In October 2003 the Supreme Court of the United States allowed Arkansas officials to force Charles Laverne Singleton, a schizophrenic prisoner convicted of murder, to take drugs that would render him sane enough to be executed. On January 6 2004 he was killed by lethal injection, raising many ethical questions. By reference to the Singleton case, this article will analyse in both moral and legal terms the controversial justifications of the enforced medical treatment of death-row inmates. Starting with (...) a description of the Singleton case, I will highlight the prima facie reasons for which this case is problematic and merits attention. Next, I will consider the justification of punishment in Western society and, in that context, the evolution of the notion of insanity in the assessment of criminal responsibility during the past two centuries, both in the US and the UK. In doing so, I will take into account the moral justification used to enforce treatment, looking at the conflict between the prisoner’s right to treatment and his right to refuse medication where not justified by outcomes that can be reasonably expected to be positive for the individual. Finally, in contrast with some retributivist arguments in favour of enforced treatment to enable execution, I will propose a possible alternative, necessary if we are to consistently uphold the notion of autonomy. (shrink)

ABSTRACT When is it right to enforce medical treatment on a patient who is refusing that treatment? English law recognises two ethical principles as of paramount importance: the autonomy of the patient; and the consequences of not treating compared with treating. The law, by and large, operates these principles in succession. Thus, in the case of a patient refusing treatment, the law asks first, is the patient competent? Only if the answer is no, are the consequences considered. (...) We criticise the position taken by English law and argue, first, that competence is a graded and not a binary concept, and secondly, that the two ethical principles should be applied not sequentially but at the same time. These two ideas form what we have called the balance model. This model could be used for an empirical study of individuals’ ethical beliefs, and in particular to test the hypothesis that the ethical beliefs of most individuals conform to the balance model rather than to the position taken by English law. (shrink)

As assisted reproductive technologies become increasingly popular, debate has intensified over the ethical justification for restricting access to ART based on various medical and non-medical factors. In 2010, the Australian state of Victoria enacted world-first legislation that denies access to ART for all patients with certain criminal or child protection histories. Patients and their partners are identified via a compulsory police and child protection check prior to commencing ART and, if found to have a previous relevant conviction or child protection (...) order, are given a “presumption against treatment.” This article reviews the legislation and identifies arguments that may be used to justify restricting access to ART for various reasons. The arguments reviewed include limitations of reproductive rights, inheriting undesirable genetic traits, distributive justice, and the welfare of the future child. We show that none of these arguments justifies restricting access to ART in the context of past criminal history. We show that a “presumption against treatment” is an unjustified infringement on reproductive freedom and that it creates various inconsistencies in current social, medical, and legal policy. We argue that a state-enforced policy of restricting access to ART based on the non-medical factor of past criminal history is an example of unjust discrimination and cannot be ethically justified, with one important exception: in cases where ART treatment may be considered futile on the basis that the parents are not expected to raise the resulting child. (shrink)

BackgroundAlthough the Life-Sustaining Treatment (LST) Decision Act was enforced in 2018 in Korea, data on whether it is well established in actual clinical settings are limited. Hospital-acquired pneumonia (HAP) is a common nosocomial infection with high mortality. However, there are limited data on the end-of-life (EOL) decision of patients with HAP. Therefore, we aimed to examine clinical characteristics and outcomes according to the EOL decision for patients with HAP.MethodsThis multicenter study enrolled patients with HAP at 16 referral hospitals (...) retrospectively from January to December 2019. EOL decisions included do-not-resuscitate (DNR), withholding of LST, and withdrawal of LST. Descriptive and Kaplan–Meier curve analyses for survival were performed.ResultsOf 1,131 patients with HAP, 283 deceased patients with EOL decisions (105 cases of DNR, 108 cases of withholding of LST, and 70 cases of withdrawal of LST) were analyzed. The median age was 74 (IQR 63–81) years. The prevalence of solid malignant tumors was high (32.4% vs. 46.3% vs. 54.3%, P = 0.011), and the ICU admission rate was lower (42.9% vs. 35.2% vs. 24.3%, P = 0.042) in the withdrawal group. The prevalence of multidrug-resistant pathogens, impaired consciousness, and cough was significantly lower in the withdrawal group. Kaplan–Meier curve analysis revealed that 30-day and 60-day survival rates were higher in the withdrawal group than in the DNR and withholding groups (log-rank P = 0.021 and 0.018). The survival of the withdrawal group was markedly decreased after 40 days; thus, the withdrawal decision was made around this time. Among patients aged below 80 years, the rates of EOL decisions were not different (P = 0.430); however, mong patients aged over 80 years, the rate of withdrawal was significantly lower than that of DNR and withholding (P = 0.001).ConclusionsAfter the LST Decision Act was enforced in Korea, a DNR order was still common in EOL decisions. Baseline characteristics and outcomes were similar between the DNR and withholding groups; however, differences were observed in the withdrawal group. Withdrawal decisions seemed to be made at the late stage of dying. Therefore, advance care planning for patients with HAP is needed. (shrink)

This volume presents a number of controversial cases of enforced medical treatment from around the globe, providing for the first time a common, biopolitcal framework for all of them. Bringing together all these real cases guarantees that a new, more complete understanding of the topic will be within grasp for readers unacquainted with the aspects involved in these cases. On the one hand, readers interested mainly in the legal and medical dimensions of cases like those considered will benefit (...) from the explanation of the biopolitical framework within which each case develops. On the other hand, those focusing on only one of the situations presented here will find the parallels between the cases an interesting expansion of the complexity of the problem. Despite the book's ambitious goal, for those willing to use it as supplemental material or interested in only one of the cases, the chapters can function as self-standing pieces to be read separately. This volume will be a valuable tool for both academics and professionals. Bioethicists in both the analytic and continental traditions, will find the book interesting for not only the specific concepts and issues considered, but also for its constructive bridging of the two schools of thought. In addition to philosophers, the structure of this work will also appeal to lawyers, doctors, human rights activists, and anyone concerned in the most disparate way with real-life cases of enforced medical treatment. (shrink)

BackgroundThe Life Extension Medical Decision law enacted on February 4, 2018 in South Korea was the first to consider the suspension of futile life-sustaining treatment, and its enactment caused a big controversy in Korean society. However, no study has evaluated whether the actual implementation of life-sustaining treatment has decreased after the enforcement of this law. This study aimed to compare the provision of patient consent before and after the enforcement of this law among cancer patients who visited a (...) tertiary university hospital's emergency room to understand the effects of this law on the clinical care of cancer patients.MethodsThis retrospective single cohort study included advanced cancer patients aged over 19 years who visited the emergency room of a tertiary university hospital. The two study periods were as follows: from February 2017 to January 2018 (before) and from May 2018 to April 2019 (after). The primary outcome was the length of hospital stay. The consent rates to perform cardiopulmonary resuscitation (CPR), intubation, continuous renal replacement therapy (CRRT), and intensive care unit (ICU) admission were the secondary outcomes.ResultsThe length of hospital stay decreased after the law was enforced from 4 to 2 days (p = 0.001). The rates of direct transfers to secondary hospitals and nursing hospitals increased from 8.2 to 21.2% (p = 0.001) and from 1.0 to 9.7%, respectively (p < 0.001). The consent rate for admission to the ICU decreased from 6.7 to 2.3% (p = 0.032). For CPR and CRRT, the consent rates decreased from 1.0 to 0.0% and from 13.9 to 8.8%, respectively, but the differences were not significant (p = 0.226 and p = 0.109, respectively).ConclusionAfter the enforcement of the Life Extension Medical Decision law, the length of stay in the tertiary university hospital decreased in patients who established their life-sustaining treatment plans in the emergency room. Moreover, the rate of consent for ICU admission decreased. (shrink)

Sometimes the mentally ill have sufficient mental capacity to refuse treatment competently, and others have a moral duty to respect their refusal. However, those with episodic mental disorders may wish to precommit themselves to treatment, using Ulysses contracts known as “mental health advance directives.” How can health care providers justify enforcing such contracts over an agent’s current, competent refusal? I argue that providers respect an agent’s autonomy not retrospectively—by reference to his or her past wishes—and not merely synchronically—so (...) that the agent gets what he or she wants right now—but diachronically and prospectively, acting so that the agent can shape his or her circumstances as the agent wishes over time, for the agent will experience the consequences of providers’ actions over time. Mental health directives accomplish this, so they are a way of respecting the agent’s autonomy even when providers override the agent’s current competent refusal. (shrink)

It might seem that racial profiling by doctors raised few of the same concerns as racial profiling by police, immigration, or airport security. This paper argues that the similarities are greater than first appear. The inappropriate use of racial generalizations by doctors may be as harmful and insulting as their use by law enforcement officials. Indeed, the former may be more problematic in compromising an ideal of individualized treatment that is more applicable to doctors than to police. Yet doctors, (...) unlike police, should not attempt to ignore race altogether. Race and ethnicity are associated with the geography of disease, with social and cultural factors relevant to disease, and, to some extent, with genetic predispositions to disease. Moreover, greater attention to the distinctive health conditions of certain racial and ethnic groups is necessary to make up for past neglect. But it will be a tricky business to steer a middle course between a naïve, reckless, or dogmatic color blindness and a stereotype-driven overreliance on race and ethnicity. In trying to steer such a course, the doctor can only hope for the day when a combination of more individualized genomic medicine and greater social equality will make it possible for her to pay less attention to race and ethnicity without detriment to her patients' health. (shrink)

In a recent paper, Mpofu, Sen Gupta, and Hays attempt to outline the obligations of recruiting high-income countries and would-be emigrant health workers to tackle the effects of mass exodus of health workers from underserved regions. They reconstruct Rawlsian and Kantian global justice approaches to argue for moral obligations of HICs and an individual justice approach to point to non-enforceable social responsibilities of HWs to assist their compatriots. This critical commentary demonstrates that the argumentation within their individual justice approach is (...) problematic on the basis of three reasons: their discussion under-theorizes and undervalues individual rights and more specifically the right to exit, their argumentation in the latter part, even if problematically, does rather point to moral obligations in lieu of social responsibilities of HWs, and they overlook many other important freedoms, interests, and values pertinent to the issue of retention. (shrink)

Trading on non-public material information is fertile ground for a discussion of ethical behavior. The long-running legal tug-of-war over what constitutes illegal insider trading delivers challenges to regulatory authorities charged with detecting and enforcing the law, and is likely one of the reasons that prosecution of insider trading events remains rather uncommon. One can observe both increased volume in the equity and option markets and run-ups in the stock price prior to the announcement of the acquisitions; however, the detection of (...) illegal or unethical insider trading can be difficult. Given the legal uncertainty around insider trading and the circumstantial evidence from the trading activity, it is almost impossible to identify unethical insider trades unless there is a whistleblower or trades are large in size and impeccable in timing. Using call option trading around two merger announcements with similar firms that resulted in different ultimate treatment from the SEC, we illustrate the struggle regulators and prosecutors have with identifying and enforcing unethical insider trades. (shrink)

This research paper examines the foreign investment laws and procedure of Pakistan and their role in protection of foreign investment in Pakistan. These laws are untapped area of research and one cannot find any specific research tracing the legal development in this highly specialized field. So far Pakistan has 48 BITs enforced with different countries and has also signed ICSID Convention, which is promulgated locally through Arbitration Act, 2011 incorporating the Convention in the schedule to ease the difficulty of (...) foreign investors to enforce the awards rendered under auspices of ICSID in the territory of Pakistan. Under this research, an attempt has been made to study prevalent foreign investment laws and its trends in Pakistan. Though Pakistan has significantly improved its foreign investment regime by introducing new investor’s friendly laws like, Special Economic Zones Act, 2011 and Investment Policy, 2013 etc., apart from its previous legislation on the subject, yet this regime needs more improvement and updating. Extensive overview of all existing foreign investment laws were carried out in this research. Fair and Equitable Treatment, Expropriation and other factors affecting foreign investment laws are the areas, which need to be taken care of by policy maker in the existing foreign investment laws of Pakistan. With these aims, it is hoped that this research paper would be a humble contribution in the literature on the subject. (shrink)

This thesis, which is based on six peer-reviewed publications, is a theoretical and qualitative treatment of the ways in which social and contextual factors serve as a resource for understanding the particularities of ‘cybercrime’ that emanates from Nigeria. The thesis illuminates how closer attention to Nigerian society aids the understanding of Nigerian cybercriminals (known as Yahoo Boys), their actions and what constitutes ‘cybercrime’ in a Nigerian context. ‘Cybercrime’ is used in everyday parlance as a simple acronym for all forms (...) of crimes on the internet, whereas ‘cybercrime’ in a Nigerian context is rooted in socioeconomics and determined by it. In particular, the defrauding of victims for monetary benefit is the most significant theme that emerged from the analysis of Yahoo Boys. While all six publications are situated at the intersections of multiple fields of study, they all share a common endorsement of the constructionist/interpretivist position. The six published works comprise: [a] three conceptual publications; and [b] three empirical publications. The conceptual publications deconstruct the meanings of multiple taken-for-granted concepts in cybercrime scholarship and develop more robust conceptual lenses, namely: (1) ‘Digital Spiritualization’; (2) ‘The Tripartite Cybercrime Framework – TCF’; and (3) ‘The Synergy between Feminist Criminology and the TCF’. These new conceptual lenses represent the candidate’s contribution to developing theory in the field. Alongside this, the empirical section includes three sets of qualitative data, which include: (1) interviews with seventeen Nigerian parents; (2) lyrics from eighteen Nigerian musicians; and (3) interviews with forty Nigerian law enforcement officers. These diverse sources of qualitative data provide a more fully-developed understanding of ‘cybercrime’ in the Nigerian context (and elsewhere). All six-published works, while individually contributing to knowledge, collectively shed clearer light on the centrality of cultural context in the explanation of ‘cybercrime’. (shrink)

The increasing use of opioid treatment agreements has prompted debate within the medical community about ethical challenges with respect to their implementation. The focus of debate is usually on the efficacy of OTAs at reducing opioid misuse, how OTAs may undermine trust between physicians and patients and the potential coercive nature of requiring patients to sign such agreements as a condition for receiving pain care. An important consideration missing from these conversations is the potential for racial bias in the (...) current way that OTAs are incorporated into clinical practice and in the amount of physician discretion that current opioid guidelines support. While the use of OTAs has become mandatory in some states for certain classes of patients, physicians are still afforded great leeway in how these OTAs are implemented in clinical practice and how their terms should be enforced. This paper uses the guidelines provided for OTA implementation by the states of Indiana and Pennsylvania as case studies in order to argue that giving physicians certain kinds of discretion may exacerbate racial health disparities. This problem cannot simply be addressed by minimising physician discretion in general, but rather by providing mechanisms to hold physicians accountable for how they treat patients on long-term opioid therapy to ensure that such treatment is equitable. There are no data in this work. (shrink)

B. Readings (University in Ruins. Cambridge: Harvard University Press, 1996) argued that universities have abandoned their original project of promoting a national culture and have tried to substitute by embracing globalization, but the vagueness and incoherence of the concept has failed to return purpose to the University. The academic treatment of corporate social responsibility illustrates this dilemma. For a generation after H.R. Bowen (Social Responsibilities of the Businessman. New York: Harper & Row, 1953) founded the field, scholars struggled to (...) fit the concept within a national system of pluralistic power-sharing among a variety of institutions that would define and enforce standards of responsibility necessary for the general good of American society. That understanding changed in the nineteen eighties, shortly after corporate executives had united to an unprecedented degree to direct the power of government in their interests, influence the public agenda, and roll back the power of unions. In response, business ethicists began to reformulate corporate social responsibility as a voluntary practice on the part of these same executives. Since the Kantian and Lockean principles upon which this approach was based were themselves problematic, it is not surprising that the experience gained over the last generation casts doubt on the efficacy of this reliance on voluntary restraint and personal initiative. However, circumstances that include the failure of globalization to deliver on its promises may have changed sufficiently in recent years to revive interest in approaches that acknowledge the importance of countervailing power for encouraging greater corporate social responsibility. (shrink)

Facelifts, tummy tucks and breast enlargements are no longer the privilege of the rich and the famous. Any woman can have all these and many more cosmetic surgical treatments, and an increasing number of women do. Are they having cosmetic surgery because they are duped by a male-dominated beauty system, or do they genuinely choose these operations themselves? Feminists give diametrically opposed answers to this question. At the heart of the controversy, or so I claim in this article, lies a (...) conceptual problem about free choice; therefore, the only thing that can settle it is a conceptual analysis of “freedom”. After having briefly outlined the views of both sides of the debate, I offer such an analysis. (shrink)

The regulation of narcotic medications used in narcotic addiction treatment is unique in medical therapeutics. Physicians who want to use narcotics for this indication must obtain a separate annual registration from the Drug Enforcement Administration. Annual registration is contingent on compliance with both the DEA's security regulations as well as treatment regulations jointly promulgated by the Food and Drug Administration and the National Institute on Drug Abuse.During the last decade, a number of events have occurred that persuaded NIDA (...) that it is time to reevaluate the current method by which the Department of Health and Human Services regulates methadone treatment. As a result of research during the past twenty years, we have learned about the effective components of methadone treatment. In comparison to other available treatment modalities for opioid addiction, methadone treatment is uniquely effective when administered by well-trained medical staffs. (shrink)

The regulation of narcotic medications used in narcotic addiction treatment is unique in medical therapeutics. Physicians who want to use narcotics for this indication must obtain a separate annual registration from the Drug Enforcement Administration. Annual registration is contingent on compliance with both the DEA's security regulations as well as treatment regulations jointly promulgated by the Food and Drug Administration and the National Institute on Drug Abuse.During the last decade, a number of events have occurred that persuaded NIDA (...) that it is time to reevaluate the current method by which the Department of Health and Human Services regulates methadone treatment. As a result of research during the past twenty years, we have learned about the effective components of methadone treatment. In comparison to other available treatment modalities for opioid addiction, methadone treatment is uniquely effective when administered by well-trained medical staffs. (shrink)

This study explores how disciplinary humor is deployed to shape and reshape social order in inter-generational encounters. Data are drawn from an ethnographic study of staff–resident encounters at a treatment home for boys, focusing on sequential patterns in the local design of jokes and teasing, analyzing language and multimodal interaction in detail. It was found that staff and boys recurrently laughed together and teased each other by invoking local hierarchical positions such as child–adult. The intrinsic ambiguity of humor and (...) teasing allowed staff members to engage in temporary breaches of social order, while simultaneously enforcing local rules of conduct. Similarly, the boys would joke with the staff, exaggerating or transgressing institutional and generational divides. But ultimately, the joking could also be seen to remind the participants of the very hierarchies that separate staff from residents and men from boys, or adults from children. (shrink)

Developmental Dyslexia significantly interferes with children’s academic, personal, social, and emotional functioning. Nevertheless, therapeutic options need to be further validated and tested in randomized controlled clinical trials. The use of transcranial direct current stimulation has been gaining ground in recent years as a new intervention option for DD. However, there are still open questions regarding the most suitable tDCS protocol for young people with DD. The current crossover study tested the effectiveness of a short and intensive tDCS protocol, including the (...) long-term effects, as well as the influence of age and neuropsychological processes at baseline on reading improvements. Twenty-four children and adolescents with DD were randomly assigned to receive active tDCS during the first slot and sham tDCS during the second slot or vice versa. Five consecutive daily sessions of left anodal/right cathodal tDCS set at 1 mA for 20 min were administered over the parieto-occipital regions. Reading measures and neuropsychological measures were collected before, immediately after, 1 week and 1 month later the treatment. Our results showed that only the active tDCS condition improved non-word reading speed immediately after and 1 month later the end of the treatment compared with baseline. In addition, the improvement in non-word reading speed was significantly correlated with age and with neuropsychological measures at baseline but only in the active tDCS condition. The current crossover study contributed to enforce previous effects of tDCS, including long-term effects, on non-word reading speed and to understand the effect of age and neuropsychological processes on reading outcomes. Our findings showed that tDCS could be a low-cost and easy-to-implement treatment option with long-term effects for children and adolescents with DD. (shrink)

Traditionally many systems subjected public employees to a separate and more restrictive labour law regime than their private sector counterparts. However, these status-based restrictions were generally modified or abandoned during the 1960s and 1970s. Greater homogeneity of treatment of public and private sector workers was also subsequently reflected in employment practices in Britain and elsewhere as a product of the «marketization» of public services, a strategy which involved replacing centralized regulation by greater local determination in accordance with «business» needs. (...) More radically, the provision of some public services was removed from the public sector altogether, either by contracting out particular elements of the service or by wholesale privatization, subject to some form of regulatory regime. These changes may appear to render otiose discussion of the case for special treatment of the employment relation in public services. This article expounds the proposition that, on the contrary, public services possess distinctive qualities which necessitate regulation of the employment relationship within those services in areas beyond those covered by the general law, and aims to provide a framework within which the justification for specific additional measures can be assessed. The article also considers the further questions which need to be addressed if the framework it proposes is accepted, including, in particular, the appropriate mechanisms for imposing and enforcing regulation. (shrink)

In recent years, misinformation sharing has become the focus of public debate and academic research. We aim to explore whether individuals prefer to share accurate information or not, and discover what factors increase people’s preferences for sharing accurate information. Combining behavioral economics experiments and psychology experiments, we construct “an information search—information sharing—information feedback experiment” to examine individuals’ behavior of sharing accurate information and its influencing factors. A total of 210 students are recruited for the laboratory experiment. Our results show that (...) when individuals can control the accuracy of the information they obtain through their efforts, they are more willing to share accurate information with others. We also find that positive feedback from information receivers can promote the accuracy of information shared by individuals, and this effect works through reciprocity norms. Individuals with higher reciprocity are more willing to share accurate information, especially in the treatment with the role of reciprocity norms enhanced by feedback. These findings indicate that individuals who are willing to obtain accurate information prefer to share information, and information feedback can enhance this preference through reciprocity norms. This study captures individuals’ behavior and preference characteristics with regard to the accuracy of the information they share in the era of highly developed network interaction. (shrink)

In the May, 1960, issue of the American Bar Association Journal (vol. 499), Morton Birnbaum, a lawyer and physician, argued for a legal right to psychiatric treatment of the involuntarily committed mentally ill person. In the 18 years since his article appeared,, there have been several key court cases in which this concept of a right to psychiatric treatment has figured prominently and decisively. It is important to note that the language of the decisions have had at least (...) an indirect effect in the recently enacted mental Hygiene Law of the State of New York. While I shall not seek to establish the historical thesis that Birnbaum’s article has been efficacious in bringing about both these court decisions and changes in statutory laws, I do want to examine Birnbaum’s article and some of the opinions for three cases: Wyatt v. Stickney (1972), Wyatt v. Aderholt (1974), and O’Connor v. Donaldson (422 US 563, 1975), in an effort to understand both the significance of these changes in our laws and the underlying philosophical and ethical notions of which they are an expression. Birnbaum observed that the notable feature of the legal situation at the time was that there had not been recognized a constitutional requirement that one who had been institutionalized for mental illness according to due process must receive treatment. Birnbaum argued that the effects of an omission of such a requirement to treat were that mental institutions typically offered only custodial care, that patients who were held only under custodial care typically did not improve, and that the result was that involuntary incarceration in a mental institution was, at least from the point of view of the patient, functionally no different than would be imprisonment for an unspecified period of time. Birnbaum argued for a recognition and enforcement in the courts of the right to treatment “...as a necessary and overdue development of our present concept of due process of law,” i.e., as required by the 14th Amendment to the U.S.. (shrink)

The use of restraints on psychiatric patients has long been criticized, and the need for self-restraint of professionals in response to new technologies has been documented from the nineteenth century. Since the middle ages, when leprosy disappeared from civilized society, individuals with a “deranged mind” came to occupy the public space of outcast once reserved for the leper. This diminished social status conflicts with the ethical precept of respect for all patients and the need for humane treatment within the (...) clinical care setting. Psychiatric patients may be presented as a physically dangerous presence in clinical care facilities. New technologies may seem to offer a solution to the problem of balancing the safety of staff with the ethical requirement to treat patients with respect and attention to their medical needs. The Taser, promoted as a safe method of law enforcement, has received notoriety in at least one case involving restraint of psychiatric patients. (shrink)

Tensions between migration enforcement and migrants’ health and rights have gained renewed urgency during the COVID-19 pandemic. This article critically analyses how the pandemic has affected detained and deportable people in Sweden. Building on an activist methodological approach and collaboration, based on a survey conducted inside Swedish detention centres during the pandemic and the authors’ research and activist engagement with migrants who are detained or legally stranded in Sweden, we argue that migration authorities’ inadequate measures to protect detained and deportable (...) people during the pandemic is a case of governance through ignorance enabled by structural racism. The article traces how this ignorance operates on a structural, institutional and micro-level, enabling public disregard and political irresponsibility for the harmful effects of migration enforcement. A broader aim of the article is to challenge the structural, societal and epistemic ignorance of the conditions for detained and deportable persons and to contribute to political change. (shrink)

In the heat of the Civil War, Abraham Lincoln made a speech in which he referred sympathetically to the Southern rebels. A member of the audience lambasted him for wanting to treat his enemies kindly when he ought to be thinking of destroying them. Lincoln's answer: "Why, madam, do I not destroy my enemies when I make them my friends?" Harshness and cruelty were to be banished from the moral imagination of the nation he was trying to save. The late (...) Jack Maple, a famously flamboyant but phenomenally effective former deputy commissioner of the NYPD, wrote that "the more information a detective has, the more creative, authoritative and effective he or she can be." Under attack in 2001, and then at war in Iraq in 2003, American law enforcement, intelligence and military really didn't have much information at first. They rounded up the usual suspects, but didn't know what usual meant. So they smacked people around, and that was always a bad idea, as Maple said: "Forget that smacking somebody around is illegal and just plain wrong, it's also the quickest way to ruin the chances of getting a statement of any kind." Professional interrogators talk about building empathy and dependence. Maple would get down on his knees and pray with a suspect if he thought that would work. But the best technique? "If you can get them to laugh, you'll get a statement. That's always true." Internal CIA documents reveal that empathy is also likely what got Abu Zubaydah to reveal how Al Qaeda planned 9/11 and its other operations. His torture brought nothing of real value, only the moral demeaning of his tormentors.... (shrink)

For people with Bipolar Affective Disorder, a self-binding (advance) directive (SBD), by which they commit themselves to treatment during future episodes of mania, even if unwilling, can seem the most rational way to deal with an imperfect predicament. Knowing that mania will almost certainly cause enormous damage to themselves, their preferred solution may well be to allow trusted others to enforce treatment and constraint, traumatic though this may be. No adequate provision exists for drafting a truly effective SBD (...) and efforts to establish such provision are hampered by very valid, but also paralysing ethical, clinical and legal concerns. Effectively, the autonomy and rights of people with bipolar are being 'protected' through being denied an opportunity to protect themselves. From a standpoint firmly rooted in the clinical context and experience of mania, this article argues that an SBD, based on a patient-centred evaluation of capacity to make treatment decisions (DMC-T) and grounded within the clinician-patient relationship, could represent a legitimate and ethically coherent form of self-determination. After setting out background information on fluctuating capacity, mania and advance directives, this article proposes a framework for constructing such an SBD, and considers common objections, possible solutions and suggestions for future research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Ethics CommentaryMichael Robertson, Senior Research FellowThe French philosopher Michel Foucault once recounted the story of the English King, George III, being restrained by his guards at the direction of his physician Dr. Willis. King George, presumably deranged by a psychotic mania consequent upon porphyria, was incapable of self-rule and his power was usurped by the medical profession in an act of coercion tantamount to treason. This for Foucault was (...) a profound metaphor of psychiatric power.1The plight of Mdm. W yokes the two most emotive issues in psychiatry — involuntary treatment and the administration of ECT. Whilst only utilised at an extremity of clinical practice, both of these are the most misunderstood of actions performed by the psychiatric profession. Yet, in many circumstances, they are life-saving.In essence, we are confronted with a profoundly depressed woman, whose illness is seemingly resistant to first line treatment and poses a serious, credible risk of harm. Most psychiatrists would regard this as somewhat of a psychiatric emergency. We are informed that Mdm. W’s family has transcended any cultural taboos about mental illness and is engaged in her care, has an extensive lived experience of her severe mood disorder and accepts, indeed welcomes, the use of ECT to terminate a severe episode of depression. In the course of a psychotic depression, Mdm. W is suffering profound distress and presents a risk of either suicide or serious medical complications if the episode persists. Despite the minimal discomfort during the actual administration of ECT, Mdm. W’s distress will be compounded by the further restraint needed to prevent from her eating and drinking prior to anaesthesia.It is difficult to know what Mdm. W’s experience of this situation would [End Page 230] be. Through the prism of her disturbed mental state, with its derangements in thinking, cognitive functioning and apprehension of reality, she would likely experience the situation as one of fear or terror; she would likely interpret ECT and the enforced restriction of oral intake prior to the procedure as punitive — further evidence of her “sins”, reinforcing her delusional guilt and nihilism. Yet to speak to Mdm. W in circumstances of euthymia or normal mood, where such derangements no longer occur, might reveal an utterly different perspective on the situation. Like many people with episodic mental illnesses, Mdm. W might, when such a scenario was put to her, consent to future treatment with ECT without equivocation. Indeed, many patients with bipolar disorder formulate advance directives in regard to the specific management of their possible future episodes of illness.If the clinical and legal aspects of this situation are so clear, why is there a sense of a dilemma in the realm of clinical ethics? Beyond the emotive nature of the situation, we see a deeply distressed woman being provided potentially life-saving treatment, which is being denied to her by the profound impairments of insight and judgement consequent upon her illness.In Singapore, such detention and enforced treatment under the Mental Capacity Act (2010) applies to a person with a mental illness or disorder who lacks capacity to make decisions in their own best interests based upon impairment of mind or brain. This would be considered a “capacity” based mental health law. In other jurisdictions, the legal test and evidentiary justification for such care may be predicated upon risk of harm to self or others. In either setting, Mdm. W’s clinical situation provides adequate legal justification for such enforced care.The moral justification of such laws falls into two general categories — the “risk” argument and the “capacity” argument. In mental health legislation, the “harm principle”, as first elaborated in John Stuart Mill’s On Liberty,2 is usually defined in terms of the construct of “risk”. Risk is a term that has multiple meanings in different disciplinary contexts, although all approaches to “risk” attempt to apply knowledge to an area of uncertainty.3 The notion of “risk assessment” is usually considered as the process of categorising individuals by their perceived likelihood of causing serious harm to themselves or harm to others. In the insurance industry, actuarial assessment is a mathematical discipline aimed at computing a probability of adversity... (shrink)

Hardly anyone disputes that discrimination can be a grave moral wrong. Yet this consensus masks fundamental disagreements about what makes something discrimination, as well as precisely why acts of discrimination are wrong. Benjamin Eidelson develops systematic answers to those two questions. He claims that discrimination is a form of differential treatment distinguished by its special connection to the differential ascription of some property to different people, and goes on to argue that what makes some cases of discrimination intrinsically wrongful (...) is that they manifest an attitude of disrespect for the personhood of those who are disfavored. He endeavors to specify what this attitude consists in, and to demonstrate how attending to its character can help us to better understand the moral dimensions of different forms of wrongful discrimination. The book concludes with an extended discussion of racial profiling in law enforcement. (shrink)

This is a theoretical treatment of the term "Sha Zhu Pan" (杀猪盘) in Chinese, which translates to “Pig-Butchering” in English. The article critically examines the propagation and validation of "Pig Butchering," an animal metaphor, and its implications for the dehumanisation of victims of online fraud across various discourses. The study provides background information about this type of fraud before investigating its theoretical foundations and linking its emergence to the dehumanisation of fraud victims. The analysis highlights the disparity between academic (...) literature, subjected to rigorous peer-review processes, and sensationalised narratives prevalent in the media. While academic works subject "pig butchering" to critical scrutiny and refrain from endorsing derogatory terms to depict fraud victims, numerous media outlets employ this term uncritically, further worsening the predicament of these victims. "Pig butchering" is firmly rooted in the concept of dehumanisation, and this article underscores how language moulds perceptions of fraud and behaviour, extending to the development of preventive strategies. The role of law enforcement agencies in generating and disseminating materials is also a central theme, emphasising their responsibility as trusted sources of information. We suggest that these agencies should adopt non-victim shaming language to encourage victims to report crimes and alleviate the stigma attached to victimisation. Additionally, the article offers valuable cross-cultural insights by comparing metaphors from Chinese and Nigerian contexts. This comparative analysis enriches our comprehension of the global dimensions of online fraud and its cultural diversities, highlighting the substantial impact of language on perceptions and behaviours. We advocate for a departure from victim-blaming tendencies perpetuated by select media outlets, urging a more compassionate and accurate portrayal of those affected by online fraud. We, therefore, call for a more empathetic and accurate portrayal of individuals affected by online fraud, aligning with the broader objective of promoting understanding and support for these victims. (shrink)

:The available treatments for disorders affecting large segments of the population are often costly, complex, and only marginally effective, and many have numerous side effects. These disorders include dementias, debilitating neurological disorders, the multiple types of drug addiction, and the spectrum of mental health disorders.Preliminary studies have shown that a variety of psychedelic and similar U.S. Drug Enforcement Administration Schedule I drugs may offer better treatment options than those that currently exist and pose potentially the same or even less (...) risk than do legal psychoactive and nonpsychoactive substances. The pharmaceutical industry and academia, however, have largely avoided this avenue of research.Fairness to the affected populations demands that these drugs be adequately studied and, if they or their congeners are shown to be effective, made available with the proper caveats, instructions, and protections that other potentially abused medications receive. These substances may prove to relieve patients’ struggles with less effective treatments and decrease mortality from nontreatment of some conditions. (shrink)

The question whether Frege’s theory of indirect reference enforces an infinite hierarchy of senses has been hotly debated in the secondary literature. Perhaps the most influential treatment of the issue is that of Burge (1979), who offers an argument for the hierarchy from rather minimal Fregean assumptions. I argue that this argument, endorsed by many, does not itself enforce an infinite hierarchy of senses. I conclude that whether or not the theory of indirect reference can avail itself of only (...) finitely many senses is pending further theoretical development. (shrink)

Shepherd propounds a theory of mind with a fair claim to be better than Hume’s at explaining the sources of commonly held human beliefs about causal necessity due largely to her relational theory of sense perception. In comparison with Hume’s account, it incorporates a more sophisticated treatment of mental representation, especially the role of relational structure and logical form. Most important, perhaps, Shepherd’s theory enforces the division, obscured by Hume, between the evidence of necessity and the metaphysical foundation of (...) necessity. (shrink)

Recent legal rulings concerning the status of advance statements have raised interest in the topic but failed to provide any definitive general guidelines for their enforcement. I examine arguments used to justify the moral authority of such statements. The fundamental ethical issue I am concerned with is how accounts of personal identity underpin our account of moral authority through the connection between personal identity and autonomy. I focus on how recent Animalist accounts of personal identity initially appear to provide a (...) sound basis for extending the moral autonomy of an individual - and hence their autonomous wishes expressed through an advance directive - past the point of severe psychological decline. I argue that neither the traditional psychological account nor the more recent Animalist account of personal identity manage to provide a sufficient basis for extending our moral autonomy past the point of incapacity or incompetence. I briefly explore how analogies to similar areas in law designed to facilitate autonomous decision, such as wills and trusts, provide at best only very limited scope for an alternative justification for granting advance statements any legal or moral authority. I conclude that whilst advance statements play a useful role in formulating what treatment is in a patient’s best interests, such statements do not ultimately have sufficient moral force to take precedence over paternalistic best interest judgements concerning an individual’s care or treatment. (shrink)

ABSTRACTMetaphors pervade discussions of critical issues and influence how people reason about these domains. For instance, when crime is a beast people are more likely to suggest enforcement-oriented approaches to crime-reduction ; reading that crime is a virus, on the other hand, leads people to suggest systemic reforms for the affected community. In the current study, we find that extending metaphoric language into the descriptions of policy interventions bolstered the persuasive influence of metaphoric frames for important issues. That is, in (...) response to a crime virus people were even more likely to endorse social reforms that were described as “treatments,” while in response to a crime beast people were even more likely to endorse “attacking” the problem with harsh enforcement tactics. Of note, people were not simply drawn to extensions of previously instantiated metaphors: when extended metaphors were paired with a conceptually incongruent policy intervention (e... (shrink)

My paper addresses a topic--the implications of Rawls's justice as fairness for affirmative action--that has received remarkably little attention from Rawls's major interpreters. The only extended treatments of it that are in print are over a quarter-century old, and they bear scarcely any relationship to Rawls's own nonideal theorizing. Following Christine Korsgaard's lead, I work through the implications of Rawls's nonideal theory and show what it entails for affirmative action: viz. that under nonideal conditions, aggressive forms of formal equality of (...) opportunity (e.g., sensitivity training, outreach efforts, external monitoring and enforcement) and compensating support (e.g., special fellowship programs, childcare facilities, mentoring, co-op opportunities, etc.) can be justified, but that "hard" and even "soft" quotas are difficult to defend under any conditions. I conclude the paper by exploring the implications of these surprising results for contemporary liberalism more broadly and for constitutional law and public policy. (shrink)

Ulysses contracts are a method by which one person binds himself by agreeing to be bound by others. In medicine such contracts have primarily been discussed as ways of treating people with episodic mental illnesses, where the features of the illness are such that they now judge that they will refuse treatment at the time it is needed. Enforcing Ulysses contracts in these circumstances would require medical professionals to override the express refusal of the patient at the time (...) class='Hi'>treatment is required, something that is generally problematic both ethically and legally. In this paper I will argue that despite appearances Ulysses contracts can make it the case that treating a patient in such circumstances is an instance of treating him with his consent, although safeguards are needed to ensure that this is the case. Given the potential benefits to patients I further argue that modified Ulysses contracts should be made legally enforceable. (shrink)

Reports in the popular press suggest that smart drugs or “nootropics” such as methylphenidate, modafinil and piracetam are increasingly being used by the healthy to augment cognitive ability. Although current nootropics offer only modest improvements in cognitive performance, it appears likely that more effective compounds will be developed in the future and that their off-label use will increase. One sphere in which the use of these drugs may be commonplace is by healthy students within academia. This article reviews the ethical (...) and pragmatic implications of nootropic use in academia by drawing parallels with issues relevant to the drugs in sport debate. It is often argued that performance-enhancing drugs should be prohibited because they create an uneven playing field. However, this appears dubious given that “unfair” advantages are already ubiquitous and generally tolerated by society. There are concerns that widespread use will indirectly coerce non-users also to employ nootropics in order to remain competitive. However, to restrict the autonomy of all people for fear that it may influence the actions of some is untenable. The use of potentially harmful drugs for the purposes of enhancement rather than treatment is often seen as unjustified, and libertarian approaches generally champion the rights of the individual in deciding if these risks are acceptable. Finally, whether the prohibition of nootropics can be effectively enforced is doubtful. As nootropics use becomes widespread among students in the future, discussion of this issue will become more pressing in the years to come. (shrink)

This chapter provides a survey of issues about diagrams in traditional geometrical reasoning. After briefly refuting several common philosophical objections, and giving a sketch of diagram-based reasoning practice in Euclidean plane geometry, discussion focuses first on problems of diagram sensitivity, and then on the relationship between uniform treatment and geometrical generality. Here, one finds a balance between representationally enforced unresponsiveness (to differences among diagrams) and the intellectual agent's contribution to such unresponsiveness that is somewhat different from what one (...) has come to expect in modern logic. Finally, challenges and opportunities for further work are indicated. (shrink)

Artificial Knowing challenges the masculine slant in the Artificial Intelligence (AI) view of the world. Alison Adam admirably fills the large gap in science and technology studies by showing us that gender bias is inscribed in AI-based computer systems. Her treatment of feminist epistemology, focusing on the ideas of the knowing subject, the nature of knowledge, rationality and language, are bound to make a significant and powerful contribution to AI studies. Drawing from theories by Donna Haraway and Sherry Turkle, (...) and using tools of feminist epistemology, Adam provides a sustained critique of AI which interestingly re-enforces many of the traditional criticisms of the AI project. Artificial Knowing is an esential read for those interested in gender studies, science and technology studies, and philosophical debates in AI. (shrink)

It is practically inevitable that even the best-intentioned public officials occasionally inflict unjust harm on people who should not have to suffer it. They mistakenly arrest innocent suspects, and convict innocent defendants. They erroneously adopt and enforce criminal laws that unduly restrict our freedom. They vote for, implement, and enforce tax laws that unfairly burden some citizens. And yet it is widely assumed that, as long as such officials act in good faith, and follow certain institutional rules, we aren’t permitted (...) to protect the innocent victims of their mistakes by inflicting defensive harm on the officials. As a result, those victims may have to suffer injustices that we could, in principle, prevent. This is so even though, if a private person imposed similarly unjust harm, and did so on the basis of mistaken judgments that were equally in good faith, and just as reliable as the institutional judgments guiding the official, we could permissibly harm that person to defend the victim. This essay considers whether, and how, this asymmetric treatment can be justified. After some ground-clearing that sharpens the question, it briefly considers the dominant explanation offered by political philosophers, which focuses on how resisting official mistakes would impact innocent third parties (most obviously, one’s fellow citizens). Finding these explanations wanting, the essay turns to a less frequently considered alternative: under certain conditions, defending the innocent victim against the official’s mistake is unfair to the official who would be harmed in the process. In particular, if officials act for their subjects (in a quite specific sense), then we may, as a matter of fairness, be barred from harming the officials to protect those subjects from (some of) the unjust harms that officials erroneously inflict. This account chimes with familiar views in the history of political thought that take legitimate political power to be held in trust for the people, and legitimate governments to stand in fiduciary relations to their subjects. It explains why officials may in principle have special moral protection that private persons usually lack, and why we may have to put up with officials’ mistakes even if they inflict injustice on innocent persons. But it also reveals how demanding the conditions are under which officials have such protection, and why many existing legal and political institutions lack the legitimacy, and their officials the special moral protection against defensive harm, that they purport to have. (shrink)

Psychedelic Harm Reduction and Integration is a transtheoretical and transdiagnostic clinical approach to working with patients who are using or considering using psychedelics in any context. The ongoing discussion of psychedelics in academic research and mainstream media, coupled with recent law enforcement deprioritization of psychedelics and compassionate use approvals for psychedelic-assisted therapy, make this model exceedingly timely. Given the prevalence of psychedelic use, the therapeutic potential of psychedelics, and the unique cultural and historical context in which psychedelics are placed, it (...) is important that mental health providers have an understanding of the unique motivations, experiences, and needs of people who use them. PHRI incorporates elements of harm reduction psychotherapy and psychedelic-assisted psychotherapy, and can be applied in both brief and ongoing psychotherapy interactions. PHRI represents a shift away from assessment limited to untoward outcomes of psychedelic use and abstinence-based addiction treatment paradigms and toward a stance of compassionate, destigmatizing acceptance of patients' choices. Considerations for assessment, preparation, and working with difficult experiences are presented. (shrink)

Most ethics guidelines for distributing scarce medical resources during the coronavirus pandemic seek to save the most lives and the most life‐years. A patient’s prognosis is determined using a SOFA or MSOFA score to measure likelihood of survival to discharge, as well as a consideration of relevant comorbidities and their effects on likelihood of survival up to one or five years. Although some guidelines use age as a tiebreaker when two patients’ prognoses are identical, others refuse to consider age for (...) fear of discriminating against the elderly. In this paper, I argue that age is directly relevant for maximizing health benefits, so current ethics guidelines are wrongly excluding or deemphasizing life‐stage in their triage algorithms. Research on COVID‐19 has shown that age is a risk factor in adverse outcomes, independent of comorbidities. And limiting a consideration of life‐years to only one or five years past discharge does not maximize health benefits. Therefore, based on their own stated values, triage algorithms for coronavirus patients ought to include life‐stage as a primary consideration, along with the SOFA score and comorbidities, rather than excluding it or using it merely as a tiebreaker. This is not discriminatory because patients ought to have equal opportunity to experience life‐stages. The equitable enforcement of that right justifies unequal treatment based on age in cases when there is a scarcity of life‐saving resources. A consideration of life‐stage would thus allow healthcare workers to responsibly steward public resources in order to maximize lives and life‐years saved. (shrink)

_Artificial Knowing_ challenges the masculine slant in the Artificial Intelligence view of the world. Alison Adam admirably fills the large gap in science and technology studies by showing us that gender bias is inscribed in AI-based computer systems. Her treatment of feminist epistemology, focusing on the ideas of the knowing subject, the nature of knowledge, rationality and language, are bound to make a significant and powerful contribution to AI studies. Drawing from theories by Donna Haraway and Sherry Turkle, and (...) using tools of feminist epistemology, Adam provides a sustained critique of AI which interestingly re-enforces many of the traditional criticisms of the AI project. _Artificial Knowing_ is an esential read for those interested in gender studies, science and technology studies, and philosophical debates in AI. (shrink)

This is a study of the treatment of library patron privacy in licenses for electronic journals in academic libraries. We begin by distinguishing four facets of privacy and intellectual freedom based on the LIS and philosophical literature. Next, we perform a content analysis of 42 license agreements for electronic journals, focusing on terms for enforcing authorized use and collection and sharing of user data. We compare our findings to model licenses, to recommendations proposed in a recent treatise on licenses, (...) and to our account of the four facets of intellectual freedom. We find important conflicts with each. (shrink)

In this article, the authors explore the impact of a potential future regulatory decision by FDA whether or not to continue its enforcement discretion policy allowing physicians to perform, and stool banks to sell, stool product for fecal microbiota transplantation as a treatment for recurrent Clostridium Difficile infection without an Investigative New Drug application. The paper looks at the Agency's regulatory options in light of the current gut microbiota based products that are in the FDA pipeline for drug approval (...) and the potential impact and repercussions of their approval on FDA action. In laying out FDA's options we consider the implications of market exclusivity and off-label use of newly approved drugs. Ultimately, we explore the potential impact of FDA's decision on patients, research, and innovation. (shrink)

How is legitimacy to be secured for constitution-like legal orders operating beyond the state? Some scholars recommend connecting aspects of global law to human rights adjudication and enforcement by adopting their preferred method for resolving conflicts, namely, proportionality analysis. Adopting a frame of analysis widely embraced by apex courts might generate the requisite regime legitimacy, it is argued. This turns out to be a strategy that is difficult to pursue in the realm of international investment law, a global legal order (...) made up of over 3,300 investment and regional treaties, enforced by private systems of dispute resolution, that incorporates standards of treatment familiar to national constitutional law. By undertaking an analysis of statements made by relevant actors in the field, principally investment lawyers and arbitrators, we learn that there is not that much interest in taking up proportionality analysis, despite the legitimacy problems that continue to dog the system. Whatever the purported advantages of turning to proportionality, it turns out that investment lawyers and arbitrators are not so interested in embracing logics other than one preoccupied with owing solicitude to foreign investors. This reluctance renders investment law a less legitimate, and therefore less sustainable, form of constitution-like global law. (shrink)

Millions of human biological samples are stored worldwide for medical research or treatment purposes. These biospecimens are of enormous potential value to law enforcement as DNA profiles can be obtained from these samples. However, forensic use of such biospecimens raises a number of ethical questions. This article aims to explore ethical issues of using human bodily material in medical biobanks for crime investigation and prosecution purposes. Concerns about confidentiality, trust, autonomy and justice will be discussed. We explore how to (...) balance these concerns against the importance of crime solving. Relevant case examples of forensic use of medical biobanks show that requests by law enforcement to access biobanks are handled in disparate ways. We identify some core ethical issues and conclude that further research on these issues is needed to provide ethical guidance. (shrink)

THE pervasive role of causality in the development of Galileo's science has been obscured largely by two factors. Philosophers who address the problem usually exhibit an anti-causal bias traceable to David Hume, and this disposes them to concentrate on passages in Galileo's writings that can be given a positivist interpretation. Historians are likewise selective in their treatment of his texts, for they tend to enforce sharp dichotomies between Galileo's earlier Latin compositions and his treatises in Italian, especially the two (...) dialogues of his later years for which he is justly famous. With this twofold reinforcement from philosophers and historians of science, one might think that the problem of causality in Galileo's science is whether or not the Italian physicist actually reasoned in causal terms such as those explained in Aristotle's Posterior Analytics. A large and influential school at the moment would say that this is the question, and that it is best answered in the negative: causal analysis played little or no role in the development of Galileo's science, and certainly less and less in his later years. Indeed, it was his rejection of Aristotle precisely on these grounds that merits for him the title, "Father of Modern Science," the canons of which science are almost diametrically opposite those of the science advocated by Greek peripatetics and medieval scholastics, before the onset of the modern era. (shrink)

BackgroundThe issue of stigma is very important in the battle against HIV/aids in Africa since it may affect patient attendance at healthcare centres for obtaining antiretroviral medications and regular medical check-ups. Stigmatization creates an unnecessary culture of secrecy and silence based on ignorance and fear of victimization. This study was designed to determine if there is external stigmatization of people living with HIV and AIDS by health care workers at a tertiary hospital in KwaZulu-Natal province, South Africa. The study investigated (...) the impact of knowledge of HIV/aids by HCWs on treatment of patients, as well as the comfort level and attitude of HCWs when rendering care to PLWHA.MethodsA descriptive cross sectional study was designed to collect data using an anonymous self-administered structured questionnaire from 334 HCWs. The study was conducted in clinical departments of a large multidisciplinary 922-bed tertiary care teaching hospital in Durban, KZN.ResultsOverall HCWs had an above average knowledge about HIV/aids although some gaps in knowledge were identified. Tests of statistical significance showed that there was association between level of education and knowledge of HIV/aids ; occupation and knowledge of HIV/aids ; and gender and knowledge of HIV/aids. Test for comfort level was only significant for gender, with males showing more comfort and empathy when dealing with PLWHA. The study also revealed that patients were sometimes tested for HIV without informed consent before surgery, due to fear of being infected, and there was some gossiping about patients' HIV status by HCWs, thereby compromising patient confidentiality. The majority of HCWs showed a willingness to report incidents of stigmatization and discrimination to higher authorities, for better monitoring and control.ConclusionsAlthough knowledge, attitude and comfort level of HCWs taking care of PLWHA was above average, enforcement of existing antidiscrimination laws and continuing education in medical ethics and healthcare law, would greatly improve the performance of HCWs taking care of PLWHAs. More psychological support and counselling should be provided to HCWs, to further reduce the impact of stigmatization and discrimination against PLWHA. (shrink)