An increasing number of people seek medical attention for mild cognitive symptoms at older age, worried that they might develop Alzheimer’s disease. Some clinical practice guidelines suggest offering biomarker testing in such cases, using a brain scan or a lumbar puncture, to improve diagnostic certainty about Alzheimer’s disease and enable an earlier diagnosis. Critics, on the other hand, point out that there is no effective Alzheimer treatment available and argue that biomarker tests lack clinical validity. The debate on the ethical (...) desirability of biomarker testing is currently polarized; advocates and opponents tend to focus on their own line of arguments. In this paper, we show how the method of reflective equilibrium can be used to systematically weigh the relevant arguments on both sides of the debate to decide whether to offer Alzheimer biomarker testing. In the tradition of RE, we reflect upon these arguments in light of their coherence with other argumentative elements, including relevant facts, ethical principles, and theories on societal ideals or relevant concepts, such as autonomy. Our stance in the debate therefore rests upon previously set out in-depth arguments and reflects a wide societal perspective. (shrink)

Many healthy volunteers choose to take part in Alzheimer’s disease prevention studies because they want to know whether they will develop dementia—and what they can do to reduce their risk—and are therefore interested in learning the results of AD biomarker tests. Proponents of AD biomarker disclosure often refer to the personal utility of AD biomarkers, claiming that research participants will be able to use AD biomarker information for personal purposes, such as planning ahead or making important life decisions. In this (...) paper, the claim that AD biomarkers have personal utility for asymptomatic individuals is critically assessed. It demonstrates that in the absence of clinical validity, AD biomarkers cannot have personal utility and do not serve research participants’ autonomy. Over the next few years, many research groups will be confronted with participants’ preferences to learn the results of AD biomarker tests. When researchers choose to make results available upon explicit request, they should ensure adequate information provision and education, notably on the uncertain clinical significance of AD biomarker information. Routine disclosure of AD biomarkers to cognitively unimpaired individuals in research settings cannot be justified with an appeal to the personal utility of AD biomarker information. (shrink)

The aim of this article is to describe the phenomenon of male rape from the victims’ perspectives. The methodology employed relied on transcendental phenomenology in order to create the rich descriptions of the lived experiences of three male survivors of rape. From the descriptions elicited from the formulation of an open-ended question, it was discovered that the phenomenon of male rape has a dominant structure that is related to the destruction and reconstruction of the masculine self. The research also revealed (...) several textural themes that include the characteristics of the assault, treatment and support that victims receive, the effects of the assault on the self, disclosure, the learning and life changes brought about by the assault, the victims’ feelings towards their assailants and the effect of the assault on the victims’ relationships. This study hopes to facilitate further descriptive research on the phenomenon of male rape in order that greater knowledge be gleaned and applied regarding its prevention and healing processes. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by policymakers and (...) practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.One expert's framing of the mission of public health may help improve understanding of the range of hazards for which to be legally prepared. These hazards include urgent realities — such as chronic disease, injury, disabilities, conventional communicable diseases, and an aging and obese population — and urgent threats, such as pandemic influenza, natural disasters, and terrorism. (shrink)

This paper is one of the four interrelated action agenda papers resulting from the National Summit on Public Health Legal Preparedness convened in June 2007 by the Centers for Disease Control and Prevention and multi-disciplinary partners. Each of the action agenda papers deals with one of the four core elements of legal preparedness: laws and legal authorities; competency in using those laws; coordination of law-based public health actions; and information. Options presented in this paper are for consideration by policymakers and (...) practitioners — in all jurisdictions and all relevant sectors and disciplines — with responsibilities for all-hazards emergency preparedness.One expert's framing of the mission of public health may help improve understanding of the range of hazards for which to be legally prepared. These hazards include urgent realities — such as chronic disease, injury, disabilities, conventional communicable diseases, and an aging and obese population — and urgent threats, such as pandemic influenza, natural disasters, and terrorism. (shrink)

The Responsible Self was H. Richard Niebuhr's most important work in Christian ethics. In it he probes the most fundamental character of the moral life and it stands today as a landmark contribution to the field. The Library of Theological Ethics series focuses on what it means to think theologically and ethically. It presents a selection of important and otherwise unavailable texts in easily accessible form. Volumes in this series will enable sustained dialogue with predecessors though reflection on classic works (...) in the field. (shrink)

Objectives: To study the consent process experienced by participants who are enrolled in a molecular genetic research study that aims to find new genetic mutations responsible for an apparently inherited disorder.Design: Semi-structured interviews and analysis/description of main themes.Participants: 78 members of 52 families who had been recruited to a molecular genetic study.Results: People were well informed about the goals, risks and benefits of the genetic research study but could not remember the consent process. They had mostly been recruited to take (...) part by trusted clinicians or their relatives but had little memory of, or concern about signing consent forms. Families appeared to regard the research as a continuation of their, or their relatives’, clinical care.Conclusions: Ethical review should be more flexible in its attitude to consent forms and written information sheets for some sorts of research. For rare genetic disease studies where research has been discussed fully within the clinical setting then the consent obtained at that time could suffice rather than needing extra consent at a later stage. However, clinician-researchers will need to ensure that their duty of care extends for the duration of the research and beyond. (shrink)

According to the biopsychosocial model, developed by the late Dr. George Engel, how physicians approach patients and the problems they present is very much ...

This paper proposes a revision of our understanding of causation that is designed to address what Hartry Field has suggested is the central problem in the metaphysics of causation today: reconciling Bertrand Russell’s arguments that the concept of causation can play no role in the advanced sciences with Nancy Cartwright’s arguments that causal concepts are essential to a scientific understanding of the world. The paper shows that Russell’s main argument is, ironically, very similar to an argument that Cartwright has put (...) forward against the truth of universal laws of nature. The paper uses this insight to develop an account of causation that does justice to traditional views yet avoids the arguments of Russell. (shrink)

> Wealthy nations must do much more, much faster. The United Nations General Assembly in September 2021 will bring countries together at a critical time for marshalling collective action to tackle the global environmental crisis. They will meet again at the biodiversity summit in Kunming, China, and the climate conference 26) in Glasgow, UK. Ahead of these pivotal meetings, we—the editors of health journals worldwide—call for urgent action to keep average global temperature increases below 1.5°C, halt the destruction of nature (...) and protect health. Health is already being harmed by global temperature increases and the destruction of the natural world, a state of affairs health professionals have been bringing attention to for decades.1 The science is unequivocal; a global increase of 1.5°C above the preindustrial average and the continued loss of biodiversity risk catastrophic harm to health that will be impossible to reverse.2 3 Despite the world’s necessary preoccupation with COVID-19, we cannot wait for the pandemic to pass to rapidly reduce emissions. Reflecting the severity of the moment, this editorial appears in health journals across the world. We are united in recognising that only fundamental and equitable changes to societies will reverse our current trajectory. The risks to health of increases above 1.5°C are now well established.2 Indeed, no temperature rise is ‘safe’. In the past 20 years, heat-related mortality among people aged over 65 has increased by more than 50%.4 Higher temperatures have brought increased dehydration and renal function loss, dermatological malignancies, tropical infections, adverse mental health outcomes, pregnancy complications, allergies, and cardiovascular and pulmonary morbidity and mortality.5 6 Harms disproportionately affect the most vulnerable, including children, older populations, ethnic minorities, poorer communities and those with underlying health problems.2 4 Global heating is also contributing to the decline in …. (shrink)

This volume is a Festschrift dedicated to Charles Kahn comprised of more than 20 papers presented at the conference "Presocratics and Plato: Festschrift Symposium in Honor of Charles Kahn", 3-7 June 2009. The conference was held at the European Cultural Center of Delphi, Greece, and was organized and sponsored by the HYELE Institute for Comparative Studies and Parmenides Publishing, with endorsement from the International Plato Society, and the Dean of the School of Arts and Sciences, University of Pennsylvania. Contributors: Julia (...) Annas - University of Arizona; Sarah Broadie - University of St. Andrews; Lesley Brown - University of Oxford; Tomás Calvo-Martínez - Universidad Complutense de Madrid; Diskin Clay - Duke University; John M. Dillon - Trinity College, Dublin; Dorothea Frede - Humbolt University, Berlin; Arnold Hermann - HYELE Institute for Comparative Studies; Carl A. Huffman - DePauw University; Enrique Hülsz Piccone - Universidad Nacional Autonoma de Mexico; D.M. Hutchinson - St. Olaf College; Paul Kalligas - National and Kapodistrian University, Athens; Vassilis Karasmanis - National Technical University, Athens; Aryeh Kosman - Haverford College; Anthony A. Long - University of California, Berkeley; Richard McKirahan - Pomona College; Susan Sauvé Meyer - University of Pennsylvania; Alexander P.D. Mourelatos - University of Texas at Austin; Satoshi Ogihara - Tohoku University, Japan; Richard Patterson - Emory University; Christopher J. Rowe - Durham University; David Sedley - University of Cambridge; Richard Sorabji - University of Oxford. (shrink)

In Neutrality and the Academic Ethic, distinguished philosopher Robert L. Simon explores the claim that universities can and should be politically neutral. He examines conceptual questions about the meaning of neutrality, distinguishes different conceptions of what neutrality involves, and considers in what sense, if any, institutional neutrality is both possible and desirable. In Part II, a collection of original and previously published essays provides different views on these and related issues.

Hom and colleagues (2016) argue in favor of allowing religious exemptions to congenital critical heart disease (CCHD) newborn screening, but the logic of their position is at odds with the moral ju...

Randomised placebo-controlled trials (RPCTs) are the gold standard for evaluating novel treatments. However, this design is rarely used in the context of orthopaedic interventions where participants are assigned to a real or placebo surgery. The present study examines attitudes towards RPCTs for orthopaedic surgery among 687 orthopaedic surgeons across the USA. When presented with a vignette describing an RPCT for orthopaedic surgery, 52.3% of participants viewed it as ‘completely’ or ‘mostly’ unethical. Participants were also asked to rank-order the value of (...) five different types of evidence supporting the efficacy of a surgery, ranging from RPCT to an anecdotal report. Responses regarding RPCTs were polarised with 26.4% viewing it as the least valuable (even less valuable than an anecdote) and 35.7.% viewing it as the most valuable. Where equipoise exists, if we want to subject orthopaedic surgeries to the highest standard of evidence (RPCTs) before they are implemented in clinical practice, it will be necessary to educate physicians on the value and ethics of placebo surgery control conditions. Otherwise, invasive procedures may be performed without any benefits beyond possible placebo effects. (shrink)

The ovarian reserve defines female reproductive lifespan, which in humans spans decades. The ovarian reserve consists of oocytes residing in primordial follicles arrested in meiotic prophase I and is maintained independent of DNA replication and cell proliferation, thereby lacking stem cell‐based maintenance. Largely unknown is how cellular states of the ovarian reserve are established and maintained for decades. Our recent study revealed that a distinct chromatin state is established during ovarian reserve formation in mice, uncovering a novel window of epigenetic (...) programming in female germline development. We showed that an epigenetic regulator, Polycomb Repressive Complex 1 (PRC1), establishes a repressive chromatin state in perinatal mouse oocytes that is essential for prophase I‐arrested oocytes to form the ovarian reserve. Here we discuss the biological roles and mechanisms underlying epigenetic programming in ovarian reserve formation, highlighting current knowledge gaps and emerging research areas in female reproductive biology. (shrink)

It is tempting to think that we have heard just about all we want or need to know about race. As the above quotes indicate, modern notions of race have always revolved around the faculty of vision, with supplementary contributions from other senses such as hearing, as Arendt notes in a tacit allusion to one mark of Jewish difference—the way they sounded when concentrated in urban settings. Yet two very recent works—Mark M. Smith's How Race Is Made and Anne C. (...) Rose's Psychology and Selfhood in the Segregated South —have much to teach us about how race has “worked”, particularly in the twentieth-century South but also, by implication, in the United States in general. Both works assume that, historically, race is no mere add-on to the self, a kind of externality that, once detected, can be relatively easily excised. Rather, it stands right at the heart of personal and group identity in a nation where race and ethnicity continue to assume surprising new shapes and forms. (shrink)

A commonly used experimental procedure for the study of granulocyte kinetics involves the labelling and subsequent tracing of granulocyte DNA. Following the introduction of a label into the system, observations are made periodically on the concentration of label in the DNA of granulocytes taken from the circulating blood. A mathematical model for the expected value of this concentration has been derived, studied, and related to experimental observations from studies using P32 as a label. Insofar as the derivation of the model (...) accurately incorporates the relevant aspects of granulocyte kinetics, the model will be useful in the interpretation of the experimental observations in terms of these kinetics.Among other things, study of the model indicates that the assumption of “flash” labelling made with respect to some labels is quite crucial and needs to be examined critically. It has also been necessary to make adjustments to allow for the observed emergence of labelled cells from the marrow soon after label introduction. In addition, despite a high degree of confounding of parameter effects it has been possible to suggest bounds on some of the parameters of the model for some species. The bounds will be refined as the model is improved and more data become available. Study and development of the model continues with particular interest in generalizations to include the diseased state chronic granulocytic leukemia. (shrink)

Aim To ascertain the quantity and nature of gifts and items provided by the pharmaceutical industry in Australia to medical specialists and to consider whether these are appropriate in terms of justifiable ethical standards, empirical research and views expressed in the literature.

Participants were asked to draw inferences about correlation from single x,y observations. In Experiment 1 statistically sophisticated participants were given the univariate characteristics of distributions of x and y and asked to infer whether a single x, y observation came from a correlated or an uncorrelated population. In Experiment 2, students with a variety of statistical backgrounds assigned posterior probabilities to five possible populations based on single x, y observations, again given knowledge of the univariate statistics. In Experiment 3, statistically (...) naïve participants were given a problem analogous to that given in Experiment 1, framed verbally. Experiment 4 replicated Experiment 3 but added an “impossible to determine” response option. Models that rely on computing sample correlations make no predictions about these investigations. From a Bayesian perspective, participants’ inferences in all four experiments tended to make probabilistically valid inferences as long as the single datum was directional. The results are discussed in light of the Brunswikian notion of vicarious functioning. (shrink)