Biotechnology and genomic innovation are seen as increasingly important for achieving public health goals in Africa. In particular, vaccines based on advances in genomic technology are deemed vital in the fight against HIV/aids. Public-Private Partnerships (PPPs) provide a collaborative mechanism to ensure these vaccines are developed when the private sector lacks incentives to develop these products. These partnerships provide new mechanisms for transferring the knowledge required to ensure vaccine development occurs as quickly and efficiently as possible. One such accine partnership (...) is the South African AIDS Vaccine Initiative (SAAVI). This has been successful in ensuring 'value added' (benefit gained by taking part) is created for those involved particularly in the area of intangible value added determinants of collaboration and knowledge capacity. This paper outlines the results of a case study of SAAVI and argues that it provides evidence of a need to strengthen our understanding of the linkage between wider conceptual 'systems' of innovation and health. In particular, it espouses the usefulness of 'Systems of Innovation' thinking as a means to ensure that more specific focus is placed on process outputs such as collaboration and knowledge capacity. This will ensure that necessary knowledge flow is transferred between those working in the vaccine project for more efficient and effective operations. The research also raises questions about the possibility of such case studies highlighting areas of attention that need addressing if greater linkage is to occur between innovation and health at a wider health research policy level. (shrink)

This investigation addresses the hypothesis that negative affect is associated with decreased ability to shift attention to a new focus. Thirty-nine participants completed a covert attentional orienting task and then viewed a distressing film clip. Mood was measured by self-report at the beginning and end of the session. Correlations between attentional orienting performance and self-reported mood indicated that participants with greater response time costs on invalidly cued trials reported more negative affect in response to the film. These results support the (...) hypothesis that negative affect is associated with a slowness to disengage attention. (shrink)

It is unclear whether someone’s responsibility for developing a disease or maintaining his or her health should affect what healthcare he or she receives. While this dispute continues, we suggest that, if responsibility is to play a role in healthcare, the concept must be rethought in order to reflect the sense in which many health-related behaviours occur repeatedly over time and are the product of more than one agent. Most philosophical accounts of responsibility are synchronic and individualistic; we indicate here (...) what paying more attention to the diachronic and dyadic aspects of responsibility might involve and what implications this could have for assessments of responsibility for health-related behaviour. (shrink)

Research using human embryonic stem cells raises an array of complex ethical issues, including, but by no means limited to, the moral status of developing human life. Unfortunately much of the public discussion fails to take into account this complexity. Advocacy for liberal and conservative positions on human embryonic stem cell research can be simplistic and misleading. Ethical concepts such as truth-telling, scientific integrity, and social justice should be part of the debate over federal support for human embryonic stem cell (...) research. Moreover, the debate should be conducted in accord with principles of deliberative democracy, including respect for people holding competing views. (shrink)

As knowledge increases about the human genome,prenatal genetic testing will become cheaper,safer and more comprehensive. It is likelythat there will be a great deal of support formaking prenatal testing for a wide range ofgenetic disorders a routine part of antenatalcare. Such routine testing is necessarilycoercive in nature and does not involve thesame standard of consent as is required inother health care settings. This paper askswhether this level of coercion is ethicallyjustifiable in this case, or whether pregnantwomen have a right to (...) remain in ignorance ofthe genetic make-up of the fetus they arecarrying. While information gained by genetictesting may be useful for pregnant women whenmaking decisions about their pregnancy, it doesnot prevent harm to future children. It isargued that as this kind of testing providesinformation in the interests of the pregnantwomen and not in the interests of any futurechild, the same standards of consent that arenormally required for genetic testing should berequired in this instance. (shrink)

This introduction provides an overview to a special issue on Critical Healing, which draws on queer theory, disability studies, postcolonial theory, and literary studies to theorize productive engagements between the clinical and cultural aspects of biomedical knowledge and practice. The essays in this issue historicize and theorize diagnosis, particularly diagnosis that impacts trans health and sexuality, homosexuality, and HIV/AIDS transmission. The essays also address racialization, disability, and colonialism through discussions of fiction, film, theoretical memoir, and comics, as well as biomedical (...) discourse and knowledge. (shrink)

By acquiring an understanding of the cultural meaning of deafness and acting as a bridge to resources and opportunities, clinicians.

Realist ideology critique (RIC) is a strand of political realism recently developed in response to concerns that realism is biased toward the status quo. RIC aims to debunk an individual's belief that a social institution is legitimate by revealing that the belief is caused by that very same institution. Despite its growing prominence, RIC has received little critical attention. In this article, I buck this trend. First, I improve on contemporary accounts of RIC by clarifying its status and the role (...) of motivated reasoning. Second, I show that realist ideology critics face a dilemma: either their account makes deeply implausible epistemological assumptions, or they temper its epistemology at the expense of rendering it toothless. I argue for each horn in turn before revealing the dilemma to be a false one by making a novel distinction between varying strengths of RIC based on their underlying epistemological assumptions. I propose Moder-ate RIC as a solution: upon discovering that one reason for your belief that a social institution is legitimate is likely malignantly epistemically circular, the belief should undergo further epistemic testing. I respond to three potential objections and suggest that Moderate RIC would make a fruitful addition to political theorists' methodological toolkit. (shrink)

An important branch of environmental theory frames the climate crisis as a moral problem in need of a moral solution: human hubris is responsible for environmental degradation and must be atoned for through humility. Politically indeterminate, however, such argumentation is vulnerable to de-politicizing and mal-politicizing capture. In an effort to fend off the threat of either, this paper turns to the history of political thought and Jean-Jacques Rousseau, who theorized the environment as both a moral and a political domain. I (...) examine how Rousseau understood the availability of republican self-rule to be contingent both on the natural environment and on the relationship we construct with it such that freedom, in his words, is not automatically ‘a fruit of every Clime.’ This is the case, he suggests, because of the environment’s intersection with political economy and political culture. At the same time, Rousseau contends, republican self-rule is also a moral practice; republican polities afford citizens a public means of achieving and exercising moral agency. Triangulating the relationship between polity, morality, and environment, Rousseau’s thought offers an integrative logic through which to imbue the environment with both moral and political salience, thereby circumventing the dangers of mere moralization alone. (shrink)

In this issue, Paul Menzel and M. Colette Chandler‐Cramer propose a novel advance directive. Besides giving competent people the opportunity to refuse future life‐prolonging medical interventions, they say, advance directives should give people the opportunity to refuse ordinary food and water if they later experience severe dementia.This proposal is both appealing and unsettling. It is appealing because it offers some relief to people seeking to avoid the prolonged decline and extreme incapacity they have witnessed in relatives and friends with advanced (...) dementia. But does it sufficiently protect patients? Menzel and Chandler‐Cramer want to empower competent persons to impose potential discomfort and distress on a later self who cannot understand the reasons for that choice. In this situation, the price of respecting autonomy is paid by a frail incapacitated patient who has no idea why food and water are no longer offered to her. (shrink)

We review a recent paper in Genome Research by Guantes et al. showing that nuclear gene expression is influenced by the bioenergetic status of the mitochondria. The amount of energy that mitochondria make available for gene expression varies considerably. It depends on: the energetic demands of the tissue; the mitochondrial DNA (mtDNA) mutant load; the number of mitochondria; stressors present in the cell. Hence, when failing mitochondria place the cell in energy crisis there are major effects on gene expression affecting (...) the risk of degenerative diseases, cancer and ageing. In 2015 the UK parliament approved a change in the regulation of IVF techniques, allowing “Mitochondrial replacement therapy” to become a reproductive choice for women at risk of transmitting mitochondrial disease to their children. This is the first time that this technique will be available. Therefore understanding the interaction between mitochondria and the nucleus has never been more important. (shrink)

This paper seeks to clear up the confusion surrounding debates over cultural appropriation. To do so, I argue for an agent-centred approach—a focus on appropriators more than appropriation. In my view, cultural misappropriation involves agents who exhibit disregard toward a relevant culture and its members. I argue further that this approach improves upon recent alternative philosophical approaches to cultural appropriation, which I divide into two camps: toleration-based and power-based.

Thomas Reid's distinction between original and acquired perception is not merely metaphysical; it has psychological and phenomenological stories to tell. Psychologically, acquired perception provides increased sensitivity to features in the environment. Phenomenologically, Reid's theory resists the notion that original perception is exhaustive of perceptual experience. James Van Cleve has argued that most cases of acquired perception do not count as perception and so do not pose a threat to Reid's direct realism. I argue that acquired perception is genuine perception and (...) as direct as original perception. Perception is grounded in a productive and developing relationship between the mind and world. (shrink)

Currently, many women who are expecting to give birth have no option but to attempt vaginal delivery, since access to elective planned caesarean sections (PCS) in the absence of what is deemed to constitute ‘clinical need’ is variable. In this paper, we argue that PCS should be routinely offered to women who are expecting to give birth, and that the risks and benefits of PCS as compared with planned vaginal delivery should be discussed with them. Currently, discussions of elective PCS (...) arise in the context of what are called ‘Maternal Request Caesarean Sections’ (MRCS) and there is a good deal of support for the position that women who request PCS without clinical indication should be provided with them. Our argument goes further than support for acceding to requests for MRCS: we submit that healthcare practitioners caring for women with uncomplicated pregnancies have a positive duty to inform them of the option of PCS as opposed to assuming vaginal delivery as a default, and to provide (or arrange for the provision of) PCS if that is the woman's preferred manner of delivery. (shrink)

ABSTRACT According to one widely accepted view, our actions and emotions ought to be proportional to the degree of value present in their objects. Against this proportionality principle, Pettigrove sketches a view according to which the value of some virtuous actions and attitudes derives from the characteristic way of being of the agent herself, and not from any other goods that agent appreciates, pursues, or promotes. Granting Pettigrove’s rejection of the proportionality principle, I raise some questions for his replacement account. (...) I suggest that it is not just the characteristic way of being of an agent who loves and forgives virtuously that explains the goodness of their love and forgiveness, but also the role such virtues play in making possible valuable relationships that are partially constitutive of human flourishing. (shrink)

Proposals to modernise fertility law in the UK In November 2023, the Human Fertilisation and Embryology Authority (HFEA) published recommendations 1 for changes to the Human Fertilisation and Embryology Act. 2 The HFEA regulates fertility treatments and embryo research in the UK. The recommendations were informed by a public consultation process during which the HFEA heard from patients, professionals and others with an interest in the regulations. The consultation ran from February - April 2023 and received just over 6800 responses. (...) The recommendations focus on four main areas that the HFEA consider to be in need of modernisation within the Act – patient protection and safety; consent; access to donor information; and future scientific developments and innovation. The Authority proposes that it should be given greater freedom and flexibility to promote patient safety and good practice. For example, through a wider range of regulatory enforcement powers,... (shrink)

Most of us have moral heroes--people such as Mother Teresa or Gandhi--who have dedicated their lives to making the world a better place. We admire such people, and may even seek to become more like them. But at the same time, we don't believe that anyone who falls short of their example is thereby bad or evil. We believe, in other words, both in the importance of moral ideals and exemplars and in the possibility of goodness short of perfection. This (...) book aims to give a rigorous philosophical account and defense of these claims from within a broadly Neo-Aristotelian perspective. (shrink)

Health will feature more prominently at this year’s United Nations Conference of the Parties (COP) to the Framework Convention on Climate Change. COP281 will include a ‘Health/Relief/Recovery and Peace’ day on the 3 December. The health day inevitably engages issues of equity and justice. It includes perspectives on identifying and scaling up adaption measures to address health impacts of climate change, acknowledging ‘findings that climate-sensitive health risks are disproportionately felt by the most vulnerable and disadvantaged, including women, children, ethnic minorities, (...) lower-income communities, migrants or displaced persons, older populations, and those with underlying health conditions’; reflections on what is known and not understood about the impacts of climate change on mental health, and potential ways to address this; ‘action-oriented’ look at responses to the ‘unprecedented levels of climate and disaster displacement, including on those communities already facing multiple crisis’; and an opportunity to share best practice approaches to advocacy and action at the intersection of climate and health. The full programme for the ‘health/relief/recovery and peace’ day can be found at www.cop28.com/en/health-events. A political declaration is anticipated on the day as ministers of health, environment, finance and other related sectors meet and set out a ‘roadmap’ and seek to embed health in the climate agenda. In the lead up to COP28, the WHO called on Ministers of Health ‘to …. (shrink)

The case studies compiled in _Another Way: Decentralization, Democratization and the Global Politics of Community-Based Schooling_ offer a comparative look at how the global politics of educational decentralization have influenced the democratic aspirations of diverse community-based schooling initiatives in Europe, Africa, Asia and the Americas.

In this Introduction to a special section on ‘Visualizing Surfaces, Surfacing Vision’, the authors argue that to conceive vision in the contemporary world it is necessary to examine its embedding within, expression via and organization on the surface. First, they review recent social and cultural theories to demonstrate how and why an attention to surfaces is salient today. Second, they consider how vision may be understood in terms of surfaces, discussing the emergence of the term ‘surface’, and its transhistorical relationship (...) with vision. Third, they introduce the contributions to the special section, which cover written articles and artworks. They make connections between them, including their exploration of reflexivity and recursion, observation, objectivity and agency, ontology and epistemology, relationality, process, and two- and three-dimensionality. Fourth, the authors consider some implications of an understanding of visualizing surfaces/surfacing vision. (shrink)

This essay explores the familiar German ideology according to which a revolution in thought would, in varying proportions, precede, succeed, accommodate, and generally upstage a political revolution whose defining feature was increasingly thought to be its founding violence: the slide from 1789 to 1793. Germany thus sets out to quarantine the political threat of revolution while siphoning off and absorbing the revolution’s intensity and energy for thinking as such. The essay holds that this structure corresponds to the psychoanalytic logic of (...) trauma: the dissolution of the event into a missed event, and the hypertrophic investment in the trivial, the non-event, the negligible remainder. (shrink)

An argument that what is usually dismissed as the “mystical shell” of Hegel's thought—the concept of absolute knowledge—is actually its most “rational kernel.” This book sets out from a counterintuitive premise: the “mystical shell” of Hegel's system proves to be its most “rational kernel.” Hegel's radicalism is located precisely at the point where his thought seems to regress most. Most current readings try to update Hegel's thought by pruning back his grandiose claims to “absolute knowing.” Comay and Ruda invert this (...) deflationary gesture by inflating what seems to be most trivial: the absolute is grasped only in the minutiae of its most mundane appearances. Reading Hegel without presupposition, without eliminating anything in advance or making any decision about what is essential and what is inessential, what is living and what is dead, they explore his presentation of the absolute to the letter. The Dash is organized around a pair of seemingly innocuous details. Hegel punctuates strangely. He ends the Phenomenology of Spirit with a dash, and he begins the Science of Logic with a dash. This distinctive punctuation reveals an ambiguity at the heart of absolute knowing. The dash combines hesitation and acceleration. Its orientation is simultaneously retrospective and prospective. It both holds back and propels. It severs and connects. It demurs and insists. It interrupts and prolongs. It generates nonsequiturs and produces explanations. It leads in all directions: continuation, deviation, meaningless termination. This challenges every cliché about the Hegelian dialectic as a machine of uninterrupted teleological progress. The dialectical movement is, rather, structured by intermittency, interruption, hesitation, blockage, abruption, and random, unpredictable change—a rhythm that displays all the vicissitudes of the Freudian drive. (shrink)

Lynne Rudder Baker, Saving Belief: A Critique of Physicalism Princeton: Princeton University Press, 1987, xii + 177 pp. Daniel C. Dennett, The Intentional Stance Cambridge: MIT Press, 1987, xi + 388 pp. Paul M. Churchland, Matter and Consciousness Cambridge: MIT Press, revised edition, 1988, xii + 184 pp.

This paper will consider the extent to which patients' dependence on clinical expertise when making medical decisions threatens patient autonomy. I start by discussing whether or not dependence on experts is prima facie troubling for autonomy and suggest that it is not. I then go on to consider doctors' and other healthcare professionals' status as ‘medical experts’ of the relevant sort and highlight a number of ways in which their expertise is likely to be deficient. I then consider how this (...) revised picture of medical expertise should lead us to view the potential threat to patient autonomy that results from depending on such ‘experts’. I argue that, whether or not patients are aware of the limitations of medical expertise, in practice it is difficult to do other than defer to medical advice, and this presents a threat to patient autonomy that should be addressed. I conclude by suggesting some ways in which this threat to autonomy might be mitigated. (shrink)

At the time of writing, the UK Government’s ‘Illegal Migration Bill’1 had started progressing through the House of Commons. The Bill will enable the removal of people who have come to the UK seeking asylum by ‘illegal’ routes, including via the dangerous Channel crossing in small boats.2 That duty would apply whether a person makes a protection claim, human rights claim or is a victim of modern slavery or human trafficking. Asylum seekers risk crossing the Channel because there are very (...) few, if any, safe and lawful ways to reach the UK. At least 60% of the people who have made the crossing last year would be recognised as refugees through the asylum process.3 The Bill will also give the UK Secretary of State a follow up duty to deny people arriving by ‘illegal’ routes access to the asylum system and to permanently deny them legal status in the UK, this includes leave to remain and citizenship. On the 24 March, the Council of Europe Commissioner for Human Rights wrote to both Speakers of the UK parliament, stating ‘… the Bill would have serious consequences both for the rights of refugees, asylum seekers and migrants in the UK, and for the upholding of the UK’s international obligations more generally. The UNHCR [UN Refugee Agency] has already stated that the Bill is in clear breach of the UK’s obligations under the 1951 …. (shrink)

In previous Ethics briefings 1 we have highlighted the developments in the case of Bell & Another v the Tavistock and Portman NHS Foundation Trust. The case concerned a judicial review of the practice of prescribing puberty blocking treatment to children and young people at the Gender Identity Development Service managed by the Tavistock and Portman NHS Foundation Trust. The Court of Appeal in its judgement2 found the Trust’s practices to be lawful, and overturned previous guidance given by the High (...) Court which had contradicted the 'Gillick principle' regarding whether a child or young person could consent to medical treatment, without the consent of its parent. Despite this legal success, concerns over the GIDS continued. In September, NHS England commissioned an independent and wide-ranging review of gender identity services for children and young people led by Dr Hilary Cass, past president of the Royal College of Paediatrics and Child Health. Dr Cass’s Interim review, published in March,3 has resulted in a decision by NHS England to close the GIDS at the Trust by Spring 2023, and replace it with regional centres at existing children’s hospitals offering more 'holistic care' with ’strong links to mental health services’. It is proposed that regional centres will be established at Great Ormond Street Hospital, and Alder Hey Children’s NHS Foundation Trust. Dr Cass was critical of the clinic’s failure to collect sufficient data on the impact of puberty blockers in under-16s. …. (shrink)

The office of the United nations high commissioner for human rights (OHCHR): serious human rights abuses against the Uyghur people in Xinjiang, China Very close to midnight on the 31 August 2022, minutes before Michelle Bachelet’s four-year term as UN Commissioner for Human Rights came to an end, her office finally succeeded in publishing her long-delayed report into serious human rights violations in the Xinjiang province in China. According to The Guardian newspaper, papers leaked in July of the same year (...) showed sustained efforts by China to prevent the report’s release, and Bachelet has subsequently spoken of the intense pressure she was put under by the Chinese to prevent the report’s publication. 1 The report is sobering. 2 It is explicit that the Peoples’ Republic of China (PRC) has committed systematic violations of fundamental human rights against the Uyghur and other Turkic Muslim minorities in Xinjiang... (shrink)

At its birth, a new scientific discipline is baptized with the names of the two parent disciplines, Science X and Science Y. Subsequently, usage tends to shorten this compound name by giving preference to one or the other of the constituting terms so that the new term is less disconcerting and novel. Take biophysics, for example. Is it more closely related to physics than to biology, or the other way round? Today this question seems naive but it did not appear (...) so a scarce thirty years ago, that is, at the beginning of the creative activity of the most, eminent scientists in the field of biophysics: it was then the subject of intense discussion. (shrink)

Inequities in global health are increasingly of interest to health care providers in developed countries. In response, many academic healthcare programs have begun to offer international service learning programs. Participants in these programs are motivated by ethical principles, but this type of work presents significant ethical challenges, and no formalized ethical guidelines for these activities exist. In this paper the ethical issues presented by international service learning programs are described and recommendations are made for how academic healthcare programs can carry (...) out international service learning programs in a way that minimizes ethical conflicts and maximizes benefits for all stakeholders. Issues related to project sustainability and community involvement are emphasized. (shrink)

Leonard Berlin (2014) reports that neuroscientific data have been presented in court by lawyers wishing to argue that their clients have reduced or absent moral responsibility for their behaviour b...