The importance of communities in strengthening the ethics of international collaborative research is increasingly highlighted, but there has been much debate about the meaning of the term ‘community’ and its specific normative contribution. We argue that ‘community’ is a contingent concept that plays an important normative role in research through the existence of morally significant interplay between notions of community and individuality. We draw on experience of community engagement in rural Kenya to illustrate two aspects of this interplay: (i) that (...) taking individual informed consent seriously involves understanding and addressing the influence of communities in which individuals’ lives are embedded; (ii) that individual participation can generate risks and benefits for communities as part of the wider implications of research. We further argue that the contingent nature of a community means that defining boundaries is generally a normative process itself, with ethical implications. Community engagement supports the enactment of normative roles; building mutual understanding and trust between researchers and community members have been important goals in Kilifi, requiring a broad range of approaches. Ethical dilemmas are continuously generated as part of these engagement activities, including the risks of perverse outcomes related to existing social relations in communities and conditions of ‘half knowing’ intrinsic to processes of developing new understandings. (shrink)
BackgroundThe potential contribution of community engagement to addressing ethical challenges for international biomedical research is well described, but there is relatively little documented experience of community engagement to inform its development in practice. This paper draws on experiences around community engagement and informed consent during a genetic cohort study in Kenya to contribute to understanding the strengths and challenges of community engagement in supporting ethical research practice, focusing on issues of communication, the role of field workers in 'doing ethics' on (...) the ground and the challenges of community consultation.MethodsThe findings are based on action research methods, including analysis of community engagement documentation and the observations of the authors closely involved in their development and implementation. Qualitative and quantitative content analysis has been used for documentation of staff meetings and trainings, a meeting with 24 community leaders, and 40 large public and 70 small community group meetings. Meeting minutes from a purposive sample of six community representative groups have been analysed using a thematic framework approach.ResultsField workers described challenges around misunderstandings about research, perceived pressure for recruitment and challenges in explaining the study. During consultation, leaders expressed support for the study and screening for sickle cell disease. In community meetings, there was a common interpretation of research as medical care. Concerns centred on unfamiliar procedures. After explanations of study procedures to leaders and community members, few questions were asked about export of samples or the archiving of samples for future research.ConclusionsCommunity engagement enabled researchers to take account of staff and community opinions and issues during the study and adapt messages and methods to address emerging ethical challenges. Field workers conducting informed consent faced complex issues and their understanding, attitudes and communication skills were key influences on ethical practice. Community consultation was a challenging concept to put into practice, illustrating the complexity of assessing information needs and levels of deliberation that are appropriate to a given study. (shrink)
The aim of this study was to explore the existence of moral distress among nurses in Lilongwe District of Malawi. Qualitative research was conducted in selected health institutions of Lilongwe District in Malawi to assess knowledge and causes of moral distress among nurses and coping mechanisms and sources of support that are used by morally distressed nurses. Data were collected from a purposive sample of 20 nurses through in-depth interviews using a semi-structured interview guide. Thematic analysis of qualitative data was (...) used. The results show that nurses, irrespective of age, work experience and tribe, experienced moral distress related to patient/nursing care. The major distressing factors were inadequate resources and lack of respect from patients, guardians, peers and bosses. Nurses desire teamwork and ethics committees in their health institutions as a means of controlling and preventing moral distress. There is a need for creation of awareness for nurses to recognize and manage moral distress, thus optimizing their ability to provide quality and uncompromised nursing care. (shrink)
Background Over the past decade, the exponential growth of the literature devoted to personalized medicine has been paralleled by an ever louder chorus of epistemic and ethical criticisms. Their differences notwithstanding, both advocates and critics share an outdated philosophical understanding of the concept of personhood and hence tend to assume too simplistic an understanding of personalization in health care. Methods In this article, we question this philosophical understanding of personhood and personalization, as these concepts shape the field of personalized medicine. (...) We establish a dialogue with phenomenology and hermeneutics in order to achieve a more sophisticated understanding of the meaning of these concepts We particularly focus on the relationship between personal subjectivity and objective data. Results We first explore the gap between the ideal of personalized healthcare and the reality of today’s personalized medicine. We show that the nearly exclusive focus of personalized medicine on the objective part of personhood leads to a flawed ethical debate that needs to be reframed. Second, we seek to contribute to this reframing by drawing on the phenomenological-hermeneutical movement in philosophy. Third, we show that these admittedly theoretical analyses open up new conceptual possibilities to tackle the very practical ethical challenges that personalized medicine faces. Conclusion Finally, we propose a reversal: if personalization is a continuous process by which the person reappropriates all manner of objective data, giving them meaning and thereby shaping his or her own way of being human, then personalized medicine, rather than being personalized itself, can facilitate personalization of those it serves through the data it provides. (shrink)
We consider a space with Generalized Uncertainty Principle which can be obtained in the frame of the deformed commutation relations. In the space with GUP we have found transformations relating coordinates and times of moving and rest frames of reference in the first order over the parameter of deformation. In the non-relativistic case we find the deformed Galilean transformation which is rotation in Euclidian space–time. This transformation is similar to the Lorentz one but written for Euclidean space–time where the speed (...) of light is replaced by some velocity related to the parameter of deformation. We show that for relativistic particle in the space with GUP the coordinates of the rest and moving frames of reference satisfy the Lorentz transformation with some effective speed of light. (shrink)
Some are inclined to perceive the liberation of our philosophical thought from the rule of official ideology as a total break with the Marxian tradition of investigating and interpreting historical reality, as the destruction of everything that had been developed and formulated in the mainstream of this tradition. The collapse of the totalitarian system has given rise to a fashion of "criticizing Marx," specializing in exposing theoretical mistakes and miscalculations, demonstrating his scientific bankruptcy, and even searching for evil intentions in (...) his writings. Marx's doctrine is described as false from the beginning, definitively obsolete, and compromised by the experience of its practical application in the twentieth century. (shrink)
Student nurses are confronted by many ethical challenges in clinical practice. The aim of the study was to explore Malawian students’ experiences of ethical problems during their clinical placement. A phenomenological hermeneutic design comprising interviews and qualitative content analysis was used. Ten students were interviewed. Three main themes emerged: 1) Conflict between patient rights and the guardians’ presence in the hospital; 2) Conflict between violation of professional values and patient rights caused by unethical behaviour; and 3) Conflict between moral awareness (...) and the ideal course of action. The students had difficulties ensuring patient rights and acting in accordance with western norms and values which are not always appropriate in the Malawian context. The students require role models who demonstrate professional attitudes towards patients’ rights and values. There is a need to create pedagogical strategies in which a caring attitude and ethical reflection can be learned and cultivated in clinical practice. (shrink)
This paper seeks to define and delimit the scope of the social responsibilities of health professionals in reference to the concept of a social contract. While drawing on both historical data and current empirical information, this paper will primarily proceed analytically and examine the theoretical feasibility of deriving social responsibilities from the phenomenon of professionalism via the concept of a social contract.
In order to protect patients against medical paternalism, patients have been granted the right to respect of their autonomy. This right is operationalized first and foremost through the phenomenon of informed consent. If the patient withholds consent, medical treatment, including life-saving treatment, may not be provided. However, there is one proviso: The patient must be competent to realize his autonomy and reach a decision about his own care that reflects that autonomy. Since one of the most important patient rights hinges (...) on the patient's competence, it is crucially important that patient decision making incompetence is clearly defined and can be diagnosed with the greatest possible degree of sensitivity and, even more important, specificity. Unfortunately, the reality is quite different. There is little consensus in the scientific literature and even less among clinicians and in the law as to what competence exactly means, let alone how it can be diagnosed reliably. And yet, patients are deemed incompetent on a daily basis, losing the right to respect of their autonomy. In this article, we set out to fill that hiatus by beginning at the very beginning, the literal meaning of the term competence. We suggest a generic definition of competence and derive four necessary conditions of competence. We then transpose this definition to the health care context and discuss patient decision making competence. (shrink)
This short comment on the Court of Protection decision in W v M draws attention to the primacy the judge gave to the preservation of life and discusses the relative lack of weight accorded to M's previously expressed views.
The legalization of euthanasia, both in the Netherlands and in other countries is usually justified in reference to the right to autonomy of patients. Utilizing recent Dutch jurisprudence, this article intends to show that the judicial proceedings on euthanasia in the Netherlands have not so much enhanced the autonomy of patients, as the autonomy of the medical profession. Keywords: allowing to die, criminal law, euthanasia, law enforcement, legal aspects, legislation, medical ethics, medical profession, self determination, the Netherlands, voluntary euthanasia, withholding (...) treatment CiteULike Connotea Del.icio.us What's this? (shrink)
In the literature three mechanisms are commonly distinguished to make decisions about the care of incompetent patients: A living will, a substituted judgment by a surrogate (who may or may not hold the power of attorney ), and a best interest judgment. Almost universally, the third mechanism is deemed the worst possible of the three, to be invoked only when the former two are unavailable. In this article, I argue in favor of best interest judgments. The evermore common aversion of (...) best interest judgments entails a risk that health care providers withdraw from the decision-making process, abandoning patients (or their family members) to these most difficult of decisions about life and death. My approach in this article is primarily negative, that is, I criticize the alleged superiority of the living will and substituted judgment. The latter two mechanisms gain their alleged superiority because they are supposedly morally neutral, whereas the best interest judgment entails a value judgment on behalf of the patient. I argue that on closer inspection living wills and substituted judgments are not morally neutral; indeed, they generally rely on best interest judgments, even if those are not made explicit. (shrink)
Increasingly, contemporary medical ethicists have become aware of the need to explicate a foundation for their various models of applied ethics. Many of these theories are inspired by the apparent incompatibility of patient autonomy and provider beneficence. The principle of patient autonomy derives its current primacy to a large extent from its legal origins. However, this principle seems at odds with the clinical reality. In the bioethical literature, the notion of authenticity has been proposed as an alternative foundational principle to (...) autonomy. This article examines this proposal in reference to various existentialist philosophers (Heidegger, Sartre, Camus and Marcel). It is concluded that the principle of autonomy fails to do what it is commonly supposed to do: provide a criterion of distinction that can be invoked to settle moral controversies between patients and providers. The existentialist concept of authenticity is more promising in at least one crucial respect: It acknowledges that the essence of human life disappears from sight if life's temporal character is reduced to a series of present decisions and actions. This also implies that the very quest for a criterion that allows physicians to distinguish between sudden, unexpected decisions of their patients to be or not to be respected, without recourse to the patient's past or future, is erroneous. (shrink)
This article examines whether cosmetic interventions by dentists and plastic surgeons are medically indicated and, hence, qualify as medical interventions proper. Cosmetic interventions (and the business strategies used to market them) are often frowned upon by dentists and physicians. However, if those interventions do not qualify as medical interventions proper, they should not be evaluated using medical-ethical norms. On the other hand, if they are to be considered medical practice proper, the medical-ethical principles of nonmaleficence, beneficence, justice and others hold (...) true for cosmetic interventions as much as they do for other medical and dental interventions. It is concluded that most cosmetic interventions do not qualify as medical interventions proper because they do not restore or maintain the patient's health (defined as the patient's integrity) by any objective standards. Rather, cosmetic interventions are intended to enhance a person's physical appearance; more specifically, they intend to fulfill the client's subjective perception of an enhanced appearance. (shrink)
This article provides a summary overview of the ideas on medical anthropology and anthropological medicine of the German philosopher-psychiatrist Viktor Emil von Gebsattel (1883–1974), and discusses in more detail his views on the doctor-patient relationship. It is argued that Von Gebsattel''s warning against a dehumanization of medicine when the person of both patient and physician are not explicitly present in their relationship remains valid notwithstanding the modern emphasis on respect for patient (and provider) autonomy.
In this article, I argue that the relationship between patients and their health care providers need not be construed as a contract between moral strangers. Contrary to the (American) legal presumption that health care providers are not obligated to assist others in need unless the latter are already contracted patients of record, I submit that the presence of a suffering human being constitutes an immediate moral commandment to try to relieve such suffering. This thesis is developed in reference to the (...) French philosopher Levinas and the Dutch theologian Schillebeeckx. An expanded version of the biblical parable of the Good Samaritan serves as test case. (shrink)
In the face of managed care and market economies infringing on the practice of medicine, reducing its autonomy and determining the moral guidelines for medical practice, many physicians are calling out for a return to what is perceived as a traditional medical ethic. Many religiously motivated critics of certain modern developments in medicine have made similar appeals. These calls are best understood as an attempt to define medicine as a practice that is necessarily ethical in nature, a practice the moral (...) basis of which is internal to that practice. This article examines and assesses this definition of medicine in reference to Aristotle's division of human undertakings into three distinct categories: theory, poieisis (i.e., production), and praxis. It is concluded that medicine can be understood as a praxis (as opposed to a theory or production, both of which are morally neutral), because the practice of medicine, and all of its constitutive acts, can only be explained and assessed in reference to health, which is itself a final good and hence of moral value. Such an understanding would immunize medicine against usurpation by the free market. However, by the same token it would also dissociate medicine from all other moralities external to it, including those grounded in faith and religion. (shrink)
On one side of his sign board, a nineteenth century surgeon depicted a physician operating on a patient's leg; the other side showed the Good Samaritan taking care of the victim's wounds. Christ's parable has often been quoted and depicted as a primary example of human compassion, to be followed by all persons and, a fortiori, by so-called professionals such as physicians and nurses. If we grant that the parable has not lost its narrative power for 20th century “postmodern” readers (...) living in a “pluralistic” society, it merits a closer analysis. (shrink)
Ideas of activity are widely used in the contemporary literature on psychology and methodology. It seems that everyone understands well what is being said. Nevertheless, one can claim that there is a methodological problem in connection with the idea of activity. Various researchers not only interpret activity differently but, what is more important, assess of the place of this category in knowledge differently. From the perspective of some researchers, activity is one way of describing and explaining reality. Others believe that (...) the category of activity presents reality itself, that there is nothing but activity. If we adhere to the former point of view, we can raise the question, for example, of studying certain types of activity, as V.V. Davydov does. (shrink)
The struggle for peace and social progress was and remains a strategic policy of the Soviet state. As the General Secretary of the CPSU Central Committee, M.S. Gorbachev, stated it at the Extraordinary March Plenum of the Central Committee, it is now vital to reach agreement "on an immediate end to the arms race—particularly nuclear arms—on earth and the banning of it in space.".
Though Joseph Nadler published the definitive, critical edition of Hamanns' complete works, the hermetic character of these texts warrants only too strongly a publication of at least the major texts with commentaries. The annotated edition is planned to comprise eight volumes. From the viewpoint of the history of ideas, Vol. IV is undoubtedly the most interesting, since it contains the important texts on the origin of language. These were directly provoked by Herder's famous Abhandlung über den Ursprung der Sprache; "the (...) Magician of the North" fights the spirit of the Aufklärung even when it is clothed in the more attractive, pre-romantic setting of Herder's prose. Besides a fantastic amount of notes and commentary, Miss Büchsel, the editor of Vol. IV, offers a comprehensive and penetrating introductory study. Especially important are the chapters on the "pre-history" of Hamanns' Herder-interpretation and its influence on the later development of German intellectual life from the early Goethe to the old Schelling Vol. V contains the so-called mystery-writings directly pertinent to the Christian doctrine of the revelation of the Incarnated Son of God. These texts are truly esoteric, and even the multitude of notes accompanying them cannot always fully overcome their terrible obscurity. And here arises the only objection against this edition. The notes and commentaries are a mine of detailed information, and they "unconceal" the meaning of every word. Yet perhaps their very abundance impedes their stated purpose. They do help in understanding the words, but they make sustained reading of the texts themselves impossible. The encyclopedical character of the notes is cause for both exasperation and for growth in knowledge and inspiration.—M. J. V. (shrink)
Friedrich Schlegel is known above all as a man of letters and political interests, while his philosophical opus has received as yet a very limited interest and attention. Perhaps this new critical edition will enable him to carve a small niche for himself in forthcoming histories of philosophy. He was certainly not the most significant thinker; but his imagination, many-sidedness, sharpness, and his unmistakable speculative gift qualify him to be in the second rank of Romantic philosophers immediately after Schelling and (...) Baader. The young Friedrich Schlegel was thoroughly under the spell of Fichte, but his later development—notwithstanding personal antipathy—carried him close to Schelling. The ethical pathos of Fichte's doctrine could not make Schlegel overlook the injustice done to nature, art, and religion. Though his celebrated conversion to Catholicism in the Dom of Cologne did not take place until 1838, Schlegel read Jacob Boehme and was a close friend of Schleiermacher, and thus was absorbed by religious problems years before. Already in his Cologne lectures he goes beyond the vague idealistic concept of the "divinity" in favor of a personal and transcendent God. These two volumes of the critical edition contain the following texts: Transzendentalphilosophie, lectures in Jena from 1800-1801. The text is the one published by J. Körner in 1935. The Development of Philosophy in Twelve Books and Propedeutic and Logic. The texts in Propedeutic and Logic are of a general introductory character. But in The Development of Philosophy a tremendous effort is made to give, if not an entirely systematic, at least a quasi-all-embracing, encyclopedic sketch of philosophy and its history. Here again we read nothing substantially new. The editor follows the text published by Windischmann in 1836 but does complete it with variants from other manuscripts. Métaphysique. These lectures were delivered in French to Madame de Staël. In addition to an already known text published by J. Körner the editor makes use of a manuscript in the hand of Schlegel which was found only after the last war. The preface of J.-J. Anstett is ascetically short and even the commentary consists only of sober and learned notes at the end of the second volume.—M. J. V. (shrink)
This is the first good book on the early Schelling since Metzger's study in 1911. What is more, it is an entirely novel interpretation of this first and most productive decade of Schelling's philosophizing. The central thesis is that Schelling's fundamental intuition had always been that of the concrete and particular character of all reality. Reality is a whole and everything real is a whole: an actual closed totality. Even in this most Fichtean period, Schelling did not really accept the (...) transcendental position, and the philosophy of nature allowed him to expand his vision of the concrete into rich and complex constructions. This is a view which one occasionally encounters in other critical writings on Schelling, but it is usually overpowered by the accumulated Hegelian prejudice concerning Schelling's "dogmatism" and "abstract formalism." It is therefore heartening to see the author, without any polemics, challenging the Hegelians on their own favorite hunting-ground: the arid pastures of the philosophy of identity. Although the author does not fully document her findings, and although the System of Transcendental Idealism is almost totally neglected, the book is undoubtedly an important event. It may even signal the opening of new research into the early Schelling. It is immensely useful--and encouraging--for a number of scholars working on the Ages of the World and on the positive philosophy: it helps them to see the continuity in the six decades of Schelling's philosophizing.--M. J. V. (shrink)