Ethical decision making in medicine has recently seen calls to move towards less prescriptive- based approaches that consider the particularities of each case. The main alternative call from the literature is for better understanding of phronesis concepts applied to decision making. A well-cited phronesis-based approach is Kaldjian’s five-stage theoretical framework: goals, concrete circumstances, virtues, deliberation and motivation to act. We build on Kaldjian’s theory after using his framework to analyse data collected from a three-year empirical study of phronesis and the (...) medical community. The data are a set of narratives collected in response to asking a medical community what making ethically wise decisions means to them. We found that Kaldjian’s five concepts are present in the accounts to some extent but that one of the elements, motivation, is constructed as playing a different, though still crucial role. Rather than being an end-stage of the process as Kaldjian’s framework suggests, motivation was constructed as initiating the process and maintaining the momentum of taking a phronesis-based approach. The implications for medical ethics decision-making education are significant as motivation itself is a highly complex concept. We therefore theorise that motivation is required for leading in, continuing and completing the actions of the ethical decision taken. Appreciating the central importance of motivation through the whole of Kaldjian’s framework has implications for cultivating the virtues of phronesis and courage to take the right course of action. (shrink)

Contemporary clinical ethics was founded on principlism, and the four principles: respect for autonomy, nonmaleficence, beneficence and justice, remain dominant in medical ethics discourse and practice. These principles are held to be expansive enough to provide the basis for the ethical practice of medicine across cultures. Although principlism remains subject to critique and revision, the four-principle model continues to be taught and applied across the world. As the practice of medicine globalizes, it remains critical to examine the extent to which (...) both the four-principle framework, and individual principles among the four, suffice patients and practitioners in different social and cultural contexts. Using the four-principle model we analyze two accounts of surrogate decision making – one from the developed and one from the developing world – in which the clinician undertakes medical decision-making with apparently little input from the patient and/or family. The purpose of this analysis is to highlight challenges in assessing ethical behaviour according to the principlist model. We next describe cultural expectations and mores that inform both patient and clinician behaviors in these scenarios in order to argue that the principle of respect for persons informed by culture-specific ideas of personhood may offer an improved ethical construct for analyzing and guiding medical practice in a globalized and plural world. (shrink)

Volume 20, Issue 3, March 2020, Page 73-74.

Multinational companies commonly and increasingly undertake their research in low and middle-income countries through commercial clinical research organizations (CROs). The involvement of these scientific middle men complicates the application of the theories of justice. We examine those complexities, and conclude that while the difficulties are not immune to analysis in terms of these theories, the theories have to be deployed in new ways in order to be useful in the new commercial world.

BackgroundMedical ethics has recently seen a drive away from multiple prescriptive approaches, where physicians are inundated with guidelines and principles, towards alternative, less deontological perspectives. This represents a clear call for theory building that does not produce more guidelines. Phronesis (practical wisdom) offers an alternative approach for ethical decision-making based on an application of accumulated wisdom gained through previous practice dilemmas and decisions experienced by practitioners. Phronesis, as an ‘executive virtue’, offers a way to navigate the practice virtues for any (...) given case to reach a final decision on the way forward. However, very limited empirical data exist to support the theory of phronesis-based medical decision-making, and what does exist tends to focus on individual practitioners rather than practice-based communities of physicians.MethodsThe primary research question was: What does it mean to medical practitioners to make ethically wise decisions for patients and their communities? A three-year ethnographic study explored the practical wisdom of doctors (n = 131) and used their narratives to develop theoretical understanding of the concepts of ethical decision-making. Data collection included narrative interviews and observations with hospital doctors and General Practitioners at all stages in career progression. The analysis draws on neo-Aristotelian, MacIntyrean concepts of practice- based virtue ethics and was supported by an arts-based film production process.ResultsWe found that individually doctors conveyed many different practice virtues and those were consolidated into fifteen virtue continua that convey the participants’ ‘collective practical wisdom’, including the phronesis virtue. This study advances the existing theory and practice on phronesis as a decision-making approach due to the availability of these continua.ConclusionGiven the arguments that doctors feel professionally and personally vulnerable in the context of ethical decision-making, the continua in the form of a video series and app based moral debating resource can support before, during and after decision-making reflection. The potential implications are that these theoretical findings can be used by educators and practitioners as a non-prescriptive alternative to improve ethical decision-making, thereby addressing the call in the literature, and benefit patients and their communities, as well. (shrink)

Objective: There is lack of information on the presentation of eating disorders (EDs) in Saudi Arabia using gold standard clinical tools. The present study aimed to provide data on the presentation of EDs in Saudi Arabia using clinically validated measures.Method: Hundred and thirty-three individuals (33 male) with a mean age of 22 years (2.63) completed three measures: the Eating Disorder Examination (EDE), a semi-structured interview, the Eating Disorder Examination Questionnaire (EDE-Q), a self-report measure, and the Depression Anxiety and Stress Scale (...) (DASS-21) to measure comorbid symptoms.Results: Individuals in Saudi Arabia reported higher levels of restraint, eating concern and shape concern and a higher global score, but lower levels of weight concern on the EDE-Q compared to the EDE. Female participants reported a higher global score, alongside significantly higher scores on the restraint, shape concern and weight concern subscales than males. The most common ED subtype was other specific feeding or ED. Compared with Western community samples, symptom severity in this purposive sample obtained from community settings was significantly higher in this sample.Discussion: Individuals with eating, weight and shape concerns in Saudi Arabia may feel more comfortable expressing their symptoms on a self-report tool compared with a face to face interview. However, it is possible that a self-report measure may over-estimate the severity of symptoms. The data suggest that clinicians in Saudi Arabia should regularly screen for EDs in all genders. It is also important to note that ED symptoms are a cause for concern in young people in Saudi Arabia. (shrink)

Prince of philosophers -- The emergence of Islam -- Boy genius -- Court physician -- A traveling philosopher -- Death of an intellectual -- A lasting legacy.

Communication between road users is a major key to coordinate movement and increase roadway safety. The aim of this work was to grasp how pedestrians, cyclists, and kick scooter users sought to visually communicate with drivengers when they would face autonomous vehicles. In each experiment, participants were asked to imagine themselves in described situations of encounters between a specific type of vulnerable road user and a human driver in an approaching car. The human driver state and the communicative means of (...) the approaching car through an external Human-Machine Interface were manipulated between the scenarios. The participants were prompted to rate from “never” to “always” the frequency with which they would seek eye contact with the human driver either in order to express their willingness to cross or to make their effective decision to cross. Our findings revealed that a passive human driver in an AV with no visual checking on the road triggered a decline in vulnerable road users’ desire to communicate by eye contact. Moreover, the results of Experiment C demonstrated that the speed screen, the text message screen, and the vibrating mobile app eHMI signals diminished kick scooter users’ desire to communicate visually with the human driver, with some age-based differences. This suggested a better comprehension of the approaching car’s intentions by the kick scooter users, driven by the features of the eHMI. (shrink)

The ‘right not to know’ can be used by patients as a safeguard against the effects that certain medical information can have on their well-being. At first glance, one might reason it suitable for a patient to enact their RNTK. However, although Davies states that RNTK gives people the ability to both protect themselves from self-perceived harm and exercise their autonomy, I will argue that ‘not knowing’ hinders patients’ ability to exercise their existential freedom and represents what Sartre calls an (...) instance of ‘bad faith’. Davies argues that the RNTK takes precedence over many related issues and objections associated with a patient’s decision to implement such a resolution.1 Fundamentally, the RNTK gives patients power to protect themselves from subjective harm and to exercise their autonomy. In most cases, objectors of RNTK cite the negative impact on the patient’s state of health, which affects not only the patient but also those persons who would also be negatively affected by patient health outcomes. For the majority of objectors, patients have moral obligations to lessen the degree of burden on others, which refusal can initiate. However, Davies concludes, ‘…the burden placed on others is not sufficiently significant …. (shrink)

This paper presents a cross-sectional study that demonstrates how King Abdulaziz University has responded to the lockdown imposed by the Ministry of Education in Saudi Arabia due to the Covid-19 pandemic. The purpose of this study was to examine the perceptions of students and faculty towards assessment that had to take place online due to physical or social distancing rules and lockdowns. A descriptive mixed-method study was conducted with two different self-administered questionnaires that were developed for students and faculty, respectively. (...) A total of 547 responses were received from undergraduate students and 213 from faculty. The main finding suggests the need for a multilevel approach to the problems of cheating and plagiarism, including raising student awareness and ethics, training teachers to detect cheating methods, and institutions activating their code of practice and applying severe sanctions on those who engage in such practices. (shrink)

To Kant, the French revolution's central events were the transfer of sovereignty to the people in 1789 and the trial and execution of the monarch in 1792-1793. Through a contextual study, this Element argues that while both events manifested the principle of popular sovereignty, the first did so in lawful ways, whereas the latter was a perversion of the principle. Kant was convinced that historical examples can help us understand political philosophy, and this Element seeks to show this in practice.

Abstract: Retama raetam (RR) is a traditional medicinal plant belongs to fabaceae family which grows in North Africa and East Mediterranean region. Locally, RR is used in several diseases including diabetes mellitus and hypertension. Thus, this study aims to investigate certain behavioral and central effects of methanolic extract of RR seeds in experimental animals (male Albino adult mice of 20 – 35 gm). Three exploratory behavioral models are used in this study, open field, elevated plus maze and light-dark box models, (...) in addition, picrotoxin induced seizure model in mice. In elevated plus-maze test of anxiety, a dose of 25 mg/kg of RR induced a significant increase in number of open arms entries and time spent on open arms of the maze compared to the control. In light-dark model, time spent on light area and number of light-dark transitions are significantly increased after treatment with 25 mg/kg RR extract of seeds. Open field model also revealed a significant increase in general motor activity of the mouse after 25 mg/kg of RR. On the other hand, a dose of 50 mg/kg of RR significantly induced a profound central and peripheral analgesic responses. In summary, this study concludes that RR seeds have a profound anxiolytic-like effect and analgesic response with delay in latency time of seizure induced by picrotoxin in mice. (shrink)

Drawing on 2 years of field research conducted between 2008 and 2010 in London’s Kurdish community, I discuss the practical and ethical challenges that confront researchers dealing with violence against women committed in the name of ‘honour’. In examining how feminist methodologies and principles inform my research, I address issues of researcher positioning and the importance of speaking with, rather than for, marginalised groups. I then explore the difficulties of operationalising this position when dealing with honour-based violence. Using the interview (...) data from the 2008–2010 study and a case study of the trial of Mehmet Goren (who was convicted in 2009 of murdering his daughter Tulay for supposedly dishonouring their family), I discuss the socio-cultural norms and values underlying honour codes, examining both the position of men and women in relation to the maintenance of family honour and the regulation of women’s sexuality and conduct. In particular, I explore the difficulties inherent in obtaining and understanding victims’ own personal narratives, especially in legal settings, while simultaneously showing how it is only through empowering women to speak for themselves that we will be able to bring about the deep societal changes needed to eradicate honour-based violence. (shrink)

This article explores how the type of consent given for organ donation should affect the judgement of a patient's overall benefit with regards to donation of their organs and the pre-mortem interventions required to facilitate this. The findings of a qualitative study of the views of 10 healthcare professionals, combined with a philosophical analysis inform the conclusion that how consent to organ donation is given is a reliable indicator only of the strength of evidence about views on donation and subsequent (...) willingness to undergo pre-mortem interventions. It is not an indicator of the strength of actual desire to donate. Clinical management of living patients prior to donation after circulatory death must therefore respect the values, wishes and beliefs of the potential donation after circulatory death donor. Our participants, however, suggested that the information currently provided is sufficient to authorise donation and that this consent, however provided, was sufficient to proceed with pre-mortem interventions. Respect for autonomy underpinned this ‘all or nothing’ approach. Although the legal requirements for donation authorisation and the protection of patients without capacity are clear, practice and policy regarding consent in donation after circulatory death may be based on donation following brainstem death where the patient is already dead when the family is approached. Custom and practice in donation after circulatory death may need to be revised to protect the interests of the dying potential donor. (shrink)

This paper examines the problematisation of sex-selective abortion (SSA) in UK parliamentary debates on Fiona Bruce's Abortion (Sex-Selection) Bill 2014–15 and on the subsequent proposed amendment to the Serious Crime Bill 2014–15. On the basis of close textual analysis, we argue that a discursive framing of SSA as a form of cultural oppression of minority women in need of protection underpinned Bruce's Bill; in contrast, by highlighting issues more commonly articulated in defence of women's reproductive rights, the second set of (...) debates displaced this framing in favour of a broader understanding, drawing on postcolonial feminist critiques, of how socio-economic factors constrain all women in this regard. We argue that the problematisation of SSA explains the original cross-party support for, and subsequent defeat of, the policies proposed to restrict SSA. Our analysis also highlights the central role of ideology in the policy process, thus making politics visible in policymaking. (shrink)

In recent years, political philosophers have debated whether human rights are a special class of moral rights we all possess simply by virtue of our common humanity and which are universal in time and space, or whether they are essentially modern political constructs defined by the role they play in an international legal-political practice that regulates the relationship between the governments of sovereign states and their citizens. This edited volume sets out to further this debate and move it ahead by (...) rethinking some of its fundamental premises and by applying it to new and challenging domains, such as socio-economic rights, indigenous rights, the rights of immigrants and the human rights responsibilities of corporations. Beyond the philosophy of human rights, the book has a broader relevance by contributing to key themes in the methodology of political philosophy and by addressing urgent issues in contemporary global policy making. (shrink)

An introduction to the political philosophy of Kant, exploring how he developed his views in a context shaped by controversies following the French revolution. It provides new information on his followers and critics as they engaged in high stakes political debates on freedom's relation to the state at this key turning point in history.

Despite the vast scholarship on Ibn Khaldun, little attention has been devoted to his views on war - views of considerable contemporary significance because he remains one of the few authoritative figures across a broad swath of the Islamic political spectrum. The first part of this article identifies jihad as a crucial element of a broader imperative for Ibn Khaldun: establishing empires of sufficient size, diversity and cosmopolitanism to sustain the kind of civilization he views as necessary for human excellence. (...) The second part of the article demonstrates that for Ibn Khaldun the good military commander, like the good religious guide, is a model for the good or artful statesman in general. In the process, Ibn Khaldun's study of war and empire emerges as one of the most innovative articulations of Realpolitik in Islamic political thought. (shrink)

The relationship between Islam with a democratic political systemhas been questionable at best and incompatible at worst. While countlessresearch has been done on this issue for decades especially with the rise ofIslamist apologists in the years following the invasion of Iraq in 2003, thispaper proposes that it is time we understand the role of Islam through the lensesof democrat Muslims. Democrat Muslims are those who seek to preserve andpromote the five major qualities in human life with values that surpass simplyprotecting (...) the people’s political, social and economic life. By comparingRashid al-Ghannouchi and Anwar Ibrahim, this paper traces their evolution tocome to a similar conclusion that is applicable to most Muslim societies. Usingthe dissonant politics theory, this paper suggests that local developments weretaken into high consideration when these two figures decided to conceptualizewhat is known today as Democrat Muslims. (shrink)

_Misapprehensions of culture and religion are used for the early marriages of women in Pakistan, which generates few significant challenges for women to pursue their higher education. The present study identifies such challenges for married women in higher education. These challenges are relevant to women’s post-marriage lifespan in rural Pakistan. Building upon Fredrickson’s (2001) and Hobfoll’s (2001) theories focused on post marriages issues, the study has developed open-ended questions for collecting in-depth information. Therefore, 43 in-depth interviews with married women were (...) conducted and through qualitative data analysis using NVIVO software, the study has highlighted that early marriages of girls have become a cultural norm, and education priorities of the girls are insignificant for parents to decide the marriage date. Married women pursuing education at marriage do not get any support from husbands and in-laws as the patriarchal norms prohibit women from stepping out from home. In these circumstances, women may get subject to the victim of many unlawful practices, including intimate partner violence (IPV). Thus, the present study findings imply that married women's participation in higher education is negligible due to weak legislation on women’s rights and strong illegitimate tribal practices._. (shrink)

The article deals with the breakdown of the co called „grand narratives“ and with processes that preceded it. The author focuses on the degradation of the traditional meaningful forms, such as myth and grand narrative, and their becoming a „story“. He offers a detailed examination of the essential characteristics of a story. He sees the particular forms of the codification of the world as related to following developments: the rise of grand narratives as related to the transition to linear alphabetical (...) codes, while their transformation into a story as connected with the rise of technological images. He sees this transition as a negative phenomenon, since this shift of the focus of human activities on images resulted in a significant reduction of our freedom. (shrink)

Although the Mukhtasar Siyasat al-Hurub has attained iconic status in the Islamic military canon, it has never received a full-length analysis. Almost all extant references, moreover, focus on its technical aspects rather than its political subtext. That subtext has a twofold purpose. First, to valorize reason by emphasizing the centrality of deliberation in jihad. Second, to ensure that such valorization nevertheless does not lose sight of (a) the uncertainties of war, which militate against replacing faith in supernatural forces with an (...) equally unwarranted faith in science; or (b) the existence of evil in the world, which precludes any hope of perpetual peace. As such, the Mukhtasar articulates a distinctive Islamic approach that diverges both from a more optimistic Western tradition extending from early Christianity to the Enlightenment, and from an alternative-- but currently resurgent-- Islamic outlook on the proper scope and conduct of jihad. (shrink)

For much of the past half century, politicians and scientists have largely spoken with a single voice on the issue of race. The experience of Nazism and the Holocaust made racial science politically unacceptable. It also shaped the scientific consensus that race was a social myth, not a biological reality. Today, however, that scientific consensus is beginning to crack.

When Kant in 1793 rejected a right of revolution, he was immediately criticized by a group of radical followers who argued that he had betrayed his own principles of justice. Jakob, Erhard, Fichte, Bergk and Schlegel proceeded to defend a right of resistance and revolution based on what they took to be his true principles. I argue that we must understand Kant's Metaphysics of Morals, which came in 1797, partly as a response to these radical democratic writings. Exploring this forgotten (...) controversy reveals that Kant did not betray his own principles when he denied a right of revolution, because he did not mean that persons have an unconditional duty to obey. This becomes clear when we read the final developments of Kant's thinking on individual liberty and republican government in light of the radical critique. (shrink)

In this work, Kenan Malik explores the history of moral thought as it has developed over three millennia, from Homer's Greece to Mao's China, from ancient India to modern America. It tells the stories of the great philosophers, and breathes life into their ideas, while also challenging many of our most cherished moral beliefs.

With a wealth of detail, this book traces the acceptance and rejection of Soren Kierkegaard's thought in the late nineteenth and early twentieth centuries. Engaging the reader with biographical sketches of Kierkegaard and his contemporaries, Habib Malik presents a fascinating historical narrative of the early reception of Kierkegaard's thought. At the center of this story is an exploration of how Kierkegaard's ideas moved from the relative obscurity of Copenhagen at the time of his death in 1855 to the center (...) of European intellectual culture in the mid-1920s. Receiving Soren Kierkegaard is the first serious attempt to chronicle the early "lost years" of Kierkegaard's intellectual legacy. It analyzes Kierkegaard's profound impact on the lives and thought of such figures as Orsted, Ibsen, Jacobsen, Brandes, Nietzsche, Dilthey, Unamuno, Joyce, Rilke, Kafka, Lukacs, and Kassner. (shrink)