Increasing ethical attention and debate is focusing on whether individuals who take part in clinical trials should be given access to post-trial care. However, the main focus of this debate has been upon drug trials undertaken in low-income settings. To broaden this debate, we report findings from interviews with individuals (n = 24) who participated in a clinical trial of a closed-loop system, which is a medical device under development for people with type 1 diabetes that automatically adjusts blood glucose (...) to help keep it within clinically recommended ranges. Individuals were recruited from UK sites and interviewed following trial close-out, at which point the closed-loop had been withdrawn. While individuals were stoical and accepting of the requirement to return the closed-loop, they also conveyed varying degrees of distress. Many described having relaxed diabetes management practices while using the closed-loop and having become deskilled as a consequence, which made reverting back to pre-trial regimens challenging. Participants also described unanticipated consequences arising from using a closed-loop. As well as deskilling, these included experiencing psychological and emotional benefits that could not be sustained after the closed-loop had been withdrawn and participants reevaluating their pre- and post-trial life in light of having used a closed-loop and now perceiving this life much more negatively. Participants also voiced frustrations about experiencing better blood glucose control using a closed-loop and then having to revert to using what they now saw as antiquated and imprecise self-management tools. We use these findings to argue that ethical debates about post-trial provisioning need to be broadened to consider potential psychological and emotional harms, and not just clinical harms, that may result from withdrawal of investigated treatments. We also suggest that individuals may benefit from information about potential nonclinical harms to help make informed decisions about trial participation. (shrink)

This paper elaborates on conceptual, empirical and practical arguments why corporations need to focus on their social dimensions, in order to further enhance organizational performance. The paper starts with an introduction on the general trend towards inclusiveness and connectedness. It then elaborates on the phase-wise development of cultures and organizational structures. Managing corporate improvement by building cultures of trust is the central focus of this contribution. By showing the cultural dimensions of Great Places to Work and their workplace practices, worthwhile (...) experiences leading to organizational improvement and superior financial performance are demonstrated. (shrink)

This article analyses the challenges for the strategies and practices of transformational development in a changing context. This reflection is based on contributions received during the process of dialogues and regional consultations, realised from August 2012 until March 2014, of the ACT Alliance, an international coalition of churches and faith-based organisations (FBOs) working in the areas of humanitarian response, development and advocacy. The main processes that affect the changing development context are addressed, such as the ongoing globalisation as well as (...) the consequences, mainly regarding the shrinking space for civil society. It discusses the concepts of human development and of transformational development, based on a people-centred development vision, a human rights-based approach and advocacy, which addresses the root causes and effects of poverty, inequality and injustice. Transformational development practices, from Latin America, are presented and analysed. The article concludes that the changing development context also offers opportunities, especially regarding regional and global alliances of FBOs, civil society organisations and of social movements. (shrink)

Objectives: The mental health legislation of most developed countries includes either a dangerousness criterion or an obligatory dangerousness criterion (ODC). A dangerousness criterion holds that mentally ill people may be given treatment without consent if they are deemed to be a risk to themselves or others. An ODC holds that mentally ill people may be given treatment without consent only if they are deemed to be a risk to themselves or others. This paper argues that the dangerousness criterion is unnecessary, (...) unethical and, in the case of the ODC, potentially harmful to mentally ill people and to the rest of the community. Methods: We examine the history of the dangerousness criterion, and provide reasoned argument and empirical evidence in support of our position. Results: Dangerousness criteria are not required to balance the perceived loss of autonomy arising from mental health legislation. Dangerousness criteria unfairly discriminate against the mentally ill, as they represent an unreasonable barrier to treatment without consent, and they spread the burden of risk that any mentally ill person might become violent across large numbers of mentally ill people who will never become violent. Mental health legislation that includes an ODC is associated with a longer duration of untreated psychosis, and probably contributes to a poorer prognosis and an increase risk of suicide and violence in patients in their first episode of psychosis. Conclusions: Dangerousness criteria should be removed from mental health legislation and be replaced by criteria that focus on a patient’s capacity to refuse treatment. (shrink)

This paper explores the nature of the language used when teaching mathematics to young children. It proposes that an important part of the teaching of a mathematical concept is the introduction of specific terminology. Children may need to be taught new meanings for already familiar words. The timing of these introductions to new words or meanings is critical to their understanding of the concepts being taught. It will be argued that there are two aspects of the children's learning that need (...) to be considered. First, their understanding of the concept being introduced, and secondly, their learning the appropriate word to describe that concept. By assessing children's understanding of new mathematical concepts through their own use of the terminology, the teacher can then negotiate new meanings with them through practical experiences, introducing new word meanings only when the concepts have been understood. (shrink)

This book explores the dynamics of the commentary and textbook traditions in Aristotelian natural philosophy under the headings of doctrine, method, and scientific and social status. It enquires what the evolution of the Aristotelian commentary tradition can tell us about the character of natural philosophy as a pedagogical tool, as a scientific enterprise, and as a background to modern scientific thought. In a unique attempt to cut old-fashioned historiographic divisions, it brings together scholars of ancient, medieval, Renaissance and seventeenth-century philosophy. (...) The book covers a remarkably broad range of topics: it starts with the first Greek commentators and ends with Leibniz. (shrink)

Continuing the dialogue: postcolonial feminist scholarship and Bourdieu — discourses of culture and points of connection Postcolonial feminist theories provide the analytic tools to address issues of structural inequities in groups that historically have been socially and economically disadvantaged. In this paper we question what value might be added to postcolonial feminist theories on culture by drawing on Bourdieu. Are there points of connection? Like postcolonial feminists, he puts forward a position that aims to unmask oppressive structures. We argue that, (...) while there are points of connection, there are also epistemologic and methodologic differences between postcolonial feminist perspectives and Bourdieu's work. Nonetheless, engagement with different theoretical perspectives carries the promise of new insights — new ways of ‘seeing’ and ‘understanding’ that might enhance a praxis‐oriented theoretical perspective in healthcare delivery. (shrink)

If it is true, as suggested by Sir Michael Marmot and other researchers, that status impacts health and therefore accounts for some of the social gradient in health, then it seems to be the case that it would be possible to bring about more equality in health by equalizing status. The purpose of this article is to analyze this suggestion. First, we suggest a working definition of what status precisely is. Second, following a luck egalitarian approach to distributive justice, we (...) consider whether and to which extent individuals are responsible themselves for their position in a status hierarchy. Third, we consider the contours of a difficult question, namely which political measures are feasible in order to reduce health-affective inequalities in status and fourth, whether or to what extent such measures are legitimate. We argue that on the basis of these considerations, we have at least some prima facie reasons to counter (at least some) status inequalities in order to equalize health. (shrink)

Consider the problem of allocating a scarce resource to people. A fair decision procedure is one where each person has an equal chance of receiving the resource. An unfair decision procedure is one where the chances are not equal. Normally we think that, in an unfair decision procedure, that the correct way to redress the injustice is by rerunning the allocation using a fair decision procedure. In this paper, I show that this actually creates an overall bias favouring one person, (...) and solutions to this problem are counterintuitive, in that they typically involve introducing additional unfair elements into the situation. (shrink)

_The Collected Works of John Stuart Mill_ took thirty years to complete and is acknowledged as the definitive edition of J.S. Mill and as one of the finest works editions ever completed. Mill's contributions to philosophy, economics, and history, and in the roles of scholar, politician and journalist can hardly be overstated and this edition remains the only reliable version of the full range of Mill's writings. Each volume contains extensive notes, a new introduction and an index. Many of the (...) volumes have been unavailable for some time, but the _Works_ are now again available, both as a complete set and as individual volumes. (shrink)