Population-level biomedical research offers new opportunities to improve population health, but also raises new challenges to traditional systems of research governance and ethical oversight. Partly in response to these challenges, various models of public involvement in research are being introduced. Yet, the ways in which public involvement should meet governance challenges are not well understood. We conducted a qualitative study with 36 experts and stakeholders using the World Café method to identify key governance challenges and explore how public involvement can (...) meet these challenges. This brief report discusses four cross-cutting themes from the study: the need to move beyond individual consent; issues in benefit and data sharing; the challenge of delineating and understanding publics; and the goal of clarifying justifications for public involvement. The report aims to provide a starting point for making sense of the relationship between public involvement and the governance of population-level biomedical research, showing connections, potential solutions and issues arising at their intersection. We suggest that, in population-level biomedical research, there is a pressing need for a shift away from conventional governance frameworks focused on the individual and towards a focus on collectives, as well as to foreground ethical issues around social justice and develop ways to address cultural diversity, value pluralism and competing stakeholder interests. There are many unresolved questions around how this shift could be realised, but these unresolved questions should form the basis for developing justificatory accounts and frameworks for suitable collective models of public involvement in population-level biomedical research governance. (shrink)

People with disabilities (PWD) comprise a significant part of the population yet experience some of the most profound health disparities. Among the greatest barriers to quality care are inadequate health professions education related to caring for PWD. Drawing upon the expertise of health professions educators in medicine, public health, nursing, social work, and physician assistant programs, this forum showcases innovative methods for teaching core disability skills and concepts grounded in disability studies and the health humanities. Each of the essays offers (...) practical guidance for developing curricular interventions appropriate for students at various levels of training and familiarity with disability to be implemented in classroom discussions, case-based learning, lectures, panels, and clinical simulations across the full spectrum of pre-health and health professions education. (shrink)

Extensively employed in reproductive science, the term fetal–maternal interface describes how maternal and fetal tissues interact in the womb to produce the transient placenta, purporting a theory of pregnancy where ‘mother’, ‘fetus’, and ‘placenta’ are already-separate entities. However, considerable scientific evidence supports a different theory, which is also elaborated in feminist and new materialist literatures. Informed by interviews with placenta scientists as well as secondary sources on placental immunology and the developmental origins of health and disease, I explore evidence not (...) of interfacing during pregnancy, but of intra-action, or the mutual emergence of entities in simultaneous practices of differentiation and connection. I argue that attending to evidence that can be figured as intra-action enables us to recognize, account for, and attend to diffuse responsibilities for fetal–maternal outcomes that extend beyond mothers to the biosocial milieus of pregnancy. In reimaging the intra-action of placentas, a new understanding of what constitutes a ‘healthy pregnancy’ becomes possible. (shrink)

In this paper I argue that bioethics is in crisis and that it will not have a future unless it begins to embrace a more Socratic approach to its leading assumptions. The absence of a critical and sceptical spirit has resulted in little more than a dominant ideology. I focus on three key issues. First, that too often bioethics collapses into medical ethics. Second, that medical ethics itself is beset by a lack of self-reflection that I characterize here as a (...) commitment to three dogmas. Third, I offer a more positive perspective by suggesting how bioethics may benefit from looking towards public health ethics as a new source of inspiration and direction. (shrink)

Machine generated contents note: Preface; Introduction Angus Dawson; Part I. Concepts: 1. Resetting the parameters: public health as the foundation for public health ethics Angus Dawson; 2. Health, disease and the goal of public health Bengt Brülde; 3. Selective reproduction, eugenics and public health Stephen Wilkinson; 4. Risk and precaution Stephen John; Part II. Issues: 5. Smoking, health and ethics Richard Ashcroft; 6. Infectious disease control Marcel Verweij; 7. Population screening Ainsley Newson; 8. Vaccination ethics Angus Dawson; (...) 9. Environment, ethics and public health: the climate change dilemma Anthony Kessel and Carolyn Stephens; 10. Public health research ethics: is non-exploitation the new principle for population-based research ethics? John McMillan; 11. Equity and population health: toward a broader bioethics agenda Norman Daniels; 12. Health inequities James Wilson; Index. (shrink)

This research addresses the question of whether men and women in sales differ in their ethical attitudes and decision making. The study asked 209 subjects to respond to 20 ethical scenarios, half of which were "relational" and half "non-relational." The study concludes (1) that there are significant ethical differences between the sexes in situations that involve relational issues, but not in non-relational situations, and (2) that gender-based ethical differences change with age and years of experience. The implications of these finding (...) for sales organizations are discussed. (shrink)

Genomic research results and incidental findings with health implications for a research participant are of potential interest not only to the participant, but also to the participant's family. Yet investigators lack guidance on return of results to relatives, including after the participant's death. In this paper, a national working group offers consensus analysis and recommendations, including an ethical framework to guide investigators in managing this challenging issue, before and after the participant's death.

From ancient times to the present, the discovery and presentation of new proofs of previously established theorems has been a salient feature of mathematical practice. Why? What purposes are served by such endeavors? And how do mathematicians judge whether two proofs of the same theorem are essentially different? Consideration of such questions illuminates the roles that proofs play in the validation and communication of mathematical knowledge and raises issues that have yet to be resolved by mathematical logicians. The Appendix, in (...) which several proofs of the Fundamental Theorem of Arithmetic are compared, provides a miniature case study. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

In the early 1970s, a World Health Organization‐initiated and United States‐funded project released lab‐reared mosquitoes outside New Delhi in the first large‐scale field trials of the genetic control of mosquitoes. Despite partnering with the Indian Council of Medical Research and investing significantly in outreach to local communities at the release sites, the project was embroiled in controversy and became an object of vehement debate within the Indian parliament and diplomatic contretemps between the United States and India. This early episode of (...) genetic control research demonstrates how a scientific collaboration was entangled in geopolitics and shaped by the legacy of colonialism. This historical case study has implications for public deliberation in the present, pointing to the challenges of shared decision‐making in the context of structural inequality, the way that a backdrop of military interest in a technology can impede trust, and the long‐term consequences of projects that foster mistrust. (shrink)

According to several commentators, Kurt Godel's incompleteness discoveries were assimilated promptly and almost without objection by his contemporaries - - a circumstance remarkable enough to call for explanation. Careful examination reveals, however, that there were doubters and critics, as well as defenders and rival claimants to priority. In particular, the reactions of Carnap, Bernays, Zermelo, Post, Finsler, and Russell, among others, are considered in detail. Documentary sources include unpublished correspondence from Godel's Nachlass.

Examination of the application of virtue ethics to business has only recently started to grapple with the measurement of virtue frameworks in a practical context. This paper furthers this agenda by measuring the impact of virtue at the level of the organisation and examining the extent to which organisational virtue impacts on moral attentiveness and the perceived role of ethics and social responsibility in creating organisational effectiveness. It is argued that people who operate in more virtuous organisational contexts will be (...) expected to be more attentive to ethical issues and in turn perceive a greater role for ethics and social responsibility in business. Analysis of results based on a sample of 137 HR professionals shows that where people report that their organisation provides meaningful work, they are more likely to display reflective MA and the belief that ethics and social responsibility are compatible with business objectives, suggesting that organisations who are interested in promoting an ethical culture should focus on their work structures and practices. More generally, OV is shown to have a more complex relationship with PRESOR than hypothesised pointing towards a more nuanced view of OV. The paper examines the implications of the results for organisations and research. (shrink)

ABSTRACTThere are many different ethical arguments that might be advanced for and against childhood vaccinations. In this paper I explore one particular argument that focuses on the idea that such vaccinations are justifiable because they are held to be in the best interests of a particular child. Two issues arise from this idea. The first issue is how best interests are to be determined in this case. The second issue is what follows from this to justify potential interventions within the (...) family in relation to such vaccinations. I argue that best interests must be characterised objectively in such situations and that this means that, in at least some cases, parental decision‐making about vaccinating their children may be overridden. (shrink)

This comprehensive analysis of the complex relationship of black political thought identifies which political ideologies are supported by blacks, then traces their historical roots and examines their effects on black public opinion.

If stem cell-based therapies are developed, we will likely confront a difficult problem of justice: for biological reasons alone, the new therapies might benefit only a limited range of patients. In fact, they might benefit primarily white Americans, thereby exacerbating long-standing differences in health and health care.

This second edition represents a wide-ranging critical introduction to the psychology of Carl Jung, one of the founders of psychoanalysis. Including two new essays and thorough revisions of most of the original chapters, it constitutes a radical assessment of his legacy. Andrew Samuels' introduction succinctly articulates the challenges facing the Jungian community. The fifteen essays set Jung in the context of his own time, outline the current practice and theory of Jungian psychology and show how Jungians continue to question and (...) evolve his thinking and apply it to aspects of modern culture and psychoanalysis. The volume includes a full chronology of Jung's life and work, extensively revised and up to date bibliographies, a case study and a glossary. It is an indispensable reference tool for both students and specialists, written by an international team of Jungian analysts and scholars from various disciplines. (shrink)

ABSTRACT This paper seeks to critically review a traditional objection to preventive medicine (which I call here the ‘prevention problem’). The prevention problem is a concern about the supposedly inequitable distribution of benefits and risks of harm resulting from preventive medicine's focus on population‐based interventions. This objection is potentially applicable to preventive vaccination programmes and could be used to argue that such programmes are unethical. I explore the structure of the prevention problem by focusing upon two different types of vaccination (...) (therapeutic vaccination and preventive vaccination). I argue that the ‘prevention problem’ cannot be fairly applied to the case of preventive vaccination because such programmes do not just focus upon benefits at the level of populations (as is claimed by the prevention problem). Most such preventive vaccination programmes explicitly seek to create and maintain herd protection. I argue that herd protection is an important public good which is a benefit shared by all individuals in the relevant population. This fact can then be used to block the ‘prevention problem’ argument in relation to preventive vaccination programmes. I conclude by suggesting that whilst the future development and use of therapeutic vaccines does raise some interesting ethical issues, any ethical objections to prophylactic vaccination on the basis of the ‘prevention problem’ will not be overcome through the substitution of therapeutic vaccines for preventive vaccines; indeed, the ‘prevention problem’ fails on its own terms in relation to preventive vaccination programmes. (shrink)

ERRATUMWe regret that, due to a technical error, the uncorrected version of Angus Dawson's article was printed in 19:1. We apologise to the author and reprint in full the corrected version of the paper on the following pages. A. Dawson et al.. Bioethics 2005; 19: 72–89. ABSTRACTThere are many different ethical arguments that might be advanced for and against childhood vaccinations. In this paper I will explore one particular argument that focuses on the idea that childhood vaccinations are (...) justifiable because they are held to be in the best interests of a particular child. Two issues arise from this idea. The first issue is how best interests are to be determined in the case of childhood vaccinations. The second issue is what follows from this to justify potential interventions within the family in relation to such vaccinations. I argue that best interests must be characterised objectively in such situations and that this means that, in at least some cases, parental decision‐making about vaccinating their children may be overridden. (shrink)

It has been acknowledged on numerous occasions that personal religiousness is a potential source of ethical norms, and consequently, an influence in ethical evaluations. An extensive literature review provides little in the way of empirical investigation of this recognized affect. This investigation conceptualizes religiousness as a motivation for ethical action, and discovers significant differences in ethical judgements among respondents categorized by personal religious motivation. Suggestions as to the source of these differences, and the implications which they offer to managers are (...) discussed and supported from the literature. (shrink)

~Et h i c a l sensitivity is investigated in an illustrative analysis of two female television nezos viewers. Transcripts of structured, in-depth interviews were analyzed according to four critical content dimensions of ethical sensitivity reflecting interviewees' mentions of story characteristics, ethical issues, consequences, and stakeholders. Cognitive maps illustrate the reasoning processes ofthe two viewers, one with relatively high and the other with relatively low ethical sensitivity. This study provides a detailed description of a new application of a research procedure, (...) and gives detailed examples of how subdimensions of ethical sensitivity interact and relate to a person's reasoning processes. The study is a pilot demonstration of a promising methodology and a precursor to more investigations on more viewers, more types of content, and more media. (shrink)

NThere are many problems with Levi and Green’s (2010) suggestion that a computer-based decision aid will overcome the major objections to advance directives (ADs). We focus on just two here. First, we argue that the key assumption underlying Levi and Green’s paper, that autonomy always ought to take priority over other values, is false. Second, we argue that the paper misses the point of the most telling objections to the use of ADs: they lack the relevant moral authority to determine (...) treatments. It is not that they are merely subject to a set of contingent problems related to capturing the wishes of individuals or being open to misinterpretation by others.We conclude that the plug should be pulled on Levi and Green’s computer-based proposal. (shrink)

The terrorist attacks of September 11, 2001 reopened what many Americans had assumed was a settled ethical question: Is torture ever morally permissible? Rebecca Gordon argues that institutionalized state torture remains as wrong today as it was before those terrible attacks, and shows how U.S. practices during the ''war on terror'' are rooted in a history that includes support for torture regimes abroad and for the use of torture in the jails and prisons of this country.

I argue that moral intuitions about Nietzsche as an exemplar of practical cruelty can be overturned. My argument is based upon the possibility of abandoning the notion of pure and unmediated passivity as intrinsic to the phenomena of human suffering and of Mitleid, as identified by Nietzsche. I claim that wrongly identifying intrinsic passivity in the phenomenology of Mitleid and of suffering generates the moral sceptical intuition. Once this case of mistaken identity is uncovered, 1 suggest, there is no reason (...) to remain subject to the force of the intuition. I support my account with a fresh reading of 'The Ugliest Man', from Book IV of Nietzsche's Thus Spoke Zarathustra. (shrink)

A colleague’s personal recollections of Jean van Heijenoort’s contributions to the editing of volumes I–III of Gödel’s Collected Works and of his interactions with the other editors.

One new tradition that has emerged from early research on autonomous robots is embodied cognitive science. This paper describes the relationship between embodied cognitive science and a related tradition, synthetic psychology. It is argued that while both are synthetic, embodied cognitive science is antirepresentational while synthetic psychology still appeals to representations. It is further argued that modern connectionism offers a medium for conducting synthetic psychology, provided that researchers analyze the internal representations that their networks develop. The paper then provides a (...) detailed example of the synthetic approach by showing how the construction of a connectionist network can be used to contribute to a theory of how humans solve Piaget's classic balance scale task. (shrink)

It gives me great pleasure to introduce the December 2013 issue of the Kennedy Institute of Ethics Journal—our ninety-second!—and to introduce myself as the new Editor-in-Chief of the journal. For almost a quarter of a century, from its special vantage point in Washington, D.C., and at Georgetown University’s Joseph and Rose Kennedy Institute of Ethics, the KIEJ has served as a leading source for practically engaged, policy-relevant philosophical work in bioethics, broadly construed. Under the expert stewardship of Robert Veatch and (...) Carol Spicer, the journal built a top-quality research legacy. It is with pride and anticipation that I take the helm.While I am committed to honoring and building on our past, I am .. (shrink)

Leibniz's widely influential account of time provides a significant puzzle for those seeking to locate this account within his hierarchical ontology. Leibniz follows his scholastic predecessors in supposing that there are different grades of being, with substances being the most real and all other things possessing their reality via their relationships to substance. Following this picture, Leibniz suggests that phenomenal bodies only possess the being that they derive from the substances (i.e., monads) that ground them. Some would argue that time (...) likewise only possesses its being based on the bodies that it relates. Contrary to this suggestion (i.e., that time is twice removed from substances), I will argue that time is derived directly from rational souls. Thus, I will argue that time is on an ontological par with the phenomenal world of bodies. (shrink)

Salsa dancing, a partnered dance premised on the felt sense of connection, is well suited to an exploration of Henry’s radical phenomenology of immanence and Heidegger’s facticity of life. Birthed in social celebratory contexts, salsa carries a particular motile freedom. What matters most is not how the dance movements are created from an outer frame of reference, but the experience of interactive responsiveness that emerges from unanticipated acts of giving life to another. Connecting to one’s partner and exuding a presence (...) filled with life is revealed in an indepth interview with two-time world champion salsa dancer, judge, choreographer and coach, Anya Katsevman. This interview attempts to invoke the kinetic, kinesthetic and affective registers of the lividness and livingness of salsa dancing. As a phenomenological inquiry into factical life, the inter-view is presented not so much as a matter of shared perspectives or viewpoints, but more in the way of an inter-feeling, a practice of life engagement. This affectively-oriented approach provides both promise and challenge to the field of phenomenology. It invites us to delve more deeply into feeling acts of seeing. It also helps us understand how, through attending more fully to acts of seeing, we can increase the intensity with which we feel the upsurge of life. (shrink)

The Commission for Religious Relations with the Jews produced The Gifts and Calling of God Are Irrevocable, in which supersessionism is firmly rejected. In this document, the term fulfillment occurs frequently to describe the relationship between the Old and New Covenant. It implies an evolutionary development from old to new, or from promise to fulfillment. Therefore, the use of this term may lead one to suspect that it is merely a synonym for supersession or a progression from good to better. (...) To avoid this connotation, I redefine this term by locating it within the Israelite cult. Through a study of Aaron’s ordination to the high priesthood in Leviticus and the claims for Jesus’s high priesthood in the Epistle to the Hebrews, I show that fulfillment already occurs in the Old Covenant by relating the historical, earthly cult to the eternal, heavenly cult. (shrink)

The Report of the Ad Hoc Adivisory Group on the Operation of NHS Research Ethics Committees has resulted in a strange mixture of the timid, the revolutionary, and the bizarre.The Report of the Ad Hoc Advisory Group on the Operation of NHS Research Ethics Committees is a curious document.1 The remit of the review was focused on the workings and effectiveness of NHS research ethics committees and the multicentre committees ). The Group was primarily set up in response to a (...) series of complaints from medical researchers about the new research governance regime in the UK as a result of the Clinical Trials Directive2 and the Governance Arrangements for NHS Research Ethics Committees.3 The opportunity was also taken to consider the role of research ethics committees in a wider context, and take account of recent developments in relation to the ethics review of social care research,4 student projects,5 as well as recent legislation such as the Human Tissue Act,6 and the Mental Capacity Act.7 However, the resulting report is a strange mixture of the timid, the revolutionary, and the bizarre.A good example of the report’s timidity is its reluctance to propose fundamental change to the process of review or seriously limit the type of research that requires REC review. To its credit AHAG does suggest that some research ‘especially surveys and many studies on NHS staff, could normally be conducted safely without a requirement for REC review’ .1 This is, of course, to be welcomed. However, the report ultimately seems dismissive of the general complaint from researchers that the current process is inappropriately uniform. For example, in section 3.2, it is argued that the ‘common perception that the NHS REC system is dominated …. (shrink)