Médecins Sans Frontières (MSF) is an independent medical humanitarian organisation working in over 70 countries. It has provided medical assistance for over 35 years to populations vulnerable through conflict, disease and inadequate health systems. Medical ethics define the starting point of the relationship between medical staff and patients. The ethics of humanitarian interventions and of research in conflict settings are much debated. However, less is known about the ethical dilemmas faced by medical humanitarian staff in their daily work. Ethical dilemmas (...) can be intensified in humanitarian contexts by insecure environments, lack of optimum care, language barriers, potentially heightened power discrepancies between care providers and patients, differing cultural values and perceptions of patients, communities and medical staff. Time constraints, stressful conditions and lack of familiarity with ethical frameworks can prevent reflection on these dilemmas, as can frustration that such reflection does not necessarily provide instant solutions. Lack of reflection, however, can be distressing for medical practitioners and can reduce the quality of care. Ethical reflection has a central role in MSF, and the organisation uses ethical frameworks to help with clinical and programmatic decisions as well as in deliberations over operational research. We illustrate and discuss some real ethical dilemmas facing MSF teams. Only by sharing and seeking guidance can MSF and similar actors make more thoughtful and appropriate decisions. Our aim in sharing these cases is to invite discussion and dialogue in the wider medical community working in crisis, conflict or with severe resource limitations. (shrink)

This experiment investigated the effect of format (line vs. bar), viewers’ familiarity with variables, and viewers’ graphicacy (graphical literacy) skills on the comprehension of multivariate (three variable) data presented in graphs. Fifty-five undergraduates provided written descriptions of data for a set of 14 line or bar graphs, half of which depicted variables familiar to the population and half of which depicted variables unfamiliar to the population. Participants then took a test of graphicacy skills. As predicted, the format influenced viewers’ interpretations (...) of data. Specifically, viewers were more likely to describe x–y interactions when viewing line graphs than when viewing bar graphs, and they were more likely to describe main effects and “z–y” (the variable in the legend) interactions when viewing bar graphs than when viewing line graphs. Familiarity of data presented and individuals’ graphicacy skills interacted with the influence of graph format. Specifically, viewers were most likely to generate inferences only when they had high graphicacy skills, the data were familiar and thus the information inferred was expected, and the format supported those inferences. Implications for multivariate data display are discussed. (shrink)

This important and comprehensive work of 18th-century Islamic religious thought written in Arabic by a pre-eminent South Asian scholar provides an extensive and detailed picture of Muslim theology and interpretive strategies on the eve of the modern period.

The aim of this paper is to define some new operation laws for the trapezoidal linguistic cubic fuzzy number and Hamming distance. Furthermore, we define and use the trapezoidal linguistic cubic fuzzy TOPSIS method to solve the multi criteria decision making (MCDM) method. The new ranking method for trapezoidal linguistic cubic fuzzy numbers (TrLCFNs) are used to rank the alternatives. Finally, an illustrative example is given to verify and prove the practicality and effectiveness of the proposed method.

Believing that p, assuming that p, and imagining that p involve regarding p as true—or, as we shall call it, accepting p. What distinguishes belief from the other modes of acceptance? We claim that conceiving of an attitude as a belief, rather than an assumption or an instance of imagining, entails conceiving of it as an acceptance that is regulated for truth, while also applying to it the standard of being correct if and only if it is true. We argue (...) that the second half of this claim, according to which the concept of belief includes a standard of correctness, is required to explain the fact that the deliberative question whether to believe that p is transparent to the question whether p. This argument raises various questions. Is there such a thing as deliberating whether to believe? Is the transparency of the deliberative question whether to believe that p the same as the transparency of the factual question whether I do believe that p? We will begin by answering these questions and then turn to a series of possible objections to our argument. (shrink)

Why, when asking oneself whether to believe that p, must one immediately recognize that this question is settled by, and only by, answering the question whether p is true? Truth is not an optional end for first-personal doxastic deliberation, providing an instrumental or extrinsic reason that an agent may take or leave at will. Otherwise there would be an inferential step between discovering the truth with respect to p and determining whether to believe that p, involving a bridge premise that (...) it is good (in whichever sense of good one likes, moral, prudential, aesthetic, allthings-considered, etc.) to believe the truth with respect to p. But there is no such gap between the two questions within the first-personal deliberative perspective; the question whether to believe that p seems to collapse into the question whether p is true. (shrink)

When we deliberate whether to believe some proposition, we feel immediately compelled to look for evidence of its truth. Philosophers have labelled this feature of doxastic deliberation 'transparency'. I argue that resolving the disagreement in the ethics of belief between evidentialists and pragmatists turns on the correct explanation of transparency. My hypothesis is that it reflects a conceptual truth about belief: a belief that p is correct if and only if p. This normative truth entails that only evidence can be (...) a reason for belief. Although evidentialism does not follow directly from the mere psychological truth that we cannot believe for non-evidential reasons, it does follow directly from the normative conceptual truth about belief which explains why we cannot do so. (shrink)

Current formal dialectical models postulate normative rules that enable discussants to conduct dialogical interactions without committing fallacies. Though the rules for conducting a dialogue are supposed to apply to interactions between actual arguers, they are without exception theoretically motivated. This creates a gap between model and reality, because dialogue participants typically leave important content-related elements implicit. Therefore, analysts cannot readily relate normative rules to actual debates in ways that will be empirically confirmable. This paper details a new, data-driven method for (...) describing discussants’ actual reply structures, wherein corpus studies serve to acknowledge the complexity of natural argumentation. Rather than refer exclusively to propositional content as an indicator of arguing pro/contra a given claim, the proposed approach to dialogue structure tracks the sequence of dialogical moves itself. This arguably improves the applicability of theoretical dialectical models to empirical data, and thus advances the study of dialogue systems. (shrink)

Writing the Mughal World: Studies on Culture and Politics. Muzzafar Alam and Sanjay Subrahmanyam. New York: Columbia University Press, 2011. Pp. xviii + 516. $89.50, £62 ; $29.50, £20.50.

Why, when asking oneself whether to believe that p, must one immediately recognize that this question is settled by, and only by, answering the question whether p is true? Truth is not an optional end for first-personal doxastic deliberation, providing an instrumental or extrinsic reason that an agent may take or leave at will. Otherwise there would be an inferential step between discovering the truth with respect to p and determining whether to believe that p, involving a bridge premise that (...) it is good to believe the truth with respect to p. But there is no such gap between the two questions within the first-personal deliberative perspective; the question whether to believe that p seems to collapse into the question whether p is true. (shrink)

It is common for philosophers to claim that doxastic voluntarism, the view that an agent can form beliefs voluntarily, is false, and therefore that agents do not have the kind of control over their beliefs required for a straightforward application of deontological concepts such as obligation or duty in the domain of epistemology. The role that the denial of doxastic voluntarism plays in an argument to the effect that agents do not have obligations with respect to belief is simply this.

“It is this distancing of personal relationships, combined with their replacement by written contractual terms and conditions, which make the discussion of ethics within a corporate institutionalised context highly limited and problematic.’ The challenge is to find means of personalising modern corporations so as to encourage ethical behaviour. Atul K. Shah PhD ACA gained his doctorate from the London School of Economics and is Lecturer in the Department of Accounting and Financial Management, at the University of Essex, Wivenhoe Park, (...) Colchester CO4 3SQ; e‐mail [email protected]. This article was conceived while he was Visiting Assistant Professor at the College of Business, University of Maryland, USA. The author wishes to thank Dan Ostas, Lee Preston and Stephen Loeb for helpful comments on earlier drafts. (shrink)

تشخيص فكري ومعرفي لمفهوم الأسرة ومكانتها في الفكر الإسلامي، وتفحّصٌ علمي ومنهجي لأسس البناء الأسري ومقاصده، وكشفٌ عن تأثير التحوّلات الاجتماعية في الأسرة والتحديات التي تواجهها، وتتبعٌ لانعكاسات الفكر الغربي في المنظومة القيمية للأسرة، وتبيّنٌ لبعض التجارب والخبرات في مجال المحافظة على دور الأسرة، لا سيما بعد هيمنة النموذج المعرفي الغربي، ومحاولة طمسه للخصوصيات الثقافية والمجتمعية. حاولت بحوث هذا الكتاب أن تجيب عن تساؤلات معرفية ومجتمعية مهمة مثل: ما أهم التحديات التي تواجه الأسرة المسلمة في الراهن المعاصر وكيفية مواجهتها، وما (...) التغيرات التي طرأت على الأسرة المسلمة في ظل التطورات والتسارعات المجتمعية والاقتصادية والتقنية إلخ، وما التصوّر الإسلامي لدور الأسرة في بناء المجتمع، وما دور مؤسسات المجتمع المدني في الحد من تأثير الاستلاب الثقافي، وما الإسهام الذي قدمته حركات الإصلاح الإسلامية في مجال المحافظة على الدور المحوري للأسرة في تشكيل الشخصية الإسلامية القادرة على تفعيل النهوض الحضاري؟ وقد أسهم المشاركون في هذا العمل الجماعي، الذين بلغ عددهم واحداً وعشرين باحثاً، في محاورة هذه الأسئلة المعرفية، وفي التأسيس لمنظومة معرفية مجتمعية قادرة على الإسهام في البناء الحضاري، وفي توجيه دفة الأسرة بما ينسجم مع التوجيهات الربانية والفطرة الإنسانية. (shrink)

According to prominent bioethics scholars and international guidelines, researchers and sponsors have obligations to ensure that the products of their research are reasonably available to research participants and their communities. In other words, the claim is that research is unethical unless it has local social value. In this article, we argue that the existing conception of reasonable availability should be replaced with a social value obligation that extends to the global poor. To the extent the social value requirement has been (...) understood as geographically constrained to the communities that host research and the countries that can afford the products of research, it has neglected to include the global poor as members of the relevant society. We argue that a new conception of social value obligations is needed for two reasons. First, duties of global beneficence give reason for researchers, sponsors, and institutions to take steps to make their products more widely accessible. Second, public commitments made by many institutions acknowledge and engender responsibilities to make the products of research more accessible to the global poor. Future research is needed to help researchers and sponsors discharge these obligations in ways that unlock their full potential. (shrink)

The present commentary on it greatly contributes to the understanding of thisvery important work. In fact, it is a good expositary commentary, lucidly explaning the knotty points. It evinces deep study and understanding of Navya-Nyaya and its methodology.yhus, the sukhabodhika Tippanika represents a positive and distinctive contribution to the vast commercial literature on the Tattvacimtamani.

Why can't deliberation conclude in an intention except by considering whether to perform the intended action? I argue that the answer to this question entails that reasons for intention are determined by reasons for action. Understanding this feature of practical deliberation thus allows us to solve the toxin puzzle.

Research teams have made considerable progress in treating absolute uterine factor infertility through uterus transplantation, though studies have differed on the choice of either deceased or living donors. While researchers continue to analyze the medical feasibility of both approaches, little attention has been paid to the ethics of using deceased versus living donors as well as the protections that must be in place for each. Both types of uterus donation also pose unique regulatory challenges, including how to allocate donated organs; (...) whether the donor / donor's family has any rights to the uterus and resulting child; how to manage contact between the donor / donor's family, recipient, and resulting child; and how to track outcomes moving forward. (shrink)

There is wide agreement that communities in lower-income countries should benefit when they participate in multinational research. Debate now focuses on how and to what extent these communities should benefit. This debate has identified compelling reasons to reject the claim that whatever benefits a community agrees to accept are necessarily fair. Yet, those who conduct clinical research may conclude from this rejection that there is no reason to involve communities in the process of deciding how they benefit. Against this possibility, (...) the present manuscript argues that involving host communities in this process helps to promote four important goals: protecting host communities, respecting host communities, promoting transparency, and enhancing social value. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:From Impatience to EmpathyStephanie Pierce and Kavita Shah AroraWe gave J.H. a label the first time we met her, as many often do—“Uncooperative.” She was a patient with autism and intellectual delay who had presented to the emergency department (ED) with vaginal bleeding. After receiving the gynecology consult request from the emergency medicine physicians, we were already mentally formulating our recommendations based on the information they told us (...) over the phone. “Does not cooperate with exam,” “no acute surgical intervention is currently warranted,” and “recommend outpatient follow–up.”When we arrived in her room, she was sitting in the hospital bed surrounded by a protective shield of caregivers from her group home. We introduced ourselves as the gynecology team but it was obvious that J.H. could not communicate verbally. Upon speaking with her caregivers we learned that she had Cowden syndrome, a genetic disease that confers significantly increased risks for several types of cancer including endometrial, thyroid, and breast cancers. J.H. had also been having heavy vaginal bleeding, which was difficult for her caregivers to manage, and this was the reason she was brought into the emergency department. After attempting to gain as much information as we could from the caregivers, we started to perform an abdominal exam, which made J.H. extremely agitated. We quickly stopped the exam and the caregivers helped to calm J.H. We remember our mixture of emotions—bewilderment at the agitation and commotion in the exam room full of people, frustration at not being able to complete our exam fully, and annoyance that this “difficult patient” was taking up our limited time between surgical cases. Thankfully, these knee–jerk reactions were quickly replaced by feelings of concern for the patient and the realization of how frightening an experience this must be for her—being in a strange place with white walls and unfamiliar people, unable to communicate her thoughts.J.H.’s mother, her surrogate decision–maker, was not at the hospital that day but the caregivers told us that she had expressed a strong desire for her daughter to have a prophylactic hysterectomy due to her lifetime risk for developing uterine cancer as well as a permanent solution to the bleeding concerns. What had initially started as a simple ED consult was now turning into a complex question. The ethical and legal dilemma was obvious—whether to perform a major surgery that would irreversibly sterilize a patient who could not consent on her own behalf in order to minimize the potential risk of cancer later in life. While medical management could improve the bleeding and potentially reduce the risk of cancer, frequent exams would be necessary [End Page 19] to ensure that the medication was working and that premalignant changes were not occurring in J.H.’s uterus. However, based on our experience in the emergency department, J.H. would need anesthesia for such exams and it was doubtful the medications would completely normalize her elevated risk of uterine malignancy. We knew that in order to address this question, we would need to see J.H. again along with her mother to have a frank discussion about the risks and benefits of such a decision, and so we made plans to see her in our outpatient clinic.Several days later, J.H., her mother, and the group home caregivers arrived in the office. Anticipating a complex discussion, we had requested a representative from the hospital ethics committee to join us at the visit. We didn’t know what to expect meeting J.H.’s mother for the first time but as we sat in the room talking, it was obvious that she was truly trying to act in her daughter’s best interest. Similarly, it was touching to watch the faces of the caregivers from the group home as they nodded in solidarity with J.H.’s mother, also clearly wanting what was best for her and supporting her mother in this difficult decision. J.H., meanwhile, seemed content to sit silently with us during the discussion, surrounded as she was by people who cared deeply for her well–being.After extensive partnership with the ethics consultants... (shrink)

Background: Healthcare providers who are accountable for patient care safety and quality but who are not empowered to actualize them experience moral distress. Interventions to mitigate moral distress in the healthcare organization are needed. Objective: To evaluate the effect on moral distress and clinician empowerment of an established, health-system-wide intervention, Moral Distress Consultation. Methods: A quasi-experimental, mixed methods study using pre/post surveys, structured interviews, and evaluation of consult themes was used. Consults were requested by staff when moral distress was present. (...) The purpose of consultation is to identify the causes of moral distress, barriers to action, and strategies to improve the situation. Intervention participants were those who attended a moral distress consult. Control participants were staff surveyed prior to the consult. Interviews were conducted after the consult with willing participants and unit managers. Moral distress was measured using the Moral Distress Thermometer. Empowerment was measured using the Global Empowerment Scale. Results: Twenty-one consults were conducted. Analysis included 116 intervention and 30 control surveys, and 11 interviews. A small but significant decrease was found among intervention participants, especially intensive care staff. Empowerment was unchanged. Interview themes support the consult service as an effective mode for open discussion of difficult circumstances and an important aspect of a healthy work environment. Conclusions: Moral distress consultation is an organization-wide mechanism for addressing moral distress. Consultation does not resolve moral distress but helps staff identify strategies to improve the situation. Further studies including follow up may elucidate consultation effectiveness. (shrink)

Medical student and resident participation in global health experiences (GHEs) has significantly increased over the last decade. In response to growing student interest and the proven impact of such experiences on the education and career decisions of resident physicians, many medical schools have begun to establish programmes dedicated to global health education. For the innumerable benefits of GHEs, it is important to note that medical students have the potential to do more harm than good in these settings when they exceed (...) their actual capabilities as physicians-in-training. While medical training programmes are beginning to provide students with the knowledge to put their GHEs in context, they must remember that they also bear the responsibility of training their students in a framework to approach these experiences in a principled and professional way. It is necessary that these institutions provide adequate and formalised preparation for both clinical and ethical challenges of working in resource-poor settings. This paper outlines potential benefits and risks of GHEs and delineates recommendations to some of the current issues. (shrink)

The hendiadys of technology and ethics is neither novel nor what we really need. Even though dialogue between ethicsEthicsand technology, namely the humanitiesHumanities / human scientistand the social sciencesSocial sciences / social scientist, on the one hand, and science and engineeringEngineering / engineer, on the other hand, is explicitly encouraged in various ways, doing this effectively remains difficult. Obstacles to an authentic dialogue are many, ranging from scientific reasons to research policy reasons to institutional reasons. After reviewing these various obstacles, (...) we propose to pursue the following suggestion in order to overcome these difficulties: we do not just need more ethics, we need a qualitative shift. That is to say, rather than delegating the task of evaluating technological outcomes to moral philosophers and social scientistsSocial sciences / social scientist, we need to make the technological system capable of designing technology through ethicsEthics. This is precisely illustrated by the contributions collected in this volume, which are the result of a collaboration between the Massachusetts Institute of Technology and Politecnico di Milano. (shrink)

Brain death, or the determination of death by neurological criteria, has been described as a legal fiction. Legal fictions are devices by which the law treats two analogous things (in this case, biological death and brain death) in the same way so that the law developed for one can also cover the other. Some scholars argue that brain death should be understood as a fiction for two reasons: the way brain death is determined does not actually satisfy legal criteria requiring (...) the permanent cessation of all brain function, and brain death is not consistent with the biological conception of death as involving the irreversible cessation of the functioning of an organism as a whole. Critics counter that the idea that brain death is a legal fiction is deceptive and undemocratic. I will argue that diagnosing brain death as a hidden legal fiction is a helpful way to understand its historical development and current status. For the legal‐fictions approach to be ethically justifiable, however, the fact that brain death is a legal fiction not aligned with the standard biological conception of death must be acknowledged and made transparent. (shrink)

Cumulative evidence has demonstrated that mobile phone distraction, in particular among emerging adults, is a growing problem. Considerable efforts have been made to contribute to the literature by proposing cognitive emotion pre-occupation which acts as an underlying mechanism through which mobile phone distraction results in a reduction in psychological well-being. The proposed model is supported by distraction-conflict theory which reveals that users, with high attention control, are better at coping with the negative consequences of mobile phone distraction. The data, consisting (...) of 914 University students in China, was analyzed using statistical tools. The results support that mobile phone distraction has a significant positive relationship with cognitive emotional pre-occupation which negatively affects users' psychological well-being. Our findings also reveal that attention control moderated the mediation effect of cognitive emotional pre-occupation in association with mobile phone distraction and psychological well-being. The theoretical and practical implications are also discussed along with limitations and future research. (shrink)

The research on the dark side of leadership is still in its infancy. We have contributed to this line of research by proposing that work alienation acts as an underlying mechanism through which aversive leadership results in reduced job performance. We further propose that psychological capital acts as an important personal resource that reduces the negative effects of aversive leadership in the form of work alienation. The proposed model gets its support from the conversation of resources theory given by Hobfoll (...) (1981) which suggests that stressful situation like an aversive leadership results in the loss of employee resources as a result of that he/she indulges in work alienation and shows poor job performance to retain back the lost resources. People with better personal resources in the form of psychological capital are better able to cope-up with the aversive leader behavior and make them able to avoid work alienation. It is a time-lagged study. The data for the current study was collected from 321 employees working in the service sector organizations, particularly universities, banks and telecom organizations, through personally administered questionnaires. The results supported the mediation and moderation hypothesis. Limitations and future research along with theoretical and practical implications are given at the end. (shrink)

The recent Ebola outbreak in West Africa began in the spring of 2014 and has since caused the deaths of over 6,000 people. Since there are no approved treatments or prevention modalities specifically targeted at Ebola Virus Disease , debate has focused on whether unproven interventions should be offered to Ebola patients outside of clinical trials. Those engaged in the debate have responded rapidly to a complex and evolving crisis, however, and this debate has not provided much opportunity for in-depth (...) analysis. Additionally, the existing literature on access to unproven therapies has focused on contexts like HIV/AIDS and oncology, which are very different than the Ebola epidemic. In this paper, we examine the ethical issues surrounding access to unproven therapies in the context of the recent Ebola outbreak to yield new insights about this controversial and unsettled issue. We argue first that, in this context, the interests of patients in obtaining access to unproven therapies are not fully aligned.. (shrink)

This study aims to draw a gender based analysis of social and economic conditions of child labourers living in Karachi. Globally the issue of child labour is growing constantly and children are engaged in all sorts of hazardous forms of work, like adults, which deprives them from education, healthy life, child hood activities and balanced diet. In Pakistan the child labour is very common in all economic sectors, but it is mainly found in the informal sector and the household sector. (...) Purposive and convenience sampling techniques of non-probability sampling are used to collect data through structured questionnaire from 900 respondents from eighteen administrative districts of Karachi, which is based upon primarily quantitative and narrowly focused qualitative research methods. The findings of the study reveal that mostly children between the ages of 12 to 14 years are commonly inducted in different economic sectors. This clear violation of child rights makes them vulnerable to health and safety threats and putting them forcefully in hazardous occupations to earn bread and butter for their family by compromising their education. (shrink)