the most comprehensive treatment of the field in history. The volume is organized into ten sections which survey the scope of the text: Introduction, People Come First, Specific Populations, Philosophy and Psychiatric Ethics, Religious Contexts of Psychiatric Ethics, Social Contexts of Psychiatric Ethics, Ethics in Psychiatric Citizenship and the Law, Ethics of Psychiatric Research, Ethics and Values in Psychiatric Assessment and Diagnosis, Ethics and Values in Psychiatric Treatment. Written and edited by an international (...) team of experts, this landmark book provides a powerful and compelling review of psychiatric ethics in the 21st Century. (shrink)

The boundary problem on defining the conceptual scope and limits of a mental disorder may be tackled at either side of the boundary. On one side, philosophers and philosophically minded clinicians tried clarifying the concept of mental disorder and its related concepts of mental illness and dysfunction in their use and definition. On the other side, Mohammed Rashed's article gives a substantive and refreshing account of this neglected side in terms of social recognition. Thereby the boundary is clarified from the (...) outside through the limits set by the epistemic status of identity claims and the diachronic and synchronic unity of the self-conceptions that make up a person's identity.Stimulated by and building... (shrink)

This article provides ethical guidance on using race in health research as a variable or in defining the study population. To this end, a plain, non-exhaustive checklist is provided for researchers and research ethics committees, preceded by a brief introduction on the need for justification when using race as a variable or in defining a study population, the problem of exoticism, that distinctions pertain between race, ethnicity and ancestry, the problematic naming of races, and that race does not serve well (...) as a presumed biological construct in genetic research. (shrink)

In this article the transactional model of narrative as expounded by Louise Rosenblatt, supported by an analysis in terms of dramatic aspect, is employed to show how the interpolated scene in John 7:53–8:11 functions as a pivot of power in the gospel. The content of the scene, as well as its placement within the gospel, serves to promote an aesthetic reading that focusses attention on the experience during the reading event. Awareness of sensations, images, feelings and ideas from past experiences, (...) as well as the sounds and rhythms of the words become important. The reader responds to the aesthetic transaction, the various elements of total experience, rather than simply to the text, during and after the reading event. (shrink)

The article by Potter and Rif S. El-Mallakh read empathically, invokes a sense of fulfilment in their experiences, serving as inspiration for others to learn and practice ethics better. It describes their growth that has culminated to this sense of fulfilment and inspirational dignity. Crucial for this desirable growth has been, I want to highlight, their good investment in virtuous relationships and diligent processes. I also highlight from their article a potential conceptual restriction to growing in our learning and practicing (...) of ethics. That is, the restriction that occurs when blinded by too narrow a view on what ethics is about or where its emphasis is supposed to be. (shrink)

This research focused on the potential for Christ-following leaders to develop a theological and missiological posture in response to the current volatile, uncertain, complex and ambiguous world context. This research looks at how the attitudes and actions of the corporate world have influenced those of Christian organisations and Christian leadership. The corporate world primarily focuses on strategies for overcoming the challenges of the VUCA environment, but this research explores how Christ-following leaders might benefit from looking more deeply at what VUCA (...) represents, rather than merely accepting and reacting to it. The research used a literature review to develop the groundwork for an increased understanding of how God and VUCA relate and how Christ followers can develop a perspective in keeping with an understanding of God’s mission, their calling and the VUCA world mindset. Although some research has been done regarding spirituality as part of a response to the VUCA world, it has often focused on the outward expressions with little attention to the Christ follower’s source of spiritual life, the trinitarian God. This research integrates recognition of the character of God, evaluation of VUCA realities and rhetoric, and the responsibilities and opportunities of leaders who desire to participate in God’s mission. In this process, the research explores strategy metaphors, missional thinking and leadership implications.Contribution: This research encourages greater theological and missiological exploration of the Christian leader’s posture and response to the VUCA world mindset. The research engages with corporate thinking regarding strategy and the implications of VUCA and with theological and missiological thinking regarding God’s role, the leader’s role and the nature of current contexts, both local and global. (shrink)