Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

Objective—To explore the opinions of unpaid healthy volunteers on the payment of research subjects.Design—Prospective cohort.Setting—Southern Alberta, Canada.Participants—Medically eligible persons responding to recruiting advertisements for a randomised vaccine trial were invited to take part in a study of informed consent at the point at which they formally consented or refused trial participation. Of 72 invited, 67 returned questionnaires at baseline and 54 at follow-up.Outcome measures—Proportions of persons who agreed or disagreed with three close-ended statements on the payment of research subjects; themes (...) and categories identified by content analysis of responses to an open-ended question.Results—A minority agreed with paying either patient or healthy volunteer participants. Opinions did not change over time. Participants' comments addressed: benefits and drawbacks to research participation; benefits and drawbacks to paying research participants; conditions under which payment of research subjects would be acceptable, and the nature of acceptable recognition. Acceptable conditions were to improve problematic recruitment, to reimburse costs, and to recognise participants, particularly for their time investment. Both non-monetary and monetary recognition of volunteers were thought to be appropriate.Conclusions—Most unpaid volunteers disagreed with paying research participants. The themes arising from their comments are similar to those that have been raised by ethicists and suggest that recognising the time and effort of participants should receive greater emphasis than presently occurs. (shrink)

Oxford Scholarly Classics is a new series that makes available again great academic works from the archives of Oxford University Press. Reissued in uniform series design, the reissues will enable libraries, scholars, and students to gain fresh access to some of the finest scholarship of the last century.

Aims and background: The present work assessed the impact of two decrees on ethics committees in Italy, aimed at bringing the national laws on the conduct of clinical trials into line with the rest of the EC, and regulating and facilitating not-for-profit research.Material and methods: Prospectively collected data from an Italian multicentre study were examined with respect to the ethics review process. Administrative and time elements of the review process were audited. Main outcome measures were time between the application submission (...) and the ethics committee definitive opinion, type and number of application submission forms, number of ethics committees that refused fee exemption, and time between the ethics committee approval and the administrative authorisation.Results: A total of 134 local research ethics committees were approached. Application submission procedures and application forms varied greatly; paper submission was mandatory. The median time from submission to approval was 72 days. Only two LRECs refused the fee exemption. The median time from LREC approval to administrative agreement was 50 days and only 9.6% of local authorities came to a verbal agreement with the sponsor.Conclusions: Italian LRECs are still not sufficiently efficient in complying with the Directive 2001/20/EC requirement . Better coordination of LRECs work is needed although the optimal level of coordination between them is still not known. In the meantime, national guidelines are needed concerning the application of Directive 2001/20/EC. The behaviour of Italian LRECs towards not-for-profit research was excellent although only the fee exemption was requested. (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)

The best-interests standard is a widely used ethical, legal, and social basis for policy and decision-making involving children and other incompetent persons. It is under attack, however, as self-defeating, individualistic, unknowable, vague, dangerous, and open to abuse. The author defends this standard by identifying its employment, first, as a threshold for intervention and judgment (as in child abuse and neglect rulings), second, as an ideal to establish policies or prima facie duties, and, third, as a standard of reasonableness. Criticisms of (...) the best-interests standard are reconsidered after clarifying these different meanings. (shrink)

A Papyrus commentary on Alcman published in 19571 brings us news of a poem in which Alcman “physiologized”. The lemmata and commentary together witness to a semi-philosophical cosmogony unlike any other hitherto known from Greece. The evidence is meagre, but it seems worth while to see what can be made of it; for it is perhaps possible to go a little farther than has so far been done.

This book's fourteen short essays are neither very technical nor definitive, as Schaff warns in his forward. They do, however, reveal the struggle of a sincere philosopher, who happens also to be a high official of the Polish Communist Party, against the absolutes that plague him—absolute determinism, total party discipline, the definitive revolution. Schaff here continues his debate with the existentialists, notably Sartre, and contributes some clarification to the problem of "Marxist ethics."—W. L. M.

Selections of roughly equal length have been included from the Greeks, the Bible, Augustine, Bodin, Vico, Herder, and Hegel. Polybius is the best represented of the Greeks; excerpts from Thucydides total only a page and a half. Tillinghast admits to being an historian rather than a philosopher, and his introductions to each set of readings are seldom profound. While one may lament the necessary brevity of all the selections and dispute some of the choices, the editor has succeeded in producing (...) a reasonably balanced, inexpensive volume for beginners in the philosophy of history.--W. L. M. (shrink)

Competent patients who refuse life saving medical treatment present a dilemma for healthcare professionals. On one hand, respect for autonomy and liberty demand that physicians respect a patient’s decision to refuse treatment. However, it is often apparent that such patients are not fully competent. They may not adequately comprehend the benefits of medical care, be overly anxious about pain, or discount the value of their future state of health. Although most bioethicists are convinced that partial autonomy or marginal competence of (...) this kind demands the same respect as full autonomy, Israeli legislators created a mechanism to allow ethics committees to override patients’ informed refusal and treat them against their will. To do so, three conditions must be satisfied: physicians must make every effort to ensure the patient understands the risks of non-treatment, the treatment physicians propose must offer a realistic chance of significant improvement, and there are reasonable expectations that the patient will consent retroactively. Although not all of these conditions are equally cogent, they offer a way forward to assure care for certain classes of competent patients without abandoning the principle of autonomy altogether. These concerns reach past Israel and should engage healthcare professionals wary that respect for autonomy may sometimes cause avoidable harm. (shrink)

A Papyrus commentary on Alcman published in 19571 brings us news of a poem in which Alcman “physiologized”. The lemmata and commentary together witness to a semi-philosophical cosmogony unlike any other hitherto known from Greece. The evidence is meagre, but it seems worth while to see what can be made of it; for it is perhaps possible to go a little farther than has so far been done.

In its American context the case of baby Messenger, a preterm infant disconnected from life-support by his father and allowed to die has generated debate about neonatal treatment protocols. Limited by the legal and ethical norms of the United States, this case did not consider treatment protocols that might be available in other countries such as Denmark and Israel: threshold protocols whereby certain classes of newborns are not treated, and preemptive abortion allowing one to choose late-term abortion rather than risk (...) delivery. Each offers a viable and ethically sound avenue for dealing with the economic and social expense of anomalous newborns by aborting or not treating those most likely to burden the health care system. Objections that these protocols are antithetical to American bioethical principles are considered but rejected as each policy answers to economic justice, utility and respect for autonomy. (shrink)

The introduction of novel diagnostic techniques in clinical domains such as genomics and radiology has led to a rich ethical debate on how to handle unsolicited findings that result from these innovations. Yet while unsolicited findings arise in both genomics and radiology, most of the relevant literature to date has tended to focus on only one of these domains. In this article, we synthesize and critically assess similarities and differences between “scanning the body” and “sequencing the genome” from an ethical (...) perspective. After briefly describing the novel diagnostic contexts leading to unsolicited findings, we synthesize and reflect on six core ethical issues that relate to both specialties: terminology; benefits and risks; autonomy; disclosure of unsolicited findings to children; uncertainty; and filters and routine screening. We identify ethical rationales that pertain to both fields and may contribute to more ethically sound policies. Considerations of preserving public trust and ensuring that people perceive healthcare policies as fair also support the need for a combined debate. (shrink)

The appearance of Jesus Christ in his time was inevitable. Plato's ideas were to find a material embodiment on earth. The image of Christ as a balance, the harmony of light-spirit and darkness-matter, is the materialization of the ideal image.

In the long section of anapaests with which they make their entry, the old men of Argos methodically deliver three essential messages to the audience: 40–71. It is the tenth year of the Trojan War. 72–82. We are men who were too old to go and fight in it. 83–103. Some new situation seems to be indicated by the fact that Clytemnestra is organizing sacrifices throughout the town.

It is generally accepted that the Homeric Hymn to Apollo was not conceived as a single poem but is a combination of two: a Delian hymn, D, performed at Delos and concerned with the god's birth there, and a Pythian hymn, P, concerned with his arrival and establishment at Delphi. What above all compels us to make a dichotomy is not the change of scene in itself, but the way D ends. The poet returns from the past to the present, (...) and takes leave of his audience; farewell, he says, and remember me ever after. He is quite clearly finishing. Whereupon there is an abrupt and unsatisfactory transition to P. (shrink)

This study offers a re-interpretation of basic elements of Aristotle's semantics and metaphysics on the basis of a meticulous reconstruction of his semantics. By eliminating anachronistic conceptions commonly ascribed to him, many shortcomings or obscurities he is accused of will disappear.

This paper aims to outline the ethical concerns regarding the use of antidepressant medication in children and adolescents. Recent debates surrounding this issue have focused on the link between selective serotonin reuptake inhibitor use and an increased risk of suicidal thinking/behaviour, and weighed that against the benefit of the alleviation of depressive symptoms. It is argued here that such an approach is simplistic. There are several serious risks surrounding antidepressant use in the young that ought to be included in the (...) equation, along with a consideration of the neuroethical concerns surrounding pharmacotherapy for affective disorders. Using the precautionary principle as a framework for analysis it is concluded that the risks are sufficiently serious and plausible that the prescribing of antidepressant medication to the young ought to be severely restricted; further it is imperative that the child and their parents are made fully aware of the risks, short-term and long-term, involved. (shrink)

Background: The search for genetic variants between racial/ethnic groups to explain differential disease susceptibility and drug response has provoked sharp criticisms, challenging the appropriateness of using race/ethnicity as a variable in genetics research, because such categories are social constructs and not biological classifications.Objectives: To gain insight into how a group of genetic scientists conceptualise and use racial/ethnic variables in their work and their strategies for managing the ethical issues and consequences of this practice.Methods: In-depth semi-structured interviews were conducted with a (...) purposive sample of 30 genetic researchers who use racial/ethnic variables in their research. Standard qualitative methods of content analysis were used.Results: Most of the genetic researchers viewed racial/ethnic variables as arbitrary and very poorly defined, and in turn as scientifically inadequate. However, most defended their use, describing them as useful proxy variables on a road to “imminent medical progress”. None had developed overt strategies for addressing these inadequacies, with many instead asserting that science will inevitably correct itself and saying that meanwhile researchers should “be careful” in the language chosen for reporting findings.Conclusions: While the legitimacy and consequences of using racial/ethnic variables in genetics research has been widely criticised, ethical oversight is left to genetic researchers themselves. Given the general vagueness and imprecision we found amongst these researchers regarding their use of these variables, they do not seem well equipped for such an undertaking. It would seem imperative that research ethicist move forward to develop specific policies and practices to assure the scientific integrity of genetic research on biological differences between population groups. (shrink)

Background: The factors influencing parents’ willingness to enroll their children in biobanks are poorly understood. This study sought to assess parents’ willingness to enroll their children, and their perceived benefits, concerns, and information needs under different consent and data-sharing scenarios, and to identify factors associated with willingness. Methods: This large, experimental survey of patients at the 11 eMERGE Network sites used a disproportionate stratified sampling scheme to enrich the sample with historically underrepresented groups. Participants were randomized to receive one of (...) three consent and data-sharing scenarios. Results: In total, 90,000 surveys were mailed and 13,000 individuals responded (15.8% response rate). 5737 respondents were parents of minor children. Overall, 55% (95% confidence interval 50–59%) of parents were willing to enroll their youngest minor child in a hypothetical biobank; willingness did not differ between consent and data-sharing scenarios. Lower educational attainment, higher religiosity, lower trust, worries about privacy, and attitudes about benefits, concerns, and information needs were independently associated with less willingness to allow their child to participate. Of parents who were willing to participate themselves, 25% were not willing to allow their child to participate. Being willing to participate but not willing to allow one’s child to participate was independently associated with multiple factors, including race, lower educational attainment, lower annual household income, public health care insurance, and higher religiosity. Conclusions: Fifty-five percent of parents were willing to allow their youngest minor child to participate in a hypothetical biobank. Building trust, protecting privacy, and addressing attitudes may increase enrollment and diversity in pediatric biobanks. (shrink)

They used to believe that mankind began in 4004 B.C. and the Greeks in 776. We now know that these last five thousand years during which man has left written record of himself are but a minute fraction of the time he has spent developing his culture. We now understand that the evolution of human society, its laws and customs, its economics, its religious practices, its games, its languages, is a very slow process, to be measured in millennia. In the (...) case of Greek religious usage it is now appreciated that it has its roots not in Mycenaean but in Palaeolithic times. As for Greek poetry, comparative studies have shown that it goes back by a continuous tradition to Indo-European poetry. (shrink)

This important and extensive fragment of the Catalogues is preserved on a papyrus of the third century A.D., no. 10560 in the Berlin collection. First published in 1907 by Schubart and Wilamowitz, Berliner Klassikertexte, v. 1. 31 ff. , it was also collated by Crönert, who published his readings in Hermes xlii , 610 ff. The most recent edition is that of Merkelbach, Die Hesiod-fragmente auf Papyrus , pp. 24 ff. The photograph mentioned above is the only one published. It (...) covers only a small portion of the text; most of the rest is too faint to be suitable for photography. (shrink)

In this paper we focus on the modularity of visual functions in the human visual cortex, that is, the specific problems that the visual system must solve in order to achieve recognition of objects and visual space. The computational theory of early visual functions is briefly reviewed and is then used as a basis for suggesting computational constraints on the higher-level visual computations. The remainder of the paper presents neurological evidence for the existence of two visual systems in man, one (...) specialized for spatial vision and the other for object vision. We show further clinical evidence for the computational hypothesis that these two systems consist of several visual modules, some of which can be isolated on the basis of specific visual deficts which occur after lesions to selected areas in the visually responsive brain. We will provide examples of visual modules which solve information processing tasks that are mediated by specific anatomic areas. We will show that the clinical data from behavioral studies of monkeys (Ungerleider and Mishkin 1984) supports the distinction between two visual systems in monkeys, the 'what' system, involved in object vision, and the 'where' system, involved in spatial vision. (shrink)

In CQ 20 , 277–87, 1 argued for dating Corinna to the third century B.C. In my Greek Metre , p. 141, I continued to assume this date, observing that not everyone accepted it but that I knew of no attempt to answer my arguments. I must confess to having overlooked at least one such attempt, by A. Allen in CJ 68 , 26–8; and now M. Davies has mounted another in SIFC 81 , 186–94, largely repeating Allen's points but (...) with some new touches. Allen upholds the traditional fifth-century date. Davies has yet to come to a decision, but meanwhile he is eager to discredit what he regards as an unsatisfactory case for a Hellenistic dating. (shrink)

Catalexis was the subject of an important recent article by L. P. E. Parker. There is one particular aspect of it that she does not touch, and that ought not to be left out of account: its presumable Indo-European origins. Consideration of this aspect leads to the drawing of distinctions which otherwise tend to escape notice.