Historically attempts to use the courts as a means of challenging decisions to refuse NHS resources have met with little success. However two recent developments, that of the Human Rights Act 1998 and the development of European Union law through the application of Article 49 of the EC Treaty have provided the prospect for a challenge to this position. This article examines the impact of a recent case that of Watts v Bedford PCT in which a woman sought to by-pass (...) NHS waiting lists by seeking treatment in France and then claimed reimbursement of the cost of the operation and the possible impact of this case in the context of patients’s rights and resource allocation. (shrink)

The use of traditional ethical methodologies is inadequate in addressing a constructed maternal–fetal rights conflict in a multicultural obstetrical setting. The use of caring ethics and a relational approach is better suited to address multicultural conceptualizations of autonomy and moral distress. The way power differentials, authoritative knowledge, and informed consent are intertwined in this dilemma will be illuminated by contrasting traditional bioethics and a caring ethics approach. Cultural safety is suggested as a way to develop a relational ontology. Using caring (...) ethics and a relational approach can alleviate moral distress in health-care providers, while promoting collaboration and trust between providers and their patients and ultimately decreasing reproductive disparities. This article examines how a relational approach can be applied to a cross-cultural reproductive dilemma. (shrink)

Whistleblowing in the NHS engages the fundamental right to free speech and as the paper makes clear is a means of ensuring individual patient safety. The discourse around the whistleblower is not simply about individuals being safeguarded if they blow the whistle on poor standards of patient care but that they may indeed be obliged as healthcare professionals to positively make the decision to blow the whistle to raise concerns. As noted in the paper, the NHS is an organisation in (...) which many—though not all—individuals who work there are bound by their own professional codes of practice in addition to broader employment requirements in relation to ethical and safety issues. But having an obligation to raise concerns and actually doing so are very different things. Individuals who blow the whistle have often found that following their conscience comes with consequences. They may ultimately be vindicated, as, for example in the 1990s, Stephen Bolsin the anaesthetist who blew the whistle in relation to Bristol Royal Infirmary in the 1990s.1 But getting such vindication can in many instances be over a long and very painful period of time and be exceedingly costly in both financial and emotional terms. Does …. (shrink)

Next SectionThe precise nature and scope of healthcare confidentiality has long been the subject of debate. While the obligation of confidentiality is integral to professional ethical codes and is also safeguarded under English law through the equitable remedy of breach of confidence, underpinned by the right to privacy enshrined in Article 8 of the Human Rights Act 1998, it has never been regarded as absolute. But when can and should personal information be made available for statistical and research purposes and (...) what if the information in question is highly sensitive information, such as that relating to the termination of pregnancy after 24 weeks? This article explores the case of In the Matter of an Appeal to the Information Tribunal under section 57 of the Freedom of Information Act 2000, concerning the decision of the Department of Health to withhold some statistical data from the publication of its annual abortion statistics. The specific data being withheld concerned the termination for serious fetal handicap under section 1(1)d of the Abortion Act 1967. The paper explores the implications of this case, which relate both to the nature and scope of personal privacy. It suggests that lessons can be drawn from this case about public interest and use of statistical information and also about general policy issues concerning the legal regulation of confidentiality and privacy in the future. (shrink)

First Published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.

First Published in 2004. Routledge is an imprint of Taylor & Francis, an informa company.

" This book focuses on the relationship between human rights and nursing in these changing times.

The huge potential of biobanks/genetic databases for the research community has been recognised across jurisdictions in both publicly funded and commercial sectors. But although there is tremendous potential there are likewise potential difficulties. The long-term storage of personal health information and samples poses major challenges. This is an area is fraught with ethical and legal uncertainties. Biobanks raise many questions of the control of rights, of consent, of privacy and confidentiality and of property in human material. It is thus unsurprising (...) then that there has been a lively debate as to how biobanks should operate, the boundaries of participation and what governance structure, if any they should adopt, a debate which has been engaged in across the academic community and by funders and researchers alike. This paper asks despite the good intentions can ad hoc ethics and ethics and governance committees long term provide an effective solution to the legal and regulatory challenges arising from biobanks. (shrink)

This paper considers the way in which English law safeguards fundamental rights to respect for faith and belief in relation to the delivery of health care. It explores the implications of the Human Rights Act 1998 and the Equality Act 2010. It explores some of the challenges in attempting to reconcile fundamental rights to faith and belief and the delivery of health care, both now and in the future and whether this is a realistic aspiration in a state funded health (...) care service. (shrink)

We study increasing F-sequences, where F is a dilator: an increasing F-sequence is a sequence (indexed by ordinal numbers) of ordinal numbers, starting with 0 and terminating at the first step x where F(x) is reached (at every step x + 1 we use the same process as in decreasing F-sequences, cf. [2], but with "+ 1" instead of "- 1"). By induction on dilators, we shall prove that every increasing F-sequence terminates and moreover we can determine for every dilator (...) F the point where the increasing F-sequence terminates. We apply these results to inverse Goodstein sequences, i.e. increasing (1 + Id) (ω) -sequences. We show that the theorem every inverse Goodstein sequence terminates (a combinatorial theorem about ordinal numbers) is not provable in ID 1 . For a general presentation of the results stated in this paper, see [1]. We use notions and results concerning the category ON (ordinal numbers), dilators and bilators, summarized in [2, pp. 25-31]. (shrink)

This text provides an account of dissonance theory and reduction. It studies the evolution of cognitive dissonance theory, providing a review and a new interpretation of Festinger's original theory - the "radical conception". The authors present research arising from this new interpretation, adding to Festinger's theory by emphasizing the importance of the status of behaviour. Their research and evidence is intended to strengthen and clarify Festinger's original and innovative arguments.

Sponges branch basally in the metazoan phylogenetic tree and are believed to be composed of four distinct lineages with still uncertain relationships. Indeed, some molecular studies propose that Homoscleromorpha may be a fourth Sponge lineage, distinct from Demospongiae in which they were traditionally classified. They harbour many features that distinguish them from other sponges and are more evocative of those of the eumetazoans. They are notably the only sponges to possess a basement membrane with collagen IV and specialized cell‐junctions, thus (...) possessing true epithelia. Among Homoscleromorphs, we have chosen Oscarella lobularis as a model species. This common and easily accessible sponge is characterized by relatively simple histology and cell composition, absence of skeleton, and strongly pronounced epithelial structure. In this review, we explore the specific features that make O. lobularis a promising homoscleromorph sponge model for evolutionary and developmental researches. (shrink)

A conceptual and mathematical model of a social community behavior in a choice situation under a veil of ignorance, where two alternative policies—Rawlsian maximin and Harsanyian utilitarianism—can be implemented through the aggregation of individual preferences over these two policies, is constructed and investigated. We first incorporate in our conceptual model psychological features such as risk-aversion and prosocial preferences that likely underlie choices of welfare policies. We secondly develop and select the mathematical model presented it by means of an autonomous system (...) of ordinary differential equations. A qualitative analysis of this system global phase-plane behavior shows possible tendencies of community development under social choices over Rawlsian or utilitarian societies depending on psychological parameters such as risk aversion and prosocial preferences. (shrink)

_The VaKE Handbook: Theory and Practice of Values and Knowledge Education_ presents a theoretical model and many examples in various fields of education and training for the realization of the principle "Values without knowledge are blind, while knowledge without values is irresponsible".

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between (...) studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

Given its non-invasive nature, there is increasing interest in the use of transcutaneous vagus nerve stimulation across basic, translational and clinical research. Contemporaneously, tVNS can be achieved by stimulating either the auricular branch or the cervical bundle of the vagus nerve, referred to as transcutaneous auricular vagus nerve stimulation and transcutaneous cervical VNS, respectively. In order to advance the field in a systematic manner, studies using these technologies need to adequately report sufficient methodological detail to enable comparison of results between (...) studies, replication of studies, as well as enhancing study participant safety. We systematically reviewed the existing tVNS literature to evaluate current reporting practices. Based on this review, and consensus among participating authors, we propose a set of minimal reporting items to guide future tVNS studies. The suggested items address specific technical aspects of the device and stimulation parameters. We also cover general recommendations including inclusion and exclusion criteria for participants, outcome parameters and the detailed reporting of side effects. Furthermore, we review strategies used to identify the optimal stimulation parameters for a given research setting and summarize ongoing developments in animal research with potential implications for the application of tVNS in humans. Finally, we discuss the potential of tVNS in future research as well as the associated challenges across several disciplines in research and clinical practice. (shrink)

Early life stress precedes alterations to neuro-immune activation, which may mediate an increased risk for stress-related psychiatric disorders, potentially through alterations of central kynurenine pathway metabolites, the latter being relatively unexplored. We hypothesized that ELS in a non-human primate model would lead to a reduction of neuroprotective and increases of neurotoxic KP metabolites. Twelve adult female bonnet macaques reared under conditions of maternal variable foraging demand were compared to 27 age- and weight-matched non-VFD-exposed female controls. Baseline behavioral observations of social (...) affiliation were taken over a 12-week period followed by the first cerebrospinal fluid sample. Subjects were then either exposed to a 12-week repeated separation paradigm or assigned to a “no-RSP” condition followed by a second CSF. We used high-performance liquid chromatography for kynurenine, tryptophan, 5-hydroxyindoleacetic acid, kynurenic acid, and anthranilic acid as a proxy for quinolinic acid determination. At baseline, social affiliation scores were reduced in VFD-reared versus control subjects. CSF log KYNA and log KYNA/KYN ratio were lower in VFD-reared versus control subjects. CSF log KYNA/KYN was positively correlated with CSF log ANTH in VFD only. Controlling for log KYNA/KYN, log ANTH was elevated in VFD-reared subjects versus controls. CSF log KYNA/KYN obtained post-RSP was positively correlated with mean social affiliation scores during RSP, specifically in VFD. ELS is associated with a reduced neuroprotective and increased neurotoxic pathway products. That the two contrasting processes are paradoxically correlated following ELS suggests a cross-talk between two opposing KP enzymatic systems. (shrink)

Of laws in general -- Of laws directly derived from the nature of government -- Of the principles of the three kinds of government -- That the laws of education ought to be relative to the principles of government -- That the laws given by the legislator ought to be relative to the nature of government -- Consquences of the principles of different governments, with respect to the simplicity of civil and criminal laws, the form of judgements, and inflicting of (...) punishments -- Consquences of the different principles of the three governments, with respect to sumptuary laws, luxury, and the condition of women -- Of the corruption of the principles of the three governments -- Of the laws in the relation they bear to defensive force -- Of laws, in the relation they bear to offensive force. (shrink)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

The purpose of this valuable book is to consider recent cultural trends in bioethics from a Catholic perspective. Bioethics is intended for a lay audience interested in understanding bioethical issues from a Catholic perspective.

This topically organized, interdisciplinary anthology provides competing perspective on the claim that western culture faces a moral crisis. Using clearly written, accessible essays by well-known authors in philosophy, the social sciences, and the humanities, the book introduces students to a variety of perspectives on the current cultural debate about values that percolates beneath the surface of most of our social and political controversies.

The March 2002 symposium Human Dignity and Reproductive Technology brought together philosophers, theologians, scientists, lawyers, and scholars from across the United States. The essays of this book are the contributions of the symposium's participants.

In Politics VII, Aristotle not only gives us some general ideas on what makes a good city and the conditions of its implementation, but also provides a description of such a regime: 1. Citizenship is reserved for those whom, due to their natural attributes and sufficient wealth, may achieve political and ethical excellence; 2. In relation to their age, they are successively hoplites, citizens or priests. Therefore, all that remains to be examined is the relationship between such a regime and (...) the “politeia”, which in the previous books is the standard regarding cities whose citizens are rich, poor, or belong to the middle class. (shrink)

Les messages de vœux des présidents de la République constituent un genre discursif particulier, lié à l’épidictique, et fournissent un angle d’approche original pour l’analyse de l’ethos présidentiel vu du rituel politique. A la différence de Cotteret [1969], Labbé [1983, 1990], désormais Mayaffre [2004], nous saisissons le discours présidentiel sous un angle plus étroit mais dont on peut penser qu’il apportera des éléments intéressants si l’on considère cette forme codifiée comme une quintessence du statut présidentiel en représentation. A la suite (...) de Françoise Finniss Boursin [1992] mais aussi de Françoise Chambre [1984] et Elisabeth Rivory [1991], nous nous intéressons aux allocutions de fin d’année des présidents français, mais adoptons une démarche plus expérimentale, mobilisant différents outils lexicométriques que nous comparons. Nous saisissons ici l’ethos politique à travers les emplois des marques personnelles inscrivant le locuteur dans son discours, par le biais de plusieurs analyses des cooccurrences. (shrink)