The Médecins Sans Frontières ethics review board has been solicited in an unprecedented way to provide advice and review research protocols in an ‘emergency’ mode during the recent Ebola epidemic. Twenty-seven Ebola-related study protocols were reviewed between March 2014 and August 2015, ranging from epidemiological research, to behavioural research, infectivity studies and clinical trials with investigational products at early development stages. This article examines the MSF ERB’s experience addressing issues related to both the process of review and substantive ethical issues (...) in this context. These topics include lack of policies regarding blood sample collection and use, and engaging communities regarding their storage and future use; exclusion of pregnant women from clinical and vaccine trials; and the difficulty of implementing timely and high-quality qualitative/anthropological research to consider potential upfront harms. Having noticed different standards across ethics committees, we propose that when multiple ethics reviews of clinical and vaccine trials are carried out during a public health emergency they should be accompanied by transparent communication between the ECs involved. The MSF ERB experience should trigger a broader discussion on the ‘optimal’ ethics review in an emergency outbreak and what enduring structural changes are needed to improve the ethics review process. (shrink)
Médecins Sans Frontières is one of the world’s leading humanitarian medical organizations. The increased emphasis in MSF on research led to the creation of an ethics review board in 2001. The ERB has encouraged innovation in the review of proposals and the interaction between the ERB and the organization. This has led to some of the advances in ethics governance described in this paper.
This article traces the history of the earliest bilateral tax treaties which were concluded prior to World War I. There are currently over 3000 bilateral tax treaties in existence and their fundamental concepts and terms can be traced back to the earliest treaties. This article explores the political and economic context of the early treaties to understand why countries entered into tax treaties. Tax treaties play an important role in facilitating economic integration and as the European Union and other regional (...) blocs seek to establish a single market, the historical context of tax treaties can assist in understanding their role in modern international economic relations. (shrink)
The nature of Self is ever-blissful, yet we feel constant pains and sufferings in the world. Each one of us is forced to face the worldly happenings in every station of our life. These sufferings cannot end without going to their root cause and finding a solution for it. The cause of these sufferings, as put by most of the schools of Indian Philosophy, is ignorance about the nature of Self that results in bondage. All the schools of Indian Philosophy, (...) except the Cārvāka, hold that ignorance is the cause of bondage and knowledge begets liberation. Realization of eternal peace or bliss is the goal of almost every school of Indian Philosophy. Here, we must know that Ānanda is of three types—Viṣayānanda, Vidyānanda and Brahmānanda. Viṣayānanda is momentary pleasure, which arises out of the contact of the mind with external objects. It has a difference in degrees. Vidyānanda is the pleasure that we derive from the feeling that “I have achieved all that was to be achieved”. It is still of the form of a mental mode. Brahmānanda is eternal bliss, which is discovered when avidyā is annihilated by akhandākāra mental mode. It is beyond mind and its modifications. The views of the Bhagavadgītā, Upaniṣad, and the elementary texts written by the proponents of the philosophy of non-dualism expound that the way to achieve the state of bliss is by inculcating the attitude of absolute detachment which, when achieved, makes a short work of our ignorance about Brahman. The paper tries to discuss all these issues and the Bliss aspect of Brahman with relevant references. It would be a success if it clarifies the different aspects of Ānanda and creates genuine interest in the researchers to further study the references for deeper understanding of bliss aspect of Brahman. (shrink)
The main purpose of this article is to broaden U.S. scholars' awareness of the similarities and differences of gender literature in another part of the world. In providing this partial review of gender scholarship in India, the authors hope to foster critical reflection on the inequities of global knowledge production and consumption and the role of U.S. academic institutions and scholars in this project. The article is written not by scholars who are based in India but by those who are (...) based in U.S. academies. Given their location, linguistic and cultural competencies, and scholarly expertise, the review, at best, can be described as a glimpse of gender scholarship in India. The four sections of this article feature theoretical and methodological issues, the women's movement, and violence against women in India. (shrink)
It is easier to resist at the beginning than at the end.– Leonardo da VinciPhysicians often believe that a conscious commitment to ethical behavior and professionalism will protect them from industry influence. Despite increasing concern over the extent of physician-industry relationships, physicians usually fail to recognize the nature and impact of subconscious and unintentional biases on therapeutic decision-making. Pharmaceutical and medical device companies, however, routinely demonstrate their knowledge of social psychology processes on behavior and apply these principles to their marketing. (...) To illustrate how pharmaceutical marketing strategies use psychological techniques to promote targeted therapies, we draw on the relevant social psychology literature on conflicts of interest and on the six principles of influence articulated by the eminent social psychologist Robert Cialdini. Hospitals, professional organizations, medical educators, and other stakeholders must also draw on social psychology to respond effectively to commercial activities that compromise good medical practice. (shrink)
Pharmaceutical and medical device companies apply social psychology to influence physicians' prescribing behavior and decision making. Physicians fail to recognize their vulnerability to commercial influences due to self-serving bias, rationalization, and cognitive dissonance. Professionalism offers little protection; even the most conscious and genuine commitment to ethical behavior cannot eliminate unintentional, subconscious bias. Six principles of influence — reciprocation, commitment, social proof, liking, authority, and scarcity — are key to the industry's routine marketing strategies, which rely on the illusion that the (...) industry is a generous avuncular partner to physicians. In order to resist industry influence, physicians must accept that they are vulnerable to subconscious bias and have both the motivation and means to resist industry influence. A culture in which accepting industry gifts engenders shame rather than gratitude will reduce conflicts of interest. If greater academic prestige accrues to distant rather than close relationships with industry, then a new social norm may emerge that promotes patient care and scientific integrity. In addition to educating faculty and students about the social psychology underlying sophisticated but potentially manipulative marketing and about how to resist it, academic medical institutions should develop strong organizational policies to counteract the medical profession's improper dependence on industry. (shrink)
The medical profession is under a state of increasing scrutiny. Recent high profile scandals regarding substantial industry payments to physicians, surgeons, and medical researchers have raised serious concerns over conflicts of interest. Amidst this background, the public, physicians, and policymakers alike appear to make the same assumption regarding conflicts of interest; that doctors who succumb to influences from industry are making a deliberate choice of self-interest over professionalism and that these doctors are corrupt. In reality, a myriad of evidence from (...) social science indicates that influence from conflicts of interest often occurs on a subconscious and unintentional level. This poses an important issue, since such conflicts can steer wellintentioned physicians away from their primary professional goal to provide the best medical advice and treatment possible. (shrink)
As a neo-liberal economy, India has become one of the new health tourism destinations, with commercial gestational surrogacy as an expanding market. Yet the Indian Assisted Reproductive Technology Bill has been pending for five years, and the guidelines issued by the Indian Council of Medical Research are somewhat vague and contradictory, resulting in self-regulated practices of fertility clinics. This paper broadly looks at clinical ethics in reproduction in the practice of surrogacy and decision-making in various procedures. Through empirical research in (...) New Delhi, the capital of India, from December 2011 to November 2012, issues of decision-making on embryo transfer, fetal reduction, and mode of delivery were identified. Interviews were carried out with doctors in eighteen ART clinics, agents from four agencies, and fourteen surrogates. In aiming to fulfil the commissioning parents’ demands, doctors were willing to go to the greatest extent possible in their medical practice. Autonomy and decision-making regarding choice of the number of embryos to transfer and the mode of delivery lay neither with commissioning parents nor surrogate mothers but mostly with doctors. In order to ensure higher success rates, surrogates faced the risk of multiple pregnancy and fetal reduction with little information regarding the risks involved. In the globalized market of commercial surrogacy in India, and with clinics compromising on ethics, there is an urgent need for formulation of regulative law for the clinical practice and maintenance of principles of reproductive ethics in order to ensure that the interests of surrogate mothers are safeguarded. (shrink)
This paper signifies the inevitability of the responsible practices of leadership into the relation with the subordinates in the Indian organizations. The theme of this study revolves around the responsibility and ethical approach of the top management which directly or indirectly influence the job-related attitudinal behavior of employees. To analyze it empirically, a questionnaire is designed and 138 middle-level managers from four private sector telecom companies in India rated their superiors on 11 items of leadership scale. This study used internal (...) consistency reliability, Pearson correlation, and exploratory factor analysis as statistical techniques. Factor analysis of the scores on such items yielded two dimensions. The paper examines the impact of leadership of managers upon their subordinates in the context of enhancing job satisfaction, affective commitment, and knowledge performance. The results of the study are not completely substantiating empirically to the theory that ethical attitude of leaders enhance commitment and satisfaction of subordinates in Indian context. (shrink)
Many real-world optimization problems usually require a large number of conflicting objectives to be optimized simultaneously to obtain solution. It has been observed that these kinds of many-objective optimization problems often pose several performance challenges to the traditional multi-objective optimization algorithms. To address the performance issue caused by the different types of MaOPs, recently, a variety of many-objective particle swarm optimization has been proposed. However, external archive maintenance and selection of leaders for designing the MaOPSO to real-world MaOPs are still (...) challenging issues. This work presents a MaOPSO based on entropy-driven global best selection strategy to solve the many-objective software package restructuring problem. EMPSO makes use of the entropy and quality indicator for the selection of global best particle. To evaluate the performance of the proposed approach, we applied it over the five MaOSPR problems. We compared it with eight variants of MaOPSO, which are based on eight different global best selection strategies. The results indicate that the proposed EMPSO is competitive with respect to the existing global best selection strategies based on variants of MaOPSO approaches. (shrink)
Senior physicians of modern medicine in India play a key role in shaping policies and public opinion and institutional management. This paper explores their perceptions of medical tourism (MT) within India which is a complex process involving international demands and policy shifts from service to commercialisation of health care for trade, gross domestic profit, and foreign exchange. Through interviews of 91 physicians in tertiary care hospitals in three cities of India, this paper explores four areas of concern: their understanding of (...) MT, their views of the hospitals they work in, perceptions of the value and place of MT in their hospital and their views on the implications of MT for medical care in the country. An overwhelming majority (90%) of physicians in the private tertiary sector and 74.3 percent in the public tertiary sector see huge scope for MT in the private tertiary sector in India. The private tertiary sector physicians were concerned about their patients alone and felt that health of the poor was the responsibility of the state. The public tertiary sector physicians’ however, were sensitive to the problems of the common man and felt responsible. Even though the glamour of hi-tech associated with MT dazzled them, only 35.8 percent wanted MT in their hospitals and a total of 56 percent of them said MT cannot be a public sector priority. 10 percent in the private sector expressed reservations towards MT while the rest demanded state subsidies for MT. The disconnect between their concern for the common man and professionals views on MT was due to the lack of appreciation of the continuum between commercialisation, the denial of resources to public hospitals and shift of subsidies to the private sector. The paper highlights the differences and similarities in the perceptions and context of the two sets of physicians, presents evidence, that questions the support for MT and finally analyzes some key implications of MT on Indian health services, ethical issues emerging out of that and the need for understanding the linkages between public and private sectors for a more effective intervention for an equitable medical care policy. (shrink)
BackgroundAnatomy Act provides legal ambit to medical educationists for the acquisition of cadavers. The changing medical education scenario, socio-demographic change, and ethical concerns have necessitated an urgent review of its legal and ethical framework. Suitable amendments addressing the current disparities and deficiencies are long overdue.MethodsAnatomy Act in India is a state Act, which ensures the provision of human bodies for medical education and research.The methodology included three components namely: Comparison of various Anatomy Acts clause by clause,Feedback from anatomists, andFormulation of (...) comprehensive model Anatomy Act.ResultsVarious Acts studied showed discrepancies in the purpose of the Act, roles and duties of stakeholders, regulation for body donation, the procedure to handle unclaimed bodies, disposal of dissected bodies, etc. No Act defines a donor and neither addresses the issue of transport of anatomical material. Only ten states have a clause for body donation. Acts of only six states have been amended over the last 50 years. Three states denied having an Act. The whole exercise of review of Acts, extensive feedback received from end-users, and taking into account global good practices, culminated in drafting a comprehensive model Anatomy Act founded on ethical principles.ConclusionIndia, with the largest number of medical colleges, is not only at the forefront but also a hub of medical education in the Southeast Asia region. Legal reform can be a torchbearer to promote ethical and transparent practices for obtaining cadavers for other countries of the region with similar socio-demography and shall also motivate anatomic fraternity across the globe for critical analysis of their respective Anatomy Acts. (shrink)
Shared decision-making involves health professionals and patients/clients working together to achieve true person-centred health care. However, this goal is infrequently realized, and most barriers are unknown. Discussion between philosophers, clinicians, and researchers can assist in confronting the epistemic and moral basis of health care, with benefits to all. The aim of this paper is to describe what shared decision-making is, discuss its necessary conditions, and develop a definition that can be used in practice to support excellence in maternity care. Discussion (...) between the authors, with backgrounds in philosophy, clinical maternity care, health care management, and maternity care research, assisted the team to confront established norms in maternity care and challenge the epistemic and moral basis of decision-making for caesarean section. The team concluded that shared decision-making must start in pregnancy and continue throughout labour and birth, with equality in discourse facilitated by the clinician. Clinicians have a duty of care for the adequacy of women's knowledge, which can only be fulfilled when relevant knowledge is offered freely and when personal beliefs and biases that may impinge on decision-making (defeaters) are disclosed. Informed consent is not shared decision-making. Key barriers include existing cultural norms of “the doctor knows best” and “patient acquiescence” that prevent defeaters being acknowledged and discussed and can lead to legal challenges, overuse of medical intervention and, in some areas, obstetric violence. Shared decision-making in maternity care can thus be defined as an enquiry by clinician and expectant woman aimed at deciding upon a course of care or none, which takes the form of a dialogue within which the clinician fulfils their duty of care to the client's knowledge by making available their complete knowledge (based on all types of evidence) and expertise, including an exposition of any relevant and recognized potential defeaters. Research to develop measurement tools is required. (shrink)
A critique of contemporary spirituality by one of its most unusual figures. This work does not equates the natural state with enlightenment, which is described as an illusion created by our culture. It states that one can do nothing to attain the natural state.
The last 20 years have seen the development of a new form of therapy, compassion focused therapy. Although CFT has a growing evidence base, there have been few studies of CFT outside of an Anglo-European cultural context. In this paper, we ask: Might a CFT-based approach be of value for Indigenous Australians? If so, what kind of cultural adaptations might be needed? We report the findings from a pilot study of an arts-based compassion skills training group, in which usual CFT (...) group processes were significantly adapted to meet the needs of Indigenous Australians. At face value, CFT appeared to be a promising approach to enhancing the social and emotional wellbeing of Australia’s Indigenous peoples. However, despite initial consultations with Indigenous health professionals, the first attempts to offer a more conventional group-based CFT to Indigenous clients were largely unsuccessful. Following a review and advice from two Indigenous clients, we combined elements of CFT with visual arts to develop a new approach, “arts-based compassion skills training”. This paper reports an evaluation of this pilot ABCST group. The group had 6 × 4 h sessions of ABCST, facilitated by two psychologists and two artists. There were 10 participants, who attended between 2 and 6 sessions: five were clients, five were health professionals. Between 1 and 3 months later, six of the participants were interviewed. Qualitative analysis of interview data identified that two key processes—creating a positive group atmosphere and channeling compassion skills training through the medium of visual arts—led to four positive outcomes for participants: planting the seeds of new understandings, embodying the skills of compassion, strengthening relationships with others, and evolving a more self-compassionate relationship. We suggest that the preliminary results are sufficiently encouraging to warrant further development of ABCST in Indigenous communities. (shrink)