There is a need for empirically based research on social and ethical challenges related to informed consent processes, particularly in studies focusing on adolescent sexual and reproductive health. In a pilot study of a school-based pregnancy prevention intervention in rural Zambia, the majority of the guardians who were asked to consent to their daughters’ participation, refused. In this paper we explore the reasons behind the low participation in the pilot with particular attention to challenges related to the community engagement and (...) informed consent process. The pilot was implemented in two schools and examined the acceptability of a package of interventions including economic support to families to keep their girls in school, pocket money for girls, youth club meetings on reproductive health, and community meetings to sensitize the community. Focus group discussions were conducted with girls who participated in the pilot, boys in their class and with parents. Individual semi-structured interviews were conducted with teachers, peer educators and community health workers involved in the coordination of the intervention as well as with religious and traditional leaders. Data were analyzed through thematic analysis. The findings indicate that inadequate use of recognized community communication channels during the community engagement process and dissemination of information about the pilot resulted in limited understanding of the pilot concept by the community. This surfaced through uncertainty and fear that the intervention may result in loss of control over daughters, worries about why money was provided unconditionally to girls, and suspicion of links to satanism. The sense of insecurity appeared to be exacerbated by low literacy levels, poverty, fear of loss of bride wealth, perceived disregard for local perceptions of social status, and scanty trust in the actors implementing the pilot. Inadequate use of locally appropriate channels in the dissemination of information created room for interpretation and facilitated development of mistrust, undermining the conditions for community engagement and actual informed consent. A key lesson learnt is the importance of taking seriously the complexity of local values and structures that may impact people’s capability to consent or not consent to a study in an informed manner. (shrink)

Name der Zeitschrift: Semiotica Jahrgang: 2018 Heft: 225 Seiten: 457-487.

There is currently an evidentiary gap in the scholarship concerning medical tourism's impact on low- and middle-income destination countries (LMICs). This article reviews relevant evidence that exists and concludes that there are signs of correlation between medical tourism and the expansion of private, technology- intensive health care in LMICs, which has largely remained out of reach for the majority of the local patients. In light of this health care inequity between local residents and medical tourists in LMICs, we argue that (...) the presumption should not be in favor of medical tourism and that governments have a legitimate interest in seeking to regulate this industry to ensure that the net effects for their citizens is positive. Moreover, sending countries, particularly those in the developed world, have the responsibility to adopt public policies to diminish demand on the part of their citizens for medical tourism and to work with LMICs to ensure that the growth of medical tourism does not occur at the expense of the poorest of the poor. (shrink)

Travelling internationally to acquire medical treatments otherwise unavailable or inaccessible in one’s home country is not a novel concept. Conventionally, such medical travel largely entailed patients from developed countries or wealthy patients from the developing world seeking care in Western facilities like the Mayo Clinic in the U.S. and myriad private clinics along Harley Street in London, England. What is different about the topical phenomenon known as “medical tourism” is the growing trend of health services export in the opposite direction. (...) The number of patients travelling from the developed world to low- and middle-income countries for treatments has ballooned in recent years, primarily driven by difficulties with accessing affordable care at home. According to a liberal estimate by the Deloitte Center for Health Solutions, the number of Americans travelling abroad for care rose from 750,000 in 2007 to 1.6 million in 2012. On the flip side, Thailand reportedly treated a total of 1.3 million foreign nationals in 2007, which represented a 16% leap from 2001. (shrink)

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

It is time for the noon conference. Your job is to impart a career-changing experience in ethics to a group of students and interns gathered from four different schools with varying curriculums in ethics. They have just finished 1½ h of didactic sessions and lunch. One third of them were on call last night. Your first job is to keep them awake. The authors argue that this “tragic case” approach to ethics education is of limited value because it limits understanding (...) of moral problems to dilemmas; negates the moral agency of the student; encourages solutions that are merely intellectual; and suggests that ethical encounters are a matter for experts. The authors propose an alternative that focuses on three issues: the provider-patient relationship, the relationships between providers in the everyday world of health work and, the social position of healthcare providers in society. In this approach, teachers are not experts but more like guides on a journey who help students to learn that much of ethical practice comprises living through difficult situations of caring for vulnerable others and who help students to navigate some of these difficulties. (shrink)

The structure of our ethical experience depends, crucially, on a fundamental distinction between what we are responsible for doing or deciding and what is given to us. As such, the boundary between chance and choice is the spine of our conventional morality, and any serious shift in that boundary is thoroughly dislocating. Against this background, I analyze the way in which techniques of prenatal genetic diagnosis (PGD) pose such a fundamental challenge to our conventional ideas of justice and moral responsibility. (...) After a short description of the situation, I first examine the influential luck egalitarian theory of justice, which is based on the distinction between choice and luck or, more specifically, between option luck and brute luck, and the way in which it would approach PGD (section II), followed by an analysis of the conceptual incoherencies (in section III) and moral problems (in section IV) that come with such an approach. Put shortly, the case of PGD shows that the luck egalitarian approach fails to express equal respect for the individual choices of people. The paradox of the matter is that by overemphasizing the fact of choice as such, without regard for the social framework in which they are being made, or for the fundamental and existential nature of particular choices—like choosing to have children and not to undergo PGD or not to abort a handicapped fetus—such choices actually become impossible. (shrink)

Since the beginning of history humans have attempted to represent nature and culture through mimesis. This article focuses on the teleologicalaspects of mimesis and offers a different perspective that transcends the notion of sustainability into an eco-humanistic metamorphosis of culture and nature.Drawing from semiotics, phenomenology and architectural design the article challenges the polarization of mimetic representations of nature and culture,which are inclusive and homomorphic phenomena, and offers insight into the mutual mimesis of nature and culture. Two different empirical observationssubstantiate the (...) theoretical perspective: 1) a tradition advanced by the Egyptians’ stylization of visual representations of the mimicry of nature and culture; and 2) acurrent architectural design activity that integrates the mimesis of nature and culture. The article makes the case for a theoretical approach that integratesmimetic principles in creating a sustainable environment and an authentic ecoliving. The article concludes with ethical implications on the way we perceive themutual resemblances in nature and culture, and on our semiotic understanding of the teleological aspects of mimesis. (shrink)

Maran ha-g. R. A. Y. L. Shṭinman z. ts. ṿe-ḳ.l. -- Rabotenu meʼore ha-dor -- Ḳiyum ha-ʻolam ʻa. y. Torah be-mishnat rabotenu -- Maran Rabi Gedalyah Aizman z. ts. ṿe-ḳ.l.

For a world mired in catastrophe, nothing could be more urgent than the question of survival. In this theoretically and methodologically groundbreaking book, Adam Y. Stern calls for a critical reevaluation of survival as a contemporary regime of representation. In Survival, Stern asks what texts, what institutions, and what traditions have made survival a recognizable element of our current political vocabulary. The book begins by suggesting that the interpretive key lies in the discursive prominence of "Jewish survival." Yet the Jewish (...) example, he argues, is less a marker of Jewish history than an index of Christianity's impact on the modern, secular, political imagination. With this inversion, the book repositions Jewish survival as the supplemental effect and mask of a more capacious political theology of Christian survival. The argument proceeds by taking major moments in twentieth-century philosophy, theology, and political theory as occasions for collecting the scattered elements of survival's theological-political archive. Through readings of canonical texts by secular and Jewish thinkers—Hannah Arendt, Walter Benjamin, Franz Rosenzweig, and Sigmund Freud—Stern shows that survival belongs to a history of debates about the sovereignty and subjection of Christ's body. Interrogating survival as a rhetorical formation, the book intervenes in discussions about biopolitics, secularism, political theology, and the philosophy of religion. (shrink)

Several defences, viewed in this study as specifications or 'offspring' of the 'parent' greater-good defence, have been formulated in response to the charge that Christianity is untenable because God's existence is incompatible with evil's existence. In this first book-length study of the parent defence, Stewart begins with careful definitions of the omni-attributes central to the dispute: omnipotence, omniscience, omnibenevolence. The parent defence is traced to tenets of theism and variant accounts of the defence considered. Plantinga's modal free-will defence and Hick's (...) and Yandell's soul-growth specifications are carefully analyzed and several difficulties resolved. An original formulation of a redemption specification and an original account of the origin of moral evil are offered. Stewart argues that the defences are rightly viewed as a family of defences falling under the greater-good heading, and that they comprise a complementary apologetic complex that refutes the claim of inconsistency. (shrink)

Transparency is a salutary value in our constitutional architecture. It has also been described as a necessary element in promoting accountability in the regulatory aspects of essential medicines. Despite its several incarnations, the Medicines and Related Substances Act (Medicines Act) retains a provision headed 'Preservation of secrecy' (section 34). This contributionseeks to evaluate section 34 in the context of transparency and ascertain whether it is in conflict with other legislation pertaining to the promotion of access to information and, in particular, (...) whether it is consistent with the Constitution of the Republic of South Africa. (shrink)

In this article, I examine Luhmann’s, Bunge’s and others’ views on emergence, and argue that Luhmann’s epistemological construal of emergence in terms of Totalausschluss (total exclusion) is both ontologically flawed and detrimental to an appropriate understanding of the distinctive features of social emergence. By contrast, Bunge’s rational emergentism, his CESM model, and Wimsatt’s characterization of emergence as nonaggregativity provide a useful framework to investigate emergence. While researchers in the field of social theory and sociology tend to regard Luhmann as the (...) sole representative of systems theory, the latter has been characterized by its diversity, and the writings of such systems theorists as Mario Bunge deserve more (critical) attention from social researchers than they receive at present. Finally, this article suggests that the perennial debate over methodological individualism and holism in social science may make real progress if such ambiguous terms as reduction and reductionism are elucidated before they are employed. (shrink)

The American Journal of Bioethics, Volume 12, Issue 3, Page 37-39, March 2012.

We show that the lattices of the normal extensions of four well-known logics—propositional intuitionistic logic \, Grzegorczyk logic \, modalized Heyting calculus \ and \—can be joined in a commutative diagram. One connection of this diagram is an isomorphism between the lattices of the normal extensions of \ and \; we show some preservation properties of this isomorphism. Two other connections are join semilattice epimorphims of the lattice of the normal extensions of \ onto that of \ and of the (...) lattice of the normal extensions of \ onto that of \. The link between \ and \ is a well-known isomorphism established by the Blok–Esakia theorem. (shrink)

The study of the relationship between religion and health has grown substantially in the past decade. There is little doubt that religion plays an important role in many people's lives and that this has an impact on their health. The question is how researchers and clinicians can best evaluate the available information and how we can improve upon the current findings. In this essay we review the current knowledge regarding religion and health and also critically review issues pertaining to methodology, (...) findings, and interpretation of these studies. It is important to maintain a rigorous perspective with regard to such studies and also to recognize inherent limitations and suggest constructive ways in which to advance this field of study. In the end, such an approach can provide new information that will improve our understanding of the overall relationship between religion and health. (shrink)

This book offers a new perception and reading of one of the most well-known documents of Indian philosophy and theology, Sankara's Brahmasutrabhasya. the author's presentation of the self as a subject free of any trace of (disturbungly ...

Venneman and colleagues argue that “do not resuscitate” (DNR) is problematic and should be replaced by “allow natural death” (AND). Their argument is flawed. First, while end-of-life discussions should be as positive as possible, they cannot and should not sidestep painful but necessary confrontations with morality. Second, while DNR can indeed be nonspecific and confusing, AND merely replaces one problematic term with another. Finally, the study’s results are not generalisable to the populations of physicians and working nurses and certainly do (...) not support the authors’ claim that there is a movement to replace DNR with AND. (shrink)

BACKGROUND: Health-based journal clubs have been in place for over 100 years. Participants meet regularly to critique research articles, to improve their understanding of research design, statistics and critical appraisal. However, there is no standard process of conducting an effective journal club. We conducted a systematic literature review to identify core processes of a successful health journal club. METHOD: We searched a range of library databases using established keywords. All research designs were initially considered to establish the body of evidence. (...) Experimental or comparative papers were then critically appraised for methodological quality and information was extracted on effective journal club processes. RESULTS: We identified 101 articles, of which 21 comprised the body of evidence. Of these, 12 described journal club effectiveness. Methodological quality was moderate. The papers described many processes of effective journal clubs. Over 80% papers reported that journal club intervention was effective in improving knowledge and critical appraisal skills. Few papers reported on the psychometric properties of their outcome instruments. No paper reported on the translation of evidence from journal club into clinical practice. CONCLUSION: Characteristics of successful journal clubs included regular and anticipated meetings, mandatory attendance, clear long- and short-term purpose, appropriate meeting timing and incentives, a trained journal club leader to choose papers and lead discussion, circulating papers prior to the meeting, using the internet for wider dissemination and data storage, using established critical appraisal processes and summarizing journal club findings. (shrink)

This book, an exploration of the work of Leibnitz, is Ortega’s most systematic contribution to philosophy. Ortega begins with a detailed definition of a principle and with an examination of the specific principles formulated by Leibnitz. He goes on to examine Leibnitz. He goes on to examine Leibnitz’s complex and mercurial attitudes towards principles and discusses the effects of these attitudes on his philosophy and on contributions to mathematics and logic.

This article demonstrates the possibilities and problems of the formation of a new type of human‐technique‐nature relationship ‐ the organic technique ‐ in modern civilization. It is a relationship in which neither human nor nature must adapt to the needs of technology; rather, the technique is embedded in nature and becomes 'human-sized'. We can find a model for building this new type of relationship in the construction of buildings from bamboo. The uniqueness of bamboo as a building material manifests in (...) two ways. The first relates to resources: bamboo is a very fast-growing plant, so cutting it's stem does not destroy the plant itself and in three to four years there is a new 'harvest'. This means bamboo has an extremely low cost, which is critical for developing countries with rapidly growing populations. Second, bamboo has a number of architectural advantages. Due to the flexibility and elasticity of this product, bamboo buildings are earthquake resistant. Such structures do not violate the natural landscape, but instead work with it; they are characterized by low cost and ease of construction, in a variety of forms. This has led to the widespread use of bamboo by leading architects and innovators from different countries. This article shows that the application of bamboo in architecture ‐ as opposed to artificial materials such as concrete, which exploit and destroy nature and impose their forms on cultures ‐ helps this building technique to integrate into the life of ecosystems and society, and thus to become a model of harmonizing human‐technique‐nature relations. (shrink)

Background: Financial conflict of interest in clinical research is an area of active debate. While data exist on the perspectives and roles of academic institutions, investigators, industry sponsors, and scientific journals, little is known about the perspectives of potential research participants.Methods: The authors surveyed potential research participants over the internet, using the Harris Interactive Chronic Illness Database. A potential research participant was defined by: self report of diagnosis by a health care professional and willingness to participate in clinical trials. Email (...) invitations were sent to 20 205 persons with coronary artery disease, breast cancer, or depression; a total of 6363 persons were screened; of these, 86% or 5478 met inclusion criteria and completed the survey. The outcome measures were respondents’ ratings on: importance of knowing conflict of interest information, whether its disclosure ought to be required, and its effect on willingness to participate—across seven widely discussed scenarios of financial conflicts of interest .Results: Majority responded that knowing conflict of interest information was “extremely” or “very” important; a larger majority felt financial conflicts of interest should be disclosed as part of informed consent . In all seven scenarios, a majority was still willing to participate but in some scenarios a sizable minority would be wary of participation. Respondents were more wary of individual than institutional conflicts of interest. Illness group and sociodemographic factors had modest effects and did not affect the main trends.Conclusions: The prevailing practice of non-disclosure of financial conflicts of interest in clinical research appears contrary to the values of potential research participants. (shrink)