Background Inadequate knowledge among health care providers (HCPs) and parents of affected children limits the understanding and utility of secondary genetic findings (SFs) in under-represented populations in genomics research. SFs arise from deep DNA sequencing done for research or diagnostic purposes and may burden patients and their families despite their potential health importance. This study aims to evaluate the perspective of both groups regarding SFs and their choices in the return of results from genetic testing in the context of orofacial (...) clefts.Methods Using an online survey, we evaluated the experiences of 252 HCPs and 197 parents across participating cleft clinics in Ghana and Nigeria toward the return of SFs across several domains.Results Only 1.6% of the HCPs felt they had an expert understanding of when and how to incorporate genomic medicine into practice, while 50.0% agreed that all SFs should be returned to patients. About 95.4% of parents were willing to receive all the information from genetic testing (including SFs), while the majority cited physicians as their primary information source (64%).Conclusions Overall, parents and providers were aware that genetic testing could help in the clinical management of diseases. However, they cited a lack of knowledge about genomic medicine, uncertain clinical utility, and lack of available learning resources as barriers. The knowledge gained from this study will assist with developing guidelines and policies to guide providers on the return of SFs in sub-Saharan Africa and across the continent. (shrink)

The need for greater privacy protections in the United States has never been greater. In their work, “Ethical Responsibilities for Companies That Process Personal Data”, McCoy et al. (2023) correct...

Ethical debates around genetic enhancement tend to include an argument that the technology will eventually be fairly accessible once available. That we can fairly distribute genetic enhancement has become a moral defence of genetic enhancement. Two distribution solutions are argued for, the first being equal distribution. Equality of access is generally believed to be the fairest and most just method of distribution. Second, equitable distribution: providing genetic enhancements to reduce social inequalities. In this paper, I make two claims. I first (...) argue that the very assumption that genetic enhancements can be distributed fairly is problematic when considering our understanding of gene–environment interactions, for example, epigenetics. I then argue that arguments that genetic enhancements are permissible because the intended benefits can be distributed fairly as intended are misinformed. My first claim rests on the assertion that genetic enhancements do not enhance traits in a vacuum; genes are dependent on conducive environments for expression. If society cannot guarantee fair environments, then any benefit conferred from being genetically enhanced will be undermined. Thus, any argument that the distribution of genetic enhancements will be fair and that the technology is therefore morally permissible, is mistaken. (shrink)

The concept of a communal type of privacy shared by interconnected social groups has wide applications in the healthcare field, specifically in genetic testing and genetic data privacy (Pyrrho, Cam...

Owners of businesses represent an interesting case in the study of the intersection of personal and corporate philanthropic values. Because individuals who own businesses have the means and the ability to act on philanthropic motivations through the medium of their businesses, it is interesting to explore the extent to which their corporate contributions to nonprofits are philanthropic in nature or instrumentally motivated, as in the instance of cause related marketing. The trade-offs between cause related marketing and corporate support of nonprofits (...) are complex. Although larger firms are increasing their investments in cause related marketing, the extent of and motivations for adoption of cause related marketing among privately held businesses is less well understood. This study of 478 businesses which are supporters of arts organizations shows that privately held businesses of medium size (300 to 500 employees) are participating in cause related marketing to a significant degree. The adoption rate of cause related marketing is about 40%, and the primary benefits sought are company image enhancement and product marketing support. Adoption of cause related marketing among privately held and smaller enterprises will grow as CEOs exhibit satisfaction with the results of their program, intend to engage in positive word of mouth about it, and plan to allocate more resources to it. (shrink)

The epidemic of COVID-19 appears to be reshaping the world, separating before and after, present and past. Its perceived novelty raises the question of what role the past might play in the present epidemic and in responses to it. Taking the view that the past has not passed, but is present in is material and immaterial remains, and continuously emerging from these, we argue that it should not be studied as closed narration but through the array of its traces, which (...) constitute the texture of the present. To that end, and building on long-term ethnographic research on past and present epidemics in western Kenya, we assemble here some preliminary observations on the first weeks of COVID-19 in Kenya. We explore how the acute epidemic crisis currently unfolding is intertwined with layered fragments of earlier epidemic events, attending to material infrastructures, institutional practices, and ritual responses, to the presence of virally loaded bodies, pharmaceuticals, and their residues, and to the resurgence of often painful memories and emotions. People in this region have experienced a long century of epidemics and anti-epidemic measures of varying duration and intensity, from colonial and postcolonial sleeping sickness and smallpox to HIV/AIDS and more recently cancer, alongside actual or anticipated outbreaks of cholera and Ebola. This local perception of one long epidemic qualifies the notion of a radical temporal break that the COVID-19 pandemic is often associated with in European conversations. (shrink)

BackgroundInternational guidelines on research have focused on protecting research participants. Ethical Research Committee (ERC) approval and informed consent are the cornerstones. Externally sponsored research requires approval through ethical review in both the host and the sponsoring country. This study aimed to determine to what extent ERC approval and informed consent procedures are documented in locally and internationally published human subject research carried out in Sri Lanka.MethodsWe obtained ERC approval in Sri Lanka and the United Kingdom. Theses from 1985 to 2005 (...) available at the Postgraduate Institute of Medicine (PGIM) library affiliated to the University of Colombo were scrutinised using checklists agreed in consultation with senior research collaborators. A Medline search was carried out with MeSH major and minor heading 'Sri Lanka' as the search term for international publications originating in Sri Lanka during 1999 to 2004. All research publications from CMJ during 1999 to 2005 were also scrutinized.ResultsOf 291 theses, 34% documented ERC approvals and 61% documented obtaining consent. From the international journal survey, 250 publications originated from Sri Lanka of which only 79 full text original research publications could be accessed electronically. Of these 38% documented ERC approval and 39% documented obtaining consent. In the Ceylon Medical Journal 36% documented ERC approval and 37% documented obtaining consent.ConclusionOnly one third of the publications scrutinized recorded ERC approval and procurement of informed consent. However, there is a positive trend in documenting these ethical requirements in local postgraduate research and in the local medical journal. (shrink)

BackgroundApproval of the research proposal by an ethical review committee from both sponsoring and host countries is a generally agreed requirement in externally sponsored research.However, capacity for ethics review is not universal. Aim of this study was to identify opinions and views of the members serving in ethical review and ethics committees in Sri Lanka on informed consent, essential components in the information leaflet and the consent form.MethodsWe obtained ethical approval from UK and Sri Lanka. A series of consensus generation (...) meetings on the protocol were conducted. A task oriented interview guide was developed. The interview was based on open-ended questionnaire. Then the participants were given a WHO checklist on informed consent and requested to rate the items on a three point scale ranging from extremely important to not important.ResultsTwenty-nine members from ethics committees participated. Majority of participants (23), believed a copy of the information leaflet and consent form, should accompany research proposal. Opinions about the items that should be included in the information leaflets varied. Participants identified 18 criteria as requirements in the information leaflet and 19 for the consent form.The majority, 20 (69%), believed that all research need ethical approval but identified limited human resource, time and inadequate capacity as constraints. Fifteen (52%) believed that written consent is not required for all research. Verbal consent emerged as an alternative to written consent. The majority of participants rated all components of the WHO checklist as important.ConclusionThe number of themes generated for the consent form (N = 18) is as many as for the information leaflet (N = 19) and had several overlaps. This suggests that the consent form should be itemized to reflect the contents covered in the information leaflet. The participants' opinion on components of the information leaflets and consent forms proved to be similar with WHO checklist on informed consent. (shrink)

Anti-selection occurs when information asymmetry exists between insurers and applicants. When an applicant knows they are at high risk of loss, but the insurer does not, the applicant may try to use this knowledge differential to secure insurance at a lower premium that does not match risk.

Antisthenes was famous in antiquity for his studies of Homer's poems, his affiliation with Gorgias and the sophistic movement, his pure Attic writing style, and his inspiration of Diogenes of Sinope, who founded the Cynic philosophical movement. Antisthenes stands at two of the greatest turning points in ancient intellectual history: from pre-Socraticism to Socraticism, and from classical Athens to the Hellenistic period. Antisthenes' works form the path to a better understanding of the intellectual culture of Athens that shaped Plato and (...) laid the foundations for Hellenistic philosophy and literature. Antisthenes of Athens keeps in mind the goals and polemics framing each philosophical and textual discussion. The volume considers the ancient traditions about Antisthenes' rejection of Plato's “Theory of Forms,” his assertion of the paradox, “It is impossible to gainsay,” and his denial that definition of essence is possible, as well as the plausible intentions of Antisthenes. In cases where these questions are not easily settled, and where modern interpretation has varied, Susan H. Prince identifies the roots of the disagreements. The goal and meaning of Antisthenes' other famous ancient paradox, “I would rather go mad than have pleasure,” is illuminated by comparison with other evidence showing that pleasure does have a place in his ideology. Evidence for his relationship to Diogenes of Sinope, and for his receptions by the Cynics, Stoics, Skeptics, Christians, and Neo-Pagans is examined for both its historical value and its distorting tendencies. (shrink)

Human adaptive behavior in sensorimotor control is aimed to increase the confidence in feedforward mechanisms when sensory afferents are uncertain. It is thought that these feedforward mechanisms rely on predictions from internal models. We investigate whether the brain uses an internal model of physical laws to help estimate body equilibrium when tactile inputs from the foot sole are depressed by carrying extra weight. As direct experimental evidence for such a model is limited, we used Judoka athletes thought to have built (...) up internal models of external loads as compared with Non-Athlete participants and Dancers. Using electroencephalography, we first tested the hypothesis that the influence of tactile inputs was amplified by descending cortical efferent signals. We compared the amplitude of P1N1 somatosensory cortical potential evoked by electrical stimulation of the foot sole in participants standing still with their eyes closed. We showed smaller P1N1 amplitudes in the Load compared to No Load conditions in both Non-Athletes and Dancers. This decrease neural response to tactile stimulation was associated with greater postural oscillations. By contrast in the Judoka’s group, the neural early response to tactile stimulation was unregulated in the Load condition. This suggests that the brain can selectively increase the functional gain of sensory inputs, during challenging equilibrium tasks when tactile inputs were mechanically depressed by wearing a weighted vest. In Judokas, the activation of regions such as the right posterior inferior parietal cortex as early as the P1N1 is likely the source of the neural responses being maintained similar in both Load and No Load conditions. An overweight internal model stored in the right PPC known to be involved in maintaining a coherent representation of one’s body in space can optimize predictive mechanisms in situations with high balance constraints. This hypothesis has been confirmed by showing that postural reaction evoked by a translation of the support surface on which participants were standing wearing extra-weight was improved in Judokas. (shrink)

This book offers the first full-length study of philosophical dialogue during the English Enlightenment. It explains why important philosophers - Shaftesbury, Mandeville, Berkeley and Hume - and innumerable minor translators, imitators and critics wrote in and about dialogue during the eighteenth century; and why, after Hume, philosophical dialogue either falls out of use or undergoes radical transformation. Philosophical Dialogue in the British Enlightenment describes the extended, heavily coded, and often belligerent debate about the nature and proper management of dialogue; and (...) it shows how the writing of philosophical fictions relates to the rise of the novel and the emergence of philosophical aesthetics. Novelists such as Fielding, Sterne, Johnson and Austen are placed in a philosophical context, and philosophers of the empiricist tradition in the context of English literary history. (shrink)

Identities ascribed to research staff in face-to-face encounters with participants have been raised as key ethical challenge in transnational health research. ‘Misattributed’ identities that do not just deviate from researchers' self-image, but obscure unequivocal aspects of researcher identity – e.g. that they are researchers – are a case of such ethical problem. Yet, the reasonable expectation of unconcealed identity can conflict with another ethical premise: confidentiality; this poses challenges to staff visiting participants at home. We explore these around a case (...) study of ‘follow-up’ staff, observed during an ethnographic study of a Kenyan HIV ‘trial community’, which included participant observation, conversations, and interviews with staff (n = 79) and participants (n = 89). We found that because of the need to maintain confidentiality and because of some suspicions towards researchers, research staff drew upon alternative identities – presenting themselves to non-participants as relatives or friends, rather than as researchers. Several staff experienced this as necessary but uncomfortable. Simultaneously, staff and participants forged close relations in line with their fictional identities, which however also posed challenges because they entailed personal responsibilities that were difficult to live up to, due to limited resources, and the trial's limited duration. Similar challenges may arise in transnational HIV treatment programmes and should be explored further in that context. (shrink)

In this paper I ask how Timaeus explains change within the trianglebased part of his cosmos. Two common views are that change among physical items is somehow caused or enabled by either the forms or the demiurge. I argue for a competing view, on which the physical items are capable of bringing about change by themselves, prior to the intervention of the demiurge, and prior to their being turned into imitations of the forms. I outline three problems for the view (...) that physical things depend on the forms for their causal powers, and show how the view I propose solves each. I then add further arguments for my view, based on (a) statements by Timaeus that seem to favor my view directly, (b) implications of Timaeus’ positions that favor the view, and (c) Timaeus’ explanatory practice in the second half of his speech. (shrink)

Background: A growing literature has raised—skeptically—the question of whether cutting-edge scientific research can identify and address broader ethical and policy considerations in real time. In genomics, the question is: Can ELSI contribute to genomics in real time, or will it be relegated to its historical role of after-the-fact outsider critique? We address this question against the background of a genomic screening project where we participated as embedded, real-time ELSI researchers and observers, from its initial design through its conclusion.Methods: As part (...) of the ELSI study design, the project included an ongoing reflexive ethnography in which the authors studied the process of its design and implementation. The authors were true participant observers, serving as members of various task-oriented groups while recording meetings and other events for ongoing qualitative analysis. We also conducted and analyzed interviews of multiple participants at the conclusion of the project.Results: Our real-time ELSI initiative had a mixed record of successes and challenges. If we define success as ELSI researchers having had an opportunity to participate fully in the project and to make the ELSI perspective heard, then our assessment is largely positive. If, however, we define successes as instances where real-time ELSI contributions changed the direction of the genomic or public health aspects of the GeneScreen project or, after careful deliberation, confirmed the appropriateness of the status quo, then we can identify only a few examples. While we had a seat at the table, we were, for the most part, tolerated guests.Conclusions: We conclude that there are significant barriers to real-time ELSI influence. The difficulty does not reside in any intended exclusion of an ELSI perspective, but in factors endemic to genomic research, including knowledge disparities, epistemological biases, and the pressures of time and money. (shrink)

The use of role-playing (“active learning”) as a teaching tool has been reported in areas as diverse as social psychology, history and analytical chemistry. Its use as a tool in the teaching of engineering ethics and professionalism is also not new, but the approach develops new perspectives when used in a college class of exceptionally wide cultural diversity. York University is a large urban university (40,000 undergraduates) that draws its enrolment primarily from the Greater Toronto Area, arguably one of the (...) most culturally diverse cities in the world, embracing the largest percentage of Canada’s immigration. Among the area’s five million inhabitants, 50% identify themselves as a visible minority born outside Canada, while over 100 languages and dialects are spoken daily. Although students admitted from this international pool have usually been exposed to western attitudes during secondary education and are rapidly assimilated into Canadian culture, responses to specific ethical issues are strongly influenced by their prior culture. Two and three-part scripts for case studies based on NSF or original scenarios were written to illustrate issues such as gifts, attitudes towards women and ethnic minorities, conflict of interest, whistle-blowing, sexual harassment, individual rights, privacy, environment, intellectual property, and others. Following the presentation, the actors lead group discussion based on previously specified questions. Once the initial shyness and reluctance of some cultures has been overcome through the building of rapport, students have written original scripts based on hypothetical or prior personal situations. The method is now being adopted in a short course format to assist the professional integration of foreign trained engineers. (shrink)

Although the Phaedo never mentions a Form of Soul explicitly, the dialogue implies this Form’s existence. First, a number of passages in which Socrates describes his views about Forms imply that there are very many Forms; thus, Socrates’ general description of his theory gives no ground for denying that there is a Form of Soul. Second, the final argument for immortality positively requires a Form of Soul.

Many languages have past-and-counterfactuality markers such as English simple past. There have been various attempts to find a common definition for both uses, but I will argue in this paper that they all have problems with (a) ruling out unacceptable interpretations, or (b) accounting for the contrary-to-fact implicature of counterfactual conditionals, or (c) predicting the observed cross-linguistic variation, or a combination thereof. By combining insights from two basic lines of reasoning, I will propose a simple and transparent approach that solves (...) all the observed problems and offers a new understanding of the concept of counterfactuality. (shrink)

The Genetic Information Nondiscrimination Act of 2008 was passed to encourage patients to seek genetic testing that could improve health outcomes and provide opportunities for preventive measures. GINA protects individuals from discrimination based upon genetic information, but not upon manifested diseases and conditions. Because the manifestation of a disease establishes a threshold of protection for individuals under GINA, the definition of manifestation is crucial to understanding the scope of the bill. This paper examines the range of possible legal definitions of (...) disease manifestation and explores the historical struggle that courts have faced when trying to apply these different definitions. Specifically, the paper examines three frameworks that courts have used in the past to interpret the manifestation of a disease; “manifestation as apparent symptoms,”“manifestation as patient action,” and “manifestation as physician action.” We argue that the “manifestation as physician action” is the best framework to utilize in this law generally, but that the definition of manifestation should be read in the light most favorable to a plaintiff in order to achieve the underlying goals of GINA. (shrink)

Congress passed the Genetic Information Nondiscrimination Act of 2008 in order to remove a perceived barrier to clinical genetic testing. By banning health insurance companies and employers from discriminating against an individual based on his or her genetic information, legislators hoped that patients would be encouraged to seek genetic testing that could improve health outcomes and provide opportunities for preventive measures. Their explicit legislative goal was to fully protect the public from discrimination and allay their concerns about the potential for (...) discrimination, thereby allowing individuals to take advantage of genetic testing, technologies, research, and new therapies.However, GINA left a number of issues unresolved, most notably failing to define the concept of disease manifestation. GINA was structured such that it only provides protection against misuse of genetic information up until the point when an individual's disease has manifested. It protects an individual with a genetic predisposition for a disease, but not an individual actively suffering from that disease. (shrink)

BackgroundLack of proper understanding on the part of researchers about public understanding of research and informed consent will increase the potential for malpractice. As a part of a larger study on ethics and informed consent in Sri Lanka, this study aimed to ascertain the level of understanding of 'research' by exploring the views of the public and professionals.MethodsConvenience sampling and snow ball technique were used for recruitment with an emphasis on balanced age and gender representation, diverse educational, socio-cultural and professional (...) backgrounds, and previous research experience, either as researchers or participants. Content analysis of the data was carried out.Results66 persons (37 males, 29 females) participated. Although fundamentally a qualitative study, themes were also quantitatively analysed for informative results. Most participants thought that the word 'research' meant searching, looking, inquiring while some others thought it meant gathering information, gaining knowledge and learning.A third of participants did not offer an alternative word for research. Others suggested the words survey, exploration, search, experiment, discovery, invention and study as being synonymous. Doctors, health professionals, health institutions, scientists, professionals, businessmen, pharmaceutical companies, students, teachers were identified as people who conduct research.Participants indicated that crucial information on deciding to participate in research included objectives of the research, project importance and relevance, potential benefits to individuals and society, credibility & legitimacy of researchers, what is expected of participant, reason for selection, expected outcome, confidentiality and ability to withdraw at any time. A majority (89%) expressed their willingness to participate in future research.ConclusionsThe results show that with or without prior experience in research, participants in this study had a reasonable understanding of research. The findings show that a decision about taking part in research is dependent on knowledge, education and also on social networks.The results demonstrate that the majority were supportive of health research and believe that research is beneficial to the welfare of society. (shrink)

Between 1869 and 1879, the communal Christian group the Oneida Community undertook a pioneering eugenics experiment called “stirpiculture” in upstate New York. Stirpiculture resulted in the planned conception, birth, and communal rearing of fifty-eight children, bred from selected members of the Oneida Community. This article concerns how the Oneida Community's unique approach to religion and science provided the framework for the creation, process, and eventual dissolution of the stirpiculture experiment. The work seeks to expand current understanding of the early history (...) of eugenics in the United States by placing its practice more than two decades earlier than is generally considered. Additionally, this article situates the Community's leader John Humphrey Noyes as an early eugenics and social scientific thinker. Finally, the treatment provides a case study for the transitional period in mid to late nineteenth century America whereby scientific modes of epistemology were accommodated within or supplanted by theological worldviews. (shrink)

At On Generation and Corruption I.7.323b1–324a5, Aristotle claims that his new method of analysis for fundamental bodies and properties resolves a traditional apparent incompatibility between opposed principles applied by different philosophical authorities to the problem of affecting and being affected (poiein and paschein): that the like interacts with the unlike, and that the like interacts with the like. Twice in this passage, Aristotle uses a form of the term hupenantion (etymologically, ‘sub-oppositional’) in an extended discussion that includes his declaration of (...) the critical insight for solving the problem and illuminates the partial truth of each of the apparently antithetical universal principles. Because Aristotle uses the uncommon term twice in close context, and because he also explains in the context how he understands the apparent incompatibility—characterized both as a verbal opposition or enantiologia and also as a partial articulation of what should be theorized as a whole—it seems (and has seemed) plausible that this augmented form of the frequently used term enantion (‘opposite’ or ‘contrary’) carries methodological weight for indicating a kind of apparent incompatibility that can be resolved through supplementation to both of the opposed statements rather than elimination of or even favor for one or the other. Although the sense of hupenantion in On Generation and Corruption 1.7 is not continuous with the concept of the ‘subcontrary’ developed by ancient commentators on Aristotle’s Interpretations and early modern logicians, a full survey of the use of this term in Aristotle’s writings shows that Aristotle did recognize and lexically mark a special kind of opposition, one productive of intellectual progress rather than indicative of total error on one side of the debate. (shrink)

The use of role-playing (“active learning”) as a teaching tool has been reported in areas as diverse as social psychology, history and analytical chemistry. Its use as a tool in the teaching of engineering ethics and professionalism is also not new, but the approach develops new perspectives when used in a college class of exceptionally wide cultural diversity. York University is a large urban university (40,000 undergraduates) that draws its enrolment primarily from the Greater Toronto Area, arguably one of the (...) most culturally diverse cities in the world, embracing the largest percentage of Canada’s immigration. Among the area’s five million inhabitants, 50% identify themselves as a visible minority born outside Canada, while over 100 languages and dialects are spoken daily. Although students admitted from this international pool have usually been exposed to western attitudes during secondary education and are rapidly assimilated into Canadian culture, responses to specific ethical issues are strongly influenced by their prior culture. Two and three-part scripts for case studies based on NSF or original scenarios were written to illustrate issues such as gifts, attitudes towards women and ethnic minorities, conflict of interest, whistle-blowing, sexual harassment, individual rights, privacy, environment, intellectual property, and others. Following the presentation, the actors lead group discussion based on previously specified questions. Once the initial shyness and reluctance of some cultures has been overcome through the building of rapport, students have written original scripts based on hypothetical or prior personal situations. The method is now being adopted in a short course format to assist the professional integration of foreign trained engineers. (shrink)

At the turn of the 1980s, Félix Guattari became interested in the Free Radio movement . He then became directly associated between 1986 and 1991 with the Minitel service entitled “3615 ALTER”, initiated by the a collective including C31, an association of critical IT specialists currently editing the journal Terminal. Contrary to the traditional Left, Félix Guattari was less interested in a critique of the content of the media and of their political instrumentalization than in their form and mode of (...) social organization. The proliferation of machine-arrangements was expected to make possible new technological articulations likely to generate innovative assemblings. (shrink)

Bowman-Smart et al. (2023) argue for a framework to examine the ethical issues associated with genetic screening for non-medical traits in the context of noninvasive prenatal testing (NIPT). Such s...

It can be assumed that value judgements, which are needed to judge what is ‘good’ or ‘better’ and what is ‘bad’ or ‘worse’, are involved in every decision-making process. The theoretical understanding and analysis of value judgements is, therefore, important in the context of bioethics, for example, to be able to ethically assess real decision-making processes in biomedical practice and make recommendations for improvements. However, real decision-making processes and the value judgements inherent in them must first be investigated empirically (‘empirical (...) bioethics’). For this to succeed, what exactly a ‘value judgement’ is and of what components it might consist must initially be theoretically clarified. A corresponding conceptual model can then support or even enable empirical data collection and analysis and, above all, subsequent ethical analysis and evaluation. This paper, therefore, presents a value judgement model with its theoretical derivation. It also illustrates its application in an interview study of decision-making between animal experimentation and alternative methods in the context of biomedical research. Though the model itself can be theoretically deepened and extended, the application of the model works in general and helps to uncover what value judgements can enter into decision-making. However, the empirical methods, for example, qualitative interviews, can also be better oriented towards eliciting value judgements (as understood according to the model). Further applications of the model to other topics or by means of other empirical methods are conceivable. (shrink)

This chapter contains sections titled: From Antisthenes to the Cynics Antisthenes the Socratic Antisthenes on Language From Discourse to Ethics Becoming Wise Diogenes of Sinope, Defacer of the Currency.

Clinicians have an obligation to ensure that patients with adequate capacity can make autonomous decisions. Thus, patients who choose to forego treatment and leave hospitals “against medical advice” are typically allowed to do so. But what happens when they require clinicians’ assistance to physically leave? Is it incumbent upon clinicians to not only respect and fulfill patients’ requests with which they disagree, but to physically assist in their fulfillment? We attempt to develop an ethical framework wherein clinicians can honor patients’ (...) wishes without necessarily sacrificing their own moral position. (shrink)

The growing practice of returning individual results to research participants has revealed a variety of interpretations of the multiple and sometimes conflicting duties that researchers may owe to participants. One particularly difficult question is the nature and extent of a researcher’s duty to facilitate a participant’s follow-up clinical care by placing research results in the participant’s medical record. The question is especially difficult in the context of genomic research. Some recent genomic research studies — enrolling patients as participants — boldly (...) address the question with protocols dictating that researchers place research results directly into study participants’ existing medical records, without participant consent. Such privileging of researcher judgment over participant choice may be motivated by a desire to discharge a duty that researchers perceive themselves as owing to participants. However, the underlying ethical, professional, legal, and regulatory duties that would compel or justify this action have not been fully explored. (shrink)