In Victoria, Australia, the law regulating abortion was reformed in 2008, and a clause was introduced requiring doctors with a conscientious objection to abortion to refer women to another provid...

During the debates about the legalization of Voluntary Assisted Dying in Victoria, Australia, the presence of anti-VAD health professionals in the medical community and reported high rates of conscientious objection to VAD suggested access may be limited. Most empirical research on CO has been conducted in the sexual and reproductive health context. However, given the fundamental differences in the nature of such procedures and the legislation governing it, these findings may not be directly transferable to VAD. Accordingly, we sought to (...) understand how CO operates in the context of VAD. Prior to the implementation of the VAD legislation in June 2019, we conducted semi-structured interviews with seventeen health professionals with a self-declared CO to VAD, to explore what motivated their CO. Participants identified multiple motivations, which can be broadly categorized as: concerns for oneself; concerns for patients; concerns about the current Victorian legislation; and concerns for the medical profession. Participants’ moral commitments included personal, professional, and political commitments. In some cases, one’s CO was specific to Victoria’s current legislation rather than VAD more broadly. Our findings suggest CO motivations extend beyond those traditionally cited and suggest a need to better understand and manage CO in the healthcare context. (shrink)

BackgroundDealing with end of life is challenging for patients and health professionals alike. The situation becomes even more challenging when a patient requests a legally permitted medical service that a health professional is unable to provide due to a conflict of conscience. Such a scenario arises when Victorian health professionals, with a conscientious objection (CO) to voluntary assisted dying (VAD), are presented with patients who request VAD or merely ask about VAD. The Voluntary Assisted Dying Act 2017 (Vic) recognizes the (...) inherent conflict of conscience that may arise for some health professionals when asked to provide VAD and responds by affording broad protection to conscientious objectors who wish to refuse to take part in the VAD process.MethodsSeventeen semi-structured qualitative interviews were conducted with Victorian health professionals with a self-identified CO to VAD in the lead-up to the implementation of VAD in Victoria. Interviews explored how participants anticipated they would manage their CO in practice. Interviews were transcribed verbatim and analyzed thematically.ResultsOur results reveal that the way in which health professionals claimed they would approach CO conversations is variable and was dependant on the strength of their opposition to VAD. We categorized conscientious objectors according to their approach as either dissuasive non-referrers, passive non-referrers, facilitators or negotiators. Our study also explores the perceived difficulties of exercising one’s CO as identified by our participants.ConclusionThe broad protection offered by the Voluntary Assisted Dying Act 2017 (Vic) encourages a range of behaviors from conscientious objectors, due to the minimal obligations imposed. In order to assist conscientious objectors, more policy, institutional guidance, and education needs to be available to conscientious objectors explicitly addressing how to effectively manage one’s CO. Such guidance is imperative to ensuring that their moral integrity is preserved and that they are exercising their CO appropriately. (shrink)

BackgroundThe use of genetic test results in risk-rated insurance is a significant concern internationally, with many countries banning or restricting the use of genetic test results in underwriting. In Australia, life insurers’ use of genetic test results is legal and self-regulated by the insurance industry (Financial Services Council (FSC)). In 2018, an Australian Parliamentary Inquiry recommended that insurers’ use of genetic test results in underwriting should be prohibited. In 2019, the FSC introduced an industry self-regulated moratorium on the use of (...) genetic test results. In the absence of government oversight, it is critical that the impact, effectiveness and appropriateness of the moratorium is monitored. Here we describe the protocol of our government-funded research project, which will serve that critical function between 2020 and 2023.MethodsA realist evaluation framework was developed for the project, using a context-mechanism-outcome (CMO) approach, to systematically assess the impact of the moratorium for a range of stakeholders. Outcomes which need to be achieved for the moratorium to accomplish its intended aims were identified, and specific data collection measures methods were developed to gather the evidence from relevant stakeholder groups (consumers, health professionals, financial industry and genetic research community) to determine if aims are achieved. Results from each arm of the study will be analysed and published in peer-reviewed journals as they become available.DiscussionThe A-GLIMMER project will provide essential monitoring of the impact and effectiveness of the self-regulated insurance moratorium. On completion of the study (3 years) a Stakeholder Report will be compiled. The Stakeholder Report will synthesise the evidence gathered in each arm of the study and use the CMO framework to evaluate the extent to which each of the outcomes have been achieved, and make evidence-based recommendations to the Australian federal government, life insurance industry and other stakeholders. (shrink)

Background Victoria was the first Australian state to legalize voluntary assisted dying (elsewhere known as physician-assisted suicide and euthanasia). Some institutions indicated they would not participate in voluntary assisted dying. The Victorian government issued policy approaches for institutions to consider Objective To describe and analyse publicly available policy documents articulating an institutional objection to voluntary assisted dying in Victoria. Methods Policies were identified using a range of strategies, and those disclosing and discussing the nature of an institutional objection were thematically (...) analysed using the framework method. Results The study identified fifteen policies from nine policymakers and developed four themes: (1) extent of refusal to participate in VAD, (2) justification for refusal to provide VAD, (3) responding to requests for VAD, and (4) appeals to state-sanctioned regulatory mechanisms. While institutional objections were stated clearly, there was very little practical detail in most documents to enable patients to effectively navigate objections in practice. Conclusion This study demonstrates that despite having clear governance pathways developed by centralized bodies (namely, the Victorian government and Catholic Health Australia), many institutions’ public-facing policies do not reflect this guidance. Since VAD is contentious, laws governing institutional objection could provide greater clarity and regulatory force than policies alone to better balance the interests of patients and non-participating institutions. (shrink)

In jurisdictions where voluntary assisted dying is legal, eligibility assessments, prescription and administration of a VAD substance are commonly performed by senior doctors. Junior doctors’ involvement is limited to a range of more peripheral aspects of patient care relating to VAD. In the Australian state of Victoria, where VAD has been legal since June 2019, all health professionals have a right under the legislation to conscientiously object to involvement in the VAD process, including provision of information about VAD. While this (...) protection appears categorical and straightforward, conscientious objection to VAD-related care is ethically complex for junior doctors for reasons that are specific to this group of clinicians. For junior doctors wishing to exercise a conscientious objection to VAD, their dependence on their senior colleagues for career progression creates unique risks and burdens. In a context where senior colleagues are supportive of VAD, the junior doctor’s subordinate position in the medical hierarchy exposes them to potential significant harms: compromising their moral integrity by participating, or compromising their career progression by objecting. In jurisdictions intending to provide all health professionals with meaningful conscientious objection protection in relation to VAD, strong specific support for junior doctors is needed through local institutional policies and culture. There are no data in this work. (shrink)

Publics are key stakeholders in population genomic screening and their perspectives on ethical considerations are relevant to programme design and policy making. Using semi-structured interviews, we explored social views and attitudes towards possible future provision of personalised genomic risk information to populations to inform prevention and/or early detection of relevant conditions. Participants were members of the public who had received information on their personal genomic risk of melanoma as part of a research project. The focus of the analysis presented here (...) is participants’ views regarding ethical considerations relevant to population genomic screening more generally. Data were analysed thematically and four key themes related to ethical considerations were identified: personal responsibility for health: ‘forewarned is forearmed’; perceptions of, and responses to, genetic fatalism; implications for parenting and reproduction; divided views on choosing to receive genomic risk information. Ethical considerations underlying these themes include the valorisation of information and choice, paternalism, non-directiveness and increasing responsibilisation of individuals in health and healthcare. These findings arguably indicate a thin public conceptualisation of population genomic testing, which draws heavily on how these themes tend to be described in existing social discourses. Findings suggest that further public engagement is required to increase complexity of debate, to consider the appropriate place of individual and social interests in population genomic testing. Further discernment of relevant ethical approaches, drawing on ethical frameworks from both public health and clinical settings, will also assist in determining the appropriate implementation of population genomic screening for complex conditions. (shrink)

Considering the popular framing of an artificial intelligence as a rational agent that always seeks to maximise its expected utility, referred to as its goal, one of the features attributed to such rational agents is that they will never select an action which will change their goal. Therefore, if such an agent is to be friendly towards humanity, one argument goes, we must understand how to specify this friendliness in terms of a utility function. Wolfhart Totschnig, argues in contrast that (...) a fully autonomous agent will have the ability to change its utility function and will do so guided by its values. This commentary examines computational accounts of goals, values and decision-making. It rejects the idea that a rational agent will never select an action that changes its goal but also argues that an artificial intelligence is unlikely to be purely rational in terms of always acting to maximise a utility function. It nevertheless also challenges the idea that an agent which does not change its goal cannot be considered fully autonomous. It does agree that values are an important component of decision-making and explores a number of reasons why. (shrink)

This article explores the evolution of Principles of Biomedical Ethics by Tom Beauchamp and James Childress over its seven editions. Many changes have occurred in the text over the last thirty-five years, including the expansion of the section on virtue ethics, the modification of the authors’ position on physician-assisted suicide, and the addition of many other ethical theories to the original two found in the first editions. The basis for these changes and others seems to be their development of the (...) theme of the “common morality.” The author suggests that Beauchamp and Childress develop the connection between their common morality and metaphysics, as it would serve to strengthen their theory and make it less susceptible to changes in society’s opinions and traditions. National Catholic Bioethics Quarterly 14.3 : 459–475. (shrink)

A vital process in maintaining a low genetic error rate is the removal of mismatched bases in DNA. The importance of this process in E. coli is demonstrated by the 100–1000 fold increase in mutation frequency observed in cells deficient in this repair system(1). Mismatches can arise as a consequence of recombination, errors in replication and as a result of spontaneous chemical deamination, the latter process resulting in an estimated twelve T:G mismatches per genome per day in mammalian cells(2). Recent (...) studies, discussed here, provide evidence for the existence of specific mismatch repair systems in mammalian and human cells. (shrink)

This book brings together the stories of biographers, novelists, scholars, and artists as they have written about the journeys (some literal, some figurative) they have made to their subjects. Contributors include Elizabeth Wood, J.J. Wilson, Leah Glasser, Jane Lazarre, and Alice Walker.

Research using explicit measures has linked decreased positive future thinking, but not increased negative future thinking, with clinical depression. However, individuals may be unable or unwilling to express thoughts about the future, and can be unaware of implicit beliefs that can influence their behavior. Implicit measures of cognition may shed light on the role of future thinking in depression. To our knowledge, the current study presents the first implicit measure of positive and negative future thinking. A sample of 71 volunteers (...) completed both implicit and explicit measures of positive and negative future thinking. The findings indicate differences in the evaluation of both positive and negative future events between the two groups. However, group differences were more pronounced on the implicit measure. These findings point to the potential utility of an implicit measure of future thinking in mental health research and clinical practice. (shrink)

The decision to divorce marks a turning point for every individual involved. It can be viewed as more than just a legal process. From a psychological perspective, it does not matter who initiated the divorce, since it always comes with emotional ramifications for all those involved. Statistically, there is a high rate of divorce in South Africa and there have been significant shifts in trends over time. While black South African men’s experience of divorce has been relatively neglected in the (...) research on divorce, it is important for understanding contemporary social arrangements and processes, and, in particular, for broadening the understanding of black South African men’s lives. How black South African men describe their experience and respond to marital dissolution may point to their positions in the gender-structured community as well as illuminate how they interpret the nature of social practice, marriage, divorce and their position in society. The aim of the research reported on in this paper was to explore black South African men’s experience of divorce. The theoretical framework underpinning this qualitative study was broadly that of Symbolic Interactionism, with Interpretative Phenomenological Analysis employed as both the research design and data analytic theory and process. The eight participants were volunteers who were recruited purposively. In keeping with IPA guidelines, data-collection proceeded by means of biographical questionnaires and semi-structured interviews. The emerging themes were grouped into three superordinate themes, namely, perceptions of divorce, social support, and experiencing of pain. Each superordinate theme had corresponding subordinate themes and experiential claims. Weed’s recommendations for the interpretative synthesis of interview data were applied. (shrink)

Males are often found to outperform females in tests of mathematics achievement and it has been proposed that this may in part be explained by differences in cognitive style. This study investigated the relation between Wholistic-Analytic and Verbal-Imagery cognitive style, gender and mathematics achievement in a sample of 190 Australian primary school students aged between 8?11?years (M?=?9.77, SD?=?1.05). It was hypothesised that males would outperform females in mathematics achievement tests, and that gender would interact with cognitive style on mathematics performance. (...) A significant gender/cognitive style interaction was found. Boys with an Analytic/Imagery style achieved significantly higher results than the girls with an Analytic/Imagery style, supporting the contention that certain cognitive styles affect boys and girls mathematics performance differently. Implications of results and strategies for improving mathematics achievement among girls are discussed. (shrink)

Weiss, Propen, and Reid gather a diverse group of scholars to analyze the growing obsolescence of the human-object dichotomy in today's world. In doing so, Design, Mediation, and the Posthuman brings together diverse disciplines to foster a dialog on significant technological issues pertinent to philosophy, rhetoric, aesthetics, and science.

In recent years there have been major shifts in how the role of science—and scientists—are understood. The critical examination of scientific expertise within the field of Science and Technology Studies are increasingly eroding notions of the “otherness” of scientists. It would seem to suggest that anyone can be a scientist—when provided with the appropriate training and access to data. In contrast, however, ethnographic evidence from the scientific community tells a different story. Scientists are quick to recognize that not everyone can—or (...) should—be a scientist. Appealing to notions such as “good hands” or “gut feelings”, scientists narrate a distinction between good and bad scientists that cannot be reduced to education, access, or opportunity. The key to good science requires scientists to express an intuitive feeling for their discipline, but also that individuals derive considerable personal satisfaction from their work. Discussing this personal joy in—and “fittingness” of—scientific occupations using the fields of STS, ethics and science policy is highly problematic. In this paper we turn to theology discourse to analyze the notion of “callings” as a means of understanding this issue. Callings highlight the identification and examination of individual talents to determine fit occupations for specific persons. Framing science as a calling represents a novel view of research that places the talents and dispositions of individuals and their relationship to the community at the center of flourishing practices. (shrink)

Given the lack of knowledge about safety and efficacy of many treatments for children, pediatric clinical trials are important, but recruitment for pediatric research is difficult. Little is known about children's perspective on participating in trials. The purpose of this study was to understand the experiences and motivations of young people who took part in clinical trials. This is a qualitative interview study of 25 young people aged 10–23 who were invited to take part in clinical trials. Interviews were audio (...) or video recorded and analyzed using framework analysis. Young peoples' motivations were both personal benefit and helping others. Both incentives appeared to be more complex than expected. We introduce the terms “network of exchange” and “intergenerational solidarity” to describe these motivations. To improve recruitment, professionals should be more open about research opportunities, provide better information, and give young people feedback after the trial has ended. (shrink)

When a chimpanzee stockpiles rocks as weapons or when a frog sends out mating calls, we might easily assume these animals know their own motivations--that they use the same psychological mechanisms that we do. But as Beyond the Brain indicates, this is a dangerous assumption because animals have different evolutionary trajectories, ecological niches, and physical attributes. How do these differences influence animal thinking and behavior? Removing our human-centered spectacles, Louise Barrett investigates the mind and brain and offers an alternative (...) approach for understanding animal and human cognition. Drawing on examples from animal behavior, comparative psychology, robotics, artificial life, developmental psychology, and cognitive science, Barrett provides remarkable new insights into how animals and humans depend on their bodies and environment--not just their brains--to behave intelligently. Barrett begins with an overview of human cognitive adaptations and how these color our views of other species, brains, and minds. Considering when it is worth having a big brain--or indeed having a brain at all--she investigates exactly what brains are good at. Showing that the brain's evolutionary function guides action in the world, she looks at how physical structure contributes to cognitive processes, and she demonstrates how these processes employ materials and resources in specific environments. Arguing that thinking and behavior constitute a property of the whole organism, not just the brain, Beyond the Brain illustrates how the body, brain, and cognition are tied to the wider world. (shrink)

A Pedagogy of Purpose offers a completely fresh take on key problems in the education system. Gary Keogh argues that the education system has lost its way; it has become mechanistic, vapid, driven by an obsession with dubious measurements and led by a very narrow understanding of what it means to succeed. It has lost its sense of purpose. Using many real classroom examples, Keogh provides a new way forward, demonstrating how insights from classical philosophy can have a (...) positive influence on crucial issues in education like student behaviour, assessment, attendance, the quality of teaching and learning, and perhaps most importantly, the mental health of students and teachers. (shrink)

There are wide individual differences in the ability to detect a stimulus contingency embedded in a complex paradigm. The present study used a cognitive masking paradigm to better understand individual differences related to contingency learning. Participants were assessed on measures of electrodermal arousal and on working memory capacity before engaging in the contingency learning task. Contingency awareness was assessed both by trial-by-trial verbal reports obtained during the task and by a short post-task recognition questionnaire. Participants who became aware had fewer (...) non-specific skin conductance responses and tended to score higher on a digit span assessment. Skin conductance level was not significantly lower in the aware group than in the unaware group. These findings are consistent with studies showing that lower arousal and greater cognitive processing capacity facilitate conscious perception of a greater breadth of information within a scene or a task. (shrink)

This book is a translation into English of La religion grecque by Louise Bruit Zaidman and Pauline Schmitt Pantel, described by Dr Simon Price as 'an excellent book, by far the best introduction to the subject in any language'. It is the purpose of the book to consider how religious beliefs and cultic rituals were given expression in the world of the Greek citizen - the functions performed by the religious personnel, and the place that religion occupied in individual, (...) social and political life. The chapters cover first ritual and then myth, rooting the account in the practices of the classical city while also taking seriously the world of the imagination. For this edition the bibliography has been substantially revised to meet the needs of a mainly student, English-speaking readership. The book is enriched throughout by illustrations, and by quotations from original sources. (shrink)

Development-oriented funding schemes such as the UK Global Challenges Research Fund (GCRF) have opened up opportunities for collaborations between low-middle income countries (LMICs) and high-income country (HIC) researchers. In particular, funding for medical technology research has seen a rise in previously under-represented disciplines such as physics and engineering. These collaborations have considerable potential to advance healthcare in LMICs, yet can pose challenges experienced to researchers undertaking these collaborations. Key challenges include a lack of tradition of HIC/LMIC collaborations within participating departments, (...) lack of experience with development agendas, designing contextually-appropriate technologies and ensuring long-term viability of research outputs. This paper reflects on these key challenges, using the experiences of the authors on the Open Laboratory Instrumentation (OLI) project as a focalizing lens. This project was a GCRF-funded collaboration between physicists in the UK and engineers in Tanzania to develop an open-source, 3D-printed, fully-automated laboratory microscope. The paper highlights key ethics lessons learnt. (shrink)

Development-oriented funding schemes such as the UK Global Challenges Research Fund (GCRF) have opened up opportunities for collaborations between low-middle income countries (LMICs) and high-income country (HIC) researchers. In particular, funding for medical technology research has seen a rise in previously under-represented disciplines such as physics and engineering. These collaborations have considerable potential to advance healthcare in LMICs, yet can pose challenges experienced to researchers undertaking these collaborations. Key challenges include a lack of tradition of HIC/LMIC collaborations within participating departments, (...) lack of experience with development agendas, designing contextually-appropriate technologies and ensuring long-term viability of research outputs. This paper reflects on these key challenges, using the experiences of the authors on the Open Laboratory Instrumentation (OLI) project as a focalizing lens. This project was a GCRF-funded collaboration between physicists in the UK and engineers in Tanzania to develop an open-source, 3D-printed, fully-automated laboratory microscope. The paper highlights key ethics lessons learnt. (shrink)

Development-oriented funding schemes such as the UK Global Challenges Research Fund (GCRF) have opened up opportunities for collaborations between low-middle income countries (LMICs) and high-income country (HIC) researchers. In particular, funding for medical technology research has seen a rise in previously under-represented disciplines such as physics and engineering. These collaborations have considerable potential to advance healthcare in LMICs, yet can pose challenges experienced to researchers undertaking these collaborations. Key challenges include a lack of tradition of HIC/LMIC collaborations within participating departments, (...) lack of experience with development agendas, designing contextually-appropriate technologies and ensuring long-term viability of research outputs. This paper reflects on these key challenges, using the experiences of the authors on the Open Laboratory Instrumentation (OLI) project as a focalizing lens. This project was a GCRF-funded collaboration between physicists in the UK and engineers in Tanzania to develop an open-source, 3D-printed, fully-automated laboratory microscope. The paper highlights key ethics lessons learnt. (shrink)

Theological reactions to the rise of the new atheist movement have largely been critically hostile or defensively deployed apologetics to shore up the faith against attack. Gary Keogh contends that focusing on scholarly material that is inherently agreeable to theology will not suffice in the context of modern academia. Theology needs to test its boundaries and venture into dialogue with those with antithetical positions. Engaging Richard Dawkins, as the embodiment of such a position, illustrates how such dialogue may offer (...) new perspectives on classical theological problems, such as the relationship of science and religion, the existence of God, creation, natural suffering and theodicy. Keogh demonstrates how a dialogical paradigm may take shape, rather than merely discussing it as a theoretical framework. A dialogue between such opposing hermeneutics may provide a new paradigm of theological scholarship - one which is up to the task of facing its critics in the public and pluralistic context of modern academia. (shrink)

Across worlds and bodies -- Touching the looking glass -- With thumbs in mind -- To touch sights and sounds -- Repetition, failure, and permanence -- From hackers to cyborgs.

The first truly multidisciplinary text of its kind, this book offers an original analysis of the current state of linguistic pragmatics. Cummings argues that no study of pragmatics can reasonably neglect the historical and contemporary influences on this.

Cet ouvrage s'inscrit dans le fil du travail collectif entrepris en 1995, l'Histoire de la pensée médicale en Occident (trois volumes sous la direction de Mirko D Grmek, Seuil, 1995, 1997, 1999). Il rend compte du déploiement des recherches pluridisciplinaires et transdisciplinaires de la pensée médicale et aborde les discussions et controverses actuelles sur les politiques de santé. Du fait du développement des connaissances théoriques et des innovations techniques, la notion même de soin, sous ses aspects sociaux, économiques, mais aussi (...) épistémiques, se trouve questionnée. La pensée médicale ne saurait se limiter aux données biologiques, et ses composantes spécifiquement humaines et sociales sont explorées et interrogées ici dans une perspective historique qui tient compte des découvertes du dernier siècle. (shrink)