All articles in May 2019’s special issue of Bioethics offer profound insights into the issue of “being a burden to others” in relation to wishes to die, which are highly relevant for ethical debates about end‐of‐life care and physician‐assisted dying. In this reply, we wish to stress the importance of acknowledging and analyzing the sociopolitical context of the phenomenon “being a burden” in relation to wishes to die and we will show how this analysis could (...) benefit from a care ethical approach. As discussions in care ethics have made clear, caring practices are both social and political practices. An empirical and ethical analysis of “being a burden” therefore needs to take institutional and societal norms and structures into account, in addition to first‐person experiences and concepts such as caring needs, relational autonomy, and interdependency. Besides the relevance of the sociopolitical context for the phenomenon “being a burden” as such, the sociopolitical context also seems relevant for the investigation of the phenomenon, which we will illustrate by reflecting on “being a burden” in relation to the practice of physician‐assisted dying in the Netherlands. (shrink)

The article explores the underlying reasons for patients’ self‐perception of being a burden (SPB) in family settings, including its impact on relationships when wishes to die (WTD) are expressed. In a prospective, interview‐based study of WTD in patients with advanced cancer and non‐cancer disease (organ failure, degenerative neurological disease, and frailty) SPB was an important emerging theme. In a sub‐analysis we examined (a) the facets of SPB, (b) correlations between SPB and WTD, and (c) SPB as a relational (...) phenomenon. We analyzed 248 interviews with 62 patients, their family caregivers, and professionals using grounded theory and interpretive phenomenological analysis. SPB appeared as important empathic concern in care situations. Patients expressed many sorts of concerns for others, but also perceived an altered self‐understanding that did not meet mutual expectations within relationships. In SPB associated with WTD three constellations were found: (a) WTD to unburden others; (b) patients decided against hastening death to prevent being a further burden to others (in these cases, the SPB counteracted the wish to die); and (c) both wishes for and against dying were sustained by SPB. These patients often felt paralyzed and suffered deeply. Family caregivers felt emotionally touched by SPB and tried to unburden patients by caring and compassion. We concluded that the impact of SPB on a WTD and the various meanings the facets of SPB have in balancing relationships need to be worked out individually. An early palliative and narrative approach is warranted. (shrink)

This article is an analysis of the relationship between US hospice structure and the feeling of being a burden to others. A goal of US hospice care is to reduce the FBO. But in America, hospice is limited in its ability to do so because of the high caregiver burden it places on family members of dying people. Through a historical study, I show that this burden was excessive when the hospice system was created and (...) has worsened over time. Through three ethnographic vignettes, I demonstrate how this burden inculcates in dying people the FBO. I then examine the bioethical implications of this finding for the existing US debate about physician-assisted suicide. The presence of FBO due to insufficient hospice care supports arguments made by PAS opponents about the social pressure placed on dying people. This finding is not itself sufficient to resolve the “right to die” debate. But it provides the ground for a compromise, across the debate, to reduce the FBO by changing US hospice structure. The resulting consensus will further the goals of both PAS proponents and opponents. (shrink)

This article is an analysis of the relationship between US hospice structure and the feeling of being a burden to others. A goal of US hospice care is to reduce the FBO. But in America, hospice is limited in its ability to do so because of the high caregiver burden it places on family members of dying people. Through a historical study, I show that this burden was excessive when the hospice system was created and (...) has worsened over time. Through three ethnographic vignettes, I demonstrate how this burden inculcates in dying people the FBO. I then examine the bioethical implications of this finding for the existing US debate about physician-assisted suicide. The presence of FBO due to insufficient hospice care supports arguments made by PAS opponents about the social pressure placed on dying people. This finding is not itself sufficient to resolve the “right to die” debate. But it provides the ground for a compromise, across the debate, to reduce the FBO by changing US hospice structure. The resulting consensus will further the goals of both PAS proponents and opponents. (shrink)

This article is an analysis of the relationship between US hospice structure and the feeling of being a burden to others. A goal of US hospice care is to reduce the FBO. But in America, hospice is limited in its ability to do so because of the high caregiver burden it places on family members of dying people. Through a historical study, I show that this burden was excessive when the hospice system was created and (...) has worsened over time. Through three ethnographic vignettes, I demonstrate how this burden inculcates in dying people the FBO. I then examine the bioethical implications of this finding for the existing US debate about physician-assisted suicide. The presence of FBO due to insufficient hospice care supports arguments made by PAS opponents about the social pressure placed on dying people. This finding is not itself sufficient to resolve the “right to die” debate. But it provides the ground for a compromise, across the debate, to reduce the FBO by changing US hospice structure. The resulting consensus will further the goals of both PAS proponents and opponents. (shrink)

Ein Argument gegen die ärztliche Beihilfe zum Suizid lautet, Patienten könnten sich um Suizidassistenz bemühen, weil sie sich als Belastung empfinden. Dabei wird die Selbstbestimmtheit eines so motivierten Todeswunsches in Frage gestellt. Ist dieses Argument überzeugungskräftig? Empirische Daten zeigen, dass die ärztliche Beihilfe zum Suizid auf der Grundlage dieses Motivs den ethischen Prinzipien der Sorge um das Patientenwohl und des Respekts vor der Autonomie des Patienten nicht widersprechen muss. Denn das Empfinden, anderen zur Last zu fallen, kann trotz adäquater palliativmedizinischer (...) Betreuung wesentlich zu einem Leidensdruck am Lebensende beitragen. Zudem ist dieses Motiv eng verknüpft mit der Sorge um das Wohl der Angehörigen, die einer erheblichen Belastungssituation ausgesetzt sein können. Da aber das Wohlergehen der Familie zu den elementaren Werten von schwerstkranken Patienten am Lebensende gehört, kann der Wunsch nach ärztlicher Beihilfe zum Suizid auch auf der Basis dieses Motivs Ausdruck eines selbstbestimmten Patientenwillens sein. Andererseits korreliert das Empfinden, anderen zur Last zu fallen, mit einer depressiven Verstimmung. Dieser Zusammenhang ist deshalb relevant, da bei depressiven Störungen eine Einschränkung der Selbstbestimmungsfähigkeit vorliegen kann. Vor diesem Hintergrund sind Zweifel an der Selbstbestimmtheit eines so motivierten Sterbewunsches durchaus begründet. Aufgrund des bestehenden Wissensdefizits bei der Feststellung der Selbstbestimmungsfähigkeit ist die Mitwirkung des Arztes bei einem so motivierten Todeswunsch daher ethisch fragwürdig. (shrink)

Ein Argument gegen die ärztliche Beihilfe zum Suizid lautet, Patienten könnten sich um Suizidassistenz bemühen, weil sie sich als Belastung empfinden. Dabei wird die Selbstbestimmtheit eines so motivierten Todeswunsches in Frage gestellt. Ist dieses Argument überzeugungskräftig? Empirische Daten zeigen, dass die ärztliche Beihilfe zum Suizid auf der Grundlage dieses Motivs den ethischen Prinzipien der Sorge um das Patientenwohl und des Respekts vor der Autonomie des Patienten nicht widersprechen muss. Denn das Empfinden, anderen zur Last zu fallen, kann trotz adäquater palliativmedizinischer (...) Betreuung wesentlich zu einem Leidensdruck am Lebensende beitragen. Zudem ist dieses Motiv eng verknüpft mit der Sorge um das Wohl der Angehörigen, die einer erheblichen Belastungssituation ausgesetzt sein können. Da aber das Wohlergehen der Familie zu den elementaren Werten von schwerstkranken Patienten am Lebensende gehört, kann der Wunsch nach ärztlicher Beihilfe zum Suizid auch auf der Basis dieses Motivs Ausdruck eines selbstbestimmten Patientenwillens sein. Andererseits korreliert das Empfinden, anderen zur Last zu fallen, mit einer depressiven Verstimmung. Dieser Zusammenhang ist deshalb relevant, da bei depressiven Störungen eine Einschränkung der Selbstbestimmungsfähigkeit vorliegen kann. Vor diesem Hintergrund sind Zweifel an der Selbstbestimmtheit eines so motivierten Sterbewunsches durchaus begründet. Aufgrund des bestehenden Wissensdefizits bei der Feststellung der Selbstbestimmungsfähigkeit ist die Mitwirkung des Arztes bei einem so motivierten Todeswunsch daher ethisch fragwürdig. (shrink)

Studies that have explored the wish to hasten death (WTHD) in patients with advanced illness have found that the feeling of being a burden may trigger WTHD. Research suggests that both the feeling and the wish are indicators of multidimensional suffering whose meaning may depend on the patient's biographical background. Therefore, we carried out a systematic review and meta‐ethnography. Fourteen qualitative studies, reported in 16 articles, met the inclusion criteria. The analysis identified two themes: the personal and social (...) dimensions that could help to explain the feeling of being a burden in these patients. These dimensions reveal how this feeling is linked to physical, psychological/emotional, existential and social factors. The feeling of being a burden cannot be understood without considering patients’ personal interpretation of their dependency or care needs, and hence it is also necessary to understand their biographical background. Such an understanding is crucial to inform clinical policies based on the moral duty to provide all patients with humane care. (shrink)

Patients at the end of their life who express a wish to die sometimes explain their wish as the desire not to be a burden to others. This feeling needs to be investigated as an emotion with an intrinsically dialogical structure. Using a phenomenological approach, two key meanings of the feeling of being a burden to others as a reason for a wish to die are identified. First, it is an existential suffering insofar as it (...) contains the perception of a plight so desperate that it can only be relieved by the end of the patient’s existence. Second, it is an empathic concern that implies caring about those who bear the burden of caring for the person at the end of their life. It is therefore a moral emotion, encompassing a series of difficulties, including the subjective perception of a stark imbalance between giving and taking, the adequacy of the representation of the caregiver burden in the patient’s mind, and the danger of diminishing the worth of one’s life out of shame or self‐denigration. R. D. Laing’s terminology of crossed perspectives in interexperience is used to systematically distinguish the actual caregiver burden, the patient’s view of the caregiver burden, the stress for the patient in feeling that s/he is a burden to the caregiver, and the caregiver’s view of the patient’s stress. The sense of being a burden implies the belief that the caregiver feels burdened, and the fear that this burden could become unbearable. (shrink)

Objective: To explore the experiences of people with a “terminal illness”, focusing on the patients’ perspective of euthanasia and assisted suicide.Method: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a “terminal” illness, malignant or non-malignant.Results: That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly (...) by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse.Conclusion: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death. (shrink)

Objectives To evaluate whether the requirement of “minimal risk and burden” for paediatric research without direct benefit to the subjects compromises the ability to obtain data necessary for improving paediatric care. To provide evidence-based reflections on the EU recommendation that allows for a higher level of risk. Design and setting Systematic analysis of the approval/rejection decisions made by the Dutch Central Committee on Research involving Human Subjects (CCMO). Review methods The analysis included 165 proposals for paediatric research without direct (...) benefit that were reviewed by the CCMO between January, 2000, and July, 2007. A separate, in-depth analysis of all drug studies included 18 early phase drug studies and nine other drug studies without direct benefit. Results 11 out of 165 studies were definitively rejected because the CCMO did not regard the risk and/or burden to be minimal. In three of these 11 cases (including two early phase drug studies) the requirement of minimal risk and burden was cited as the only reason for rejection. Four other early phase drug studies also involved risks and/or burdens that were not regarded to be minimal but were nevertheless approved. Conclusions The requirement of minimal risk and burden, aiming to protect research subjects, occasionally leads to rejection of protocols. Early phase drug studies relatively often do not comply with the requirement. Committees may find ways to approve important studies that formally should be rejected, but that is not a desirable solution. The regulatory framework should be revised to make such occasional exceptions to the requirement legitimate and transparent. (shrink)

University based academic Research Ethics Boards (REB) face the particularly difficult challenge of trying to achieve representation from a variety of disciplines, methodologies and research interests. Additionally, many are currently facing another decision – whether to have students as REB members or not. At Ryerson University, we are uniquely situated. Without a medical school in which an awareness of the research ethics review process might be grounded, our mainly social science and humanities REB must also educate and foster awareness of (...) the ethics review process throughout the academic community. Our Board has had and continues to have students as active members. While there are challenges to having students as Board members, these are clearly outweighed by the advantages, for both the academic community and the future of ethically sound research in the social sciences and humanities. Moreover, the challenges are often based on misconceptions and can be easily overcome through increased education and understanding of the research ethics review process by the academic community at large. The purpose of this paper is to describe and discuss the experiences, advantages and challenges of having students as REB members. The advantages of having students as REB members include the following: (1) Students are the proposed participants in many of our reviewed protocols and student members may illuminate unique issues of participation. (2) Students are active and highly engaged members of the REB. (3) Having students on the REB enhances awareness of research ethics within the University. (4) Student REB members have an opportunity to mentor other students and provide leadership for both undergraduate and graduate students. (5) Students are more vigorously recruited than faculty members and often apply for student positions with enthusiasm and preparation. (6) In creating an atmosphere of excellence in research, engaging students at the beginning of their research career will help in creating tomorrow’s leaders in research and research ethics. The challenges of having students as REB members include the following: (1) Faculty members may be uneasy regarding the prospect of students reviewing protocols. (2) Faculty members may be concerned about confidentiality and respect with students reviewing faculty research protocols. (3) There may be an increased burden for students who serve as members on an REB. (4) There is concern that students will offer less continuous service to the REB. (5) There is a common misconception that students do not have the experience to carry out ethical reviews. While there are challenges from faculty members and others regarding having students as REB members, these challenges are often based on misconceptions about the nature of the REB work and the ethics review process in general. These challenges are also often based on the misconception of the ethics review process as one of peer review and evaluation, instead of a community-based and inclusive process. Having student members is a long-term strategy for both overcoming the misconceptions of the REB as a “necessary evil” and for fostering an awareness of the imperative for ethically sound research in the social sciences and humanities. (shrink)

This article draws attention to the limited amount of scholarship on what constitutes fairness and equity in resource allocation to health research by individual funders. It identifies three key decisions of ethical significance about resource allocation that research funders make regularly and calls for prioritizing scholarship on those topics – namely, how health resources should be fairly apportioned amongst public health and health care delivery versus health research, how health research resources should be fairly allocated between health problems experienced domestically (...) versus other health problems typically experienced by disadvantaged populations outside the funder's country, and how domestic and non-domestic health research funding should be further apportioned to different areas, e.g. types of research and recipients. These three topics should be priorities for bioethics research because their outcomes have a substantial bearing on the achievement of health justice. The proposed agenda aims to move discussion on the ethics of health research funding beyond its current focus on the mismatch between worldwide basic and clinical research investment and the global burden of disease. Individual funders’ decision-making on whether and to what extent to allocate resources to non-domestic health research, health systems research, research on the social determinants of health, capacity development, and recipients in certain countries should also be the focus of ethical scrutiny. (shrink)

The possibility of cloning human beings raises the difficult question: Which human lives have value and deserve legal protection? Current cloning legislation tries to hide the problem by illegitimately renaming the entities and processes in question. The Delaware cloning bill, (SB55 2003/2004) for example, permits and protects the creation of human embryos by cloning, as long as they will be destroyed for research and therapeutic purposes, but it adopts terminology which renders its import unclear. I show that, in the case (...) of cloning legislation, the burden of proof is on those who would adopt new terminology, and it has not been met. (shrink)

As support for clinical ethics committees in the UK grows, care must be taken to define their function, membership and method of working and the status of their decisions.The modern practice of medicine raises a plethora of complex issues—medical, ethical and legal. Doctors and other healthcare professionals increasingly must try to resolve these and may sometimes have to do so in the face of contrary opinion expressed by patients and/or their surrogates. While clearly qualified in the medical arena, and although (...) there is now more ethics teaching in the medical curriculum, healthcare professionals are seldom qualified to adjudicate on ethical or legal matters, or even, perhaps, to recognise them when they arise. Yet, as Doyal says, “clinical life must go on and moral and legal indeterminacy within medicine cries out for practical resolution.”1 Meanwhile, the expectations of patients and their families—and, indeed, of wider society—are that decisions about patient care, resources and therapeutic regimes should be soundly based on appropriate ethicolegal, as well as scientific, principle.Recognition of these additional burdens on healthcare professionals has generated some interest in the provision of ethics consultation. In the USA this has been undertaken by a variety of tribunals and individuals. Hospital ethics committees and ethics consultants feature in many US hospitals and perform a variety of roles. In Europe, a number of countries have also established clinical ethics committees and they are becoming more common in the UK—primarily in England and Wales for the moment. Whereas, however, “[i]n North America, CECs have … become an integral part of the organisational infrastructure of hospitals ...”,1 in the United Kingdom they remain essentially ad hoc bodies, generated for a variety of reasons and with different goals, structures, membership, methods of working and functions. The initial impetus for the …. (shrink)

The growing support for voluntary active euthanasia is evident in the recently approved Dutch Law on Termination of Life on Request. Indeed, the debate over legalized VAE has increased in European countries, the United States, and many other nations over the last several years. The proponents of VAE argue that when a patient judges that the burdens of living outweigh the benefits, euthanasia can be justified. If some adults suffer to such an extent that VAE is justified, then one may (...) conclude that some children suffer to this extent as well. In an attempt to alleviate the suffering of extremely ill neonates, the University Medical Center Groningen developed a protocol for neonatal euthanasia. In this article, I first present the ethical justifications for VAE and discuss how these arguments relate to euthanizing ill neonates. I then argue that, even if one accepts the justification for VAE in adults, neonatal euthanasia cannot be supported, primarily because physicians and parents can never accurately assess the suffering of children. I argue that without the testament of the patient herself as to the nature and magnitude of her suffering, physicians can never accurately weigh the benefits and burdens of a child’s life, and therefore any such system would condemn to death some children whose suffering is not unbearable. I conclude that because the primary duty of physicians is to never harm their patients, neonatal euthanasia cannot be supported. (shrink)

The notion of being a burden to others is mostly discussed in the context of care‐intensive diseases or end‐of‐life decisions. But the notion is also crucial in decision‐making at the beginning of life, namely regarding prenatal testing. Ever more sophisticated testing methods, especially non‐invasive prenatal testing (NIPT), allow the detection of genetic traits in the unborn child that may cause disabilities. A positive result often influences the decision of the pregnant women towards a termination of the pregnancy. (...) Thus, critics claim that these testing methods send a negative message to people with disabilities. At the core of this is what we call the burden assumption. This assumption claims that children with disabilities are necessarily a burden to others, especially to their parents and other family members. In this paper, we discuss what being a burden to others means in this context and how such an attitude can be avoided without restraining reproductive autonomy. A closer examination shows that the burden assumption is mostly based on misinformation and a false model of disability. Empirical studies as well as narrative evidence from parents who raise a child with disabilities show that the burden assumption is wrong. Raising a child with disabilities does not necessarily mean a decrease in the quality of life. We show how the burden assumption can be challenged through an advanced genetic counselling that combines empirical evidence with narratives from a first‐person perspective. (shrink)

The emphasis on the limitations of objectivity, in specific guises and networks, has been a continuing theme of contemporary analytic philosophy for the past few decades. The popular sport of baiting feminist philosophers — into pointing to what's left out of objective knowledge, or into describing what methods, exactly, they would offer to replace the powerful objective methods grounding scientific knowledge — embodies a blatant double standard which has the effect of constantly putting feminist epistemologists on the defensive, on the (...) fringes, on the run.This strategy can only work if objectivity is transparent, simple, stable, and clear in its meaning. It most certainly is not. In fact, taking objectivity as a sort of beautiful primitive, self-evident in its value, and all-powerful in its revelatory power, requires careless philosophy, and the best workers in metaphysics, epistemology, and philosophy of science have made reworked definitions of objectivity absolutely central to their own projects. In fact, classic feminist concerns with exploring the impact of sex and gender on knowledge, understanding, and other relations between human beings and the rest of the world fall squarely within the sort of human and social settings thatare already considered central in most current analytic metaphysics, epistemology, and philosophy of science. I argue that the burden of proof is clearly on those who wish toreject the centrality and relevance of sex and gender to our most fundamental philosophical work on knowledge and reality. (shrink)

It could be argued that tort law is failing, and arguably an example of this failure is the recent public liability and insurance (‘PL&I’) crisis. A number of solutions have been proposed, but ultimately the chosen solution should address whatever we take to be the cause of this failure. On one account, the PL&I crisis is a result of an unwarranted expansion of the scope of tort law. Proponents of this position sometimes argue that the duty of care owed by (...) defendants to plaintiffs has expanded beyond reasonable levels, such that parties who were not really responsible for another’s misfortune are successfully sued, while those who really were to blame get away without taking any responsibility. However people should take responsibility for their actions, and the only likely consequence of allowing them to shirk it is that they and others will be less likely to exercise due care in the future, since the deterrents of liability and of no compensation for accidentally self-imposed losses will not be there. Others also argue that this expansion is not warranted because it is inappropriately fueled by ‘deep pocket’ considerations rather than by considerations of fault. They argue that the presence of liability insurance sways the judiciary to award damages against defendants since they know that insurers, and not the defendant personally, will pay for it in the end anyway. But although it may seem that no real person has to bear these burdens when they are imposed onto insurers, in reality all of society bears them collectively when insurers are forced to hike their premiums to cover these increasing damages payments. In any case, it seems unfair to force insurers to cover these costs simply because they can afford to do so. If such an expansion is indeed the cause of the PL&I crisis, then a contraction of the scope of tort liability, and a pious return to the fault principle, might remedy the situation. However it could also be argued that inadequate deterrence is the cause of this crisis. On this account the problem would lie not with the tort system’s continued unwarranted expansion, but in the fact that defendants really have been too careless. If prospective injurers were appropriately deterred from engaging in unnecessarily risky activities, then fewer accidents would ever occur in the first place, and this would reduce the need for litigation at its very source. If we take this to be the cause of tort law’s failure then our solution should aim to improve deterrence. Glen Robinson has argued that improved deterrence could be achieved if plaintiffs were allowed to sue defendants for wrongful exposure to ongoing risks of future harm, even in the absence of currently materialized losses. He argues that at least in toxic injury type cases the tortious creation of risk [should be seen as] an appropriate basis of liability, with damages being assessed according to the value of the risk, as an alternative to forcing risk victims to abide the outcome of the event and seek damages only if and when harm materializes. In a sense, Robinson wishes to treat newly-acquired wrongful risks as de-facto wrongful losses, and these are what would be compensated in liability for risk creation (‘LFRC’) cases. Robinson argues that if the extent of damages were fixed to the extent of risk exposure, all detected unreasonable risk creators would be forced to bear the costs of their activities, rather than only those who could be found responsible for another’s injuries ‘on the balance of probabilities’. The incidence of accidents should decrease as a result of improved deterrence, reduce the ‘suing fest’, and so resolve the PL&I crisis. So whilst the first solution involves contracting the scope of tort liability, Robinson’s solution involves an expansion of its scope. However Robinson acknowledges that LFRC seems prima facie incompatible with current tort principles which in the least require the presence of plaintiff losses, defendant fault, and causation to be established before making defendants liable for plaintiffs’ compensation. Since losses would be absent in LFRC cases by definition, the first evidentiary requirement would always be frustrated, and in its absence proof of defendant fault and causation would also seem scant. If such an expansion of tort liability were not supported by current tort principles then it would be no better than proposals to switch accident law across to no-fault, since both solutions would require comprehensive legal reform. However Robinson argues that the above three evidentiary requirements could be met in LFRC cases to the same extent that they are met in other currently accepted cases, and hence that his solution would therefore be preferable to no-fault solutions as it would only require incremental but not comprehensive legal reform. Although I believe that actual losses should be present before allowing plaintiffs to seek compensation, I will not present a positive argument for this conclusion. My aim in this paper is not to debate the relative merits of Robinson’s solution as compared to no-fault solutions, nor to determine which account of the cause of the PL&I crisis is closer to the truth, but rather to find out whether Robinson’s solution would indeed require less radical legal reform than, for example, proposed no-fault solutions. I will argue that Robinson fails to show that current tort principles would support his proposed solution, and hence that his solution is at best on an even footing with no-fault solutions since both would require comprehensive legal reform. (shrink)

Background: Chronic Pain (CP) has serious medical and social consequences, and leads to economic burden that threatens the sustainability of healthcare services. Thus, optimized management of pain tools to support CP patients in adjusting to their condition and improving quality of life is timely. Although Acceptance and Commitment Therapy (ACT) is considered an evidence-based psychological approach for CP, evidence for the efficacy of online-delivered ACT for CP is still scarce. At the same time, studies suggest that self-compassion mediates the (...) change in disability and psychopathological symptoms in ACT interventions for CP, although self-compassion is not a specific target in ACT. Thus, an explicit focus on self-compassion might increase the efficacy of ACT interventions for CP, although this hypothesis has not been tested. This study aims to develop an eHealth ACT and compassion-based self-management intervention for CP, the iACTwithPain, and to compare its efficacy in improving health outcomes to a similar ACT-only intervention and a waiting list group. Methods: The eHealth platform that will host the interventions will be developed using a flat design identity and will be interactive. The iACTwithPain intervention will comprise 8 weekly self-management sessions, and will be developed taking into consideration the psychological flexibility model applied to CP, with the addition of explicit compassion-based components. To analyse whether the iACTwithPain intervention will present superiority in improving CP’s impact and related health markers over the two other conditions, this study will follow a RCT design with three arms. CP patients will be recruited through direct contact with patient associations and healthcare services and a national press release in Portugal. Outcome measurement will be conducted at baseline, post-intervention and at 3- and 6-months follow-ups. The interventions’ acceptability will also be assessed. Discussion: The iACTwithPain intervention is expected to improve CP patients’ psychosocial functioning, quality of life, and empowerment, by promoting adaptive disease management and regulation of pain-related internal experiences. Results will contribute to a better understanding on the pertinence of adding compassion elements to ACT for CP and to reach an optimized intervention for CP. (shrink)

Abstractabstract:Recent clinical trials of psychedelic drugs aim to treat a range of psychiatric conditions in adults. MDMA and psilocybin administered with psychotherapy have received FDA designation as "breakthrough therapies" for post-traumatic stress disorder (PTSD) and treatment-resistant depression (TRD) respectively. Given the potential benefit for minors burdened with many of the same disorders, calls to expand experimentation to minors are inevitable. This essay examines psychedelic research conducted on children from 1959 to 1974, highlighting methodological and ethical flaws. It provides ethics and (...) policy recommendations for psychedelics research involving children and adolescents, including recognizing that the psychedelic experience is an ineffable one that makes informed proxy consent for parents, guardians, and others especially challenging. Psychedelic experiences are associated with novel benefits and risks, such as significant personality changes, shifts in fundamental values, and possible re-exposure to traumatic memories. These effects may alter the process of personality development in minors. Recommendations for ethically sound psychedelics research in minors include strict adherence to eligibility criteria, including a comprehensive family and individual psychiatric, substance use, and trauma history. An age-appropriate assent process that includes considerations related to the use of therapeutic touch should be developed. In addition, oversight by data safety monitoring boards and patient and family advocates, coupled with the adoption of pharmacoequity best practices, will help to ensure safety and fairness of psychedelics research in children. (shrink)

While vaccination rates in the United States are high — generally over 90 percent — rates of exemptions have been going up, and preventable diseases coming back. Aside from their human cost and the financial cost of treatment imposed on those who become ill, outbreaks impose financial costs on an already burdened public health system, diverting resources from other areas. This article examines the financial costs of non-vaccination, showing how high they can be and what they include. It makes a (...) case for requiring those who do not vaccinate to cover the costs of outbreak caused by their choice. Such recouping is justified because the choice not to vaccinate can easily be seen as negligent. But even if it is not, that choice involves imposing costs on others, and there are good reasons to require the actors to internalize those costs. The article proposes alternative statutory and regulatory schemes to cover the costs imposed on the public purse, focusing on no-fault mechanisms. We consider both ex ante mechanisms like a tax or a fee that will go into a no-fault fund to cover the costs and ex post mechanisms like a statutory authorization for recoupment of those costs by health officials. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

Despite recent advances in HIV prevention and treatment, high HIV incidence persists among people who inject drugs. Difficult legal and political environments and lack of services for PWID likely contribute to high HIV incidence. Some advocates question whether any HIV prevention research is ethically justified in settings where healthcare system fails to provide basic services to PWID and where implementation of research findings is fraught with political barriers. Ethical challenges in research with PWID include concern about whether research evidence will (...) be translated into practice; concerns that research might exacerbate background risks; and ethical challenges regarding the standard of HIV prevention in research. While these questions arise in other research settings, for research with PWID, these questions are especially controversial. This paper analyses four ethical questions in determining whether research could be ethically acceptable: Can researchers ensure that research does not add to the burden of social harms and poor health experienced by PWID? Should research be conducted in settings where it is uncertain whether research findings will be translated into practice? When best practices in prevention and care are not locally available, what standard of care and prevention is ethically appropriate? Does the conduct of research in settings with oppressive policies constitute complicity? We outline specific criteria to address these four ethical challenges. We also urge researchers to join the call to action for policy change to provide proven safe and effective HIV prevention and harm reduction interventions for PWID around the world. (shrink)

In the twenty-first century, the debate about life on other worlds is quickly changing from the realm of speculation to the domain of hard science. Within a few years, as a consequence of the rapid discovery by astronomers of planets around other stars, astronomers very likely will have discovered clear evidence of life beyond the Earth. Such a discovery of extraterrestrial life will change everything. Knowing the answer as to whether humanity has company in the universe will trigger one of (...) the greatest intellectual revolutions in history, not the least of which will be a challenge for at least some terrestrial religions. Which religions will handle the discovery of extraterrestrial life with ease and which will struggle to assimilate this new knowledge about our place in the universe? Some religions as currently practiced appear to only be viable on Earth. Other religions could be practiced on distant worlds but nevertheless identify both Earth as a place and humankind as a species of singular spiritual religious importance, while some religions could be practiced equally well anywhere in the universe by any sentient beings. Weintraub guides readers on an invigorating tour of the world's most widely practiced religions. It reveals what, if anything, each religion has to say about the possibility that extraterrestrial life exists and how, or if, a particular religion would work on other planets in distant parts of the universe. (shrink)

Some have objected to the laboratory cloning of human preembryos on the grounds that the procedure would violate the dignity of and respect owed to human preembryos. Others have argued that human cloning ought be permitted if it will predictably benefit, or at least not burden, individuals who are, unlike the human preembryo, clearly entitled to our respect and concern. Taking this latter position, the legal theorist John A. Robertson has argued that, since cloning does not harm anyone (...) who is clearly entitled to our respect and concern, it should be permitted. In particular, the offspring of cloning, he argues, cannot be genuinely harmed by cloning, since they owe their very existence to the cloning procedure. In this paper, I argue that cloning coupled with its related procedures does in fact place the flesh and blood human offspring of cloning at risk of genuine harm. I thus provide a basis for questioning the moral permissibility of cloning and its related technologies without implying that the human preembryo has dignity or is owed respect. (shrink)

Purpose. To examine the existential anthropology of G. Marcel and E. Minkowski, in order to demonstrate the necessity of distinguishing the universal-spiritual, as human in human being, apart from the individual-existential in him, and to reveal the hierarchical correlation of biosocial, existential and spiritual spheres in personality. Theoretical basis. Within existential philosophy the author differentiates two separate traditions and proceeds from the insufficiency of the distinction of existential sphere, proposed by phenomenological tradition, showing the necessity of its correlation with (...) the spiritual sphere as a sphere of humanity, proposed by non-phenomenological tradition of G. Marcel and E. Minkowski. Originality. The author presents the anthropological conception of G. Marcel and E. Minkowski, in which human personality is understood as unity of individual-existential and universal-spiritual, which requires a special trans-empirical field of culture, which contains senses, images and symbols of humanity. Also, the author presents the recent developments of existential thinkers in distinguishing existential and spiritual dimensions, both not reducible to the physical and social dimensions. Conclusions. In both existential traditions, the specifically human was founded as a trans-biological and trans-social phenomenon, which appears as indefinable and non-predetermined. But in first tradition, humanity is understood as an existence, as a unique individuality, "project", variant of humanity, equivalent to other variants, and universal is understood as a community of human condition in the world. While in the second tradition, the universal is understood as spiritual. Thus, horizontal level of our private existence, as the process of movement from birth to death, is supplemented by vertical of human, universal ideals and images. Humanity appears as a task, on the way to which human being transcends beyond the limits of his individual "self" to the "super-individual", through inclusion into spiritual community, into universal culture. (shrink)

Hundreds of thousands of individuals experience traumatic injuries each year. Some are mild to moderate in nature and patients experience full functional recovery and little change to their physical appearance. Others result in enduring, if not permanent, changes in physical functioning and appearance. Reconstructive plastic surgical procedures are viable treatments options for many patients who have experienced the spectrum of traumatic injuries. The goal of these procedures is to restore physical functioning and reduce the psychosocial burden of living (...) with an appearance that may be viewed negatively by the patient or by others. Even after receipt of reconstructive procedures, many patients are left with residual disfigurement. In some, disability and disfigurement may be so profound that individuals are candidates for vascularized composite allotransplantation procedures, i.e., the transplantation of a vascularized human body part containing multiple tissue types as an anatomical and/or structural unit. This narrative review paper summarizes the literature on the psychosocial burden experienced by those who have visible disfigurement. While many of these individuals experience stigma and discrimination, relatively few studies have employed a stigma framework to understand the psychosocial sequelea. This paper briefly addresses this framework. Last, particular focus is given to the psychosocial issues of individuals with particularly severe injuries who are potential candidates for VCA procedures. (shrink)

CRISPR‐Cas technology accelerates development of fast, accurate, and portable diagnostic tools, typified by recent applications in COVID‐19 diagnosis. Parasitic helminths cause devastating diseases afflicting 1.5 billion people globally, representing a significant public health and economic burden, especially in developing countries. Currently available diagnostic tests for worm infection are neither sufficiently sensitive nor field‐friendly for use in low‐endemic or resource‐poor settings, leading to underestimation of true prevalence rates. Mass drug administration programs are unsustainable long‐term, and diagnostic tools – required to (...) be rapid, specific, sensitive, cost‐effective, and user‐friendly without specialized equipment and expertise – are urgently needed for rapid mapping of helminthic diseases and monitoring control programs. We describe the key features of the CRISPR‐Cas12/13 system and emphasise its potential for the development of effective tools for the diagnosis of parasitic and other neglected tropical diseases (NTDs), a key recommendation of the NTDs 2021–2030 roadmap released by the World Health Organization. (shrink)

John Rawls is widely regarded as one of the most influential philosophers of the twentieth century, and his work has permanently shaped the nature and terms of moral and political philosophy, deploying a robust and specialized vocabulary that reaches beyond philosophy to political science, economics, sociology, and law. This volume is a complete and accessible guide to Rawls' vocabulary, with over 200 alphabetical encyclopaedic entries written by the world's leading Rawls scholars. From 'basic structure' to 'burdened society', from 'Sidgwick' to (...) 'strains of commitment', and from 'Nash point' to 'natural duties', the volume covers the entirety of Rawls' central ideas and terminology, with illuminating detail and careful cross-referencing. It will be an essential resource for students and scholars of Rawls, as well as for other readers in political philosophy, ethics, political science, sociology, international relations and law. (shrink)

For nearly twenty-five years, federal regulation of privacy issues in research involving human subjects was the primary province of the federal rule for Protection of Human Subjects. As of April 14, 2003, the compliance date for the Privacy Rule of the Health Insurance Portability and Accountability Act, however, the Common Rule and the Privacy Rule jointly regulate research privacy. Although, in theory, the Privacy Rule is intended to complement the Common Rule, there are several areas in which the rules diverge. (...) In some instances the inconsistencies result in gaps in privacy protection; in other instances the inconsistencies result in added burdens on researchers without additional privacy protections. In all instances, the lack of harmonization of these rules has created confusion, frustration, and misunderstanding by researchers, research subjects, and institutional review boards. In this article, I review the major provisions of the Privacy Rule for research, explain the areas in which the Privacy Rule and Common Rule differ, and conclude that the two rules should be revised to promote consistency and maximize privacy protections while minimizing the burdens on research. (shrink)

For nearly twenty-five years, federal regulation of privacy issues in research involving human subjects was the primary province of the federal rule for Protection of Human Subjects. As of April 14, 2003, the compliance date for the Privacy Rule of the Health Insurance Portability and Accountability Act, however, the Common Rule and the Privacy Rule jointly regulate research privacy. Although, in theory, the Privacy Rule is intended to complement the Common Rule, there are several areas in which the rules diverge. (...) In some instances the inconsistencies result in gaps in privacy protection; in other instances the inconsistencies result in added burdens on researchers without additional privacy protections. In all instances, the lack of harmonization of these rules has created confusion, frustration, and misunderstanding by researchers, research subjects, and institutional review boards. In this article, I review the major provisions of the Privacy Rule for research, explain the areas in which the Privacy Rule and Common Rule differ, and conclude that the two rules should be revised to promote consistency and maximize privacy protections while minimizing the burdens on research. (shrink)

The U.S. Department of Health and Human Services has proposed substantial changes to the current regulatory system governing human subjects research in its Advanced Notice of Proposed Rulemaking, entitled “Human Subjects Research Protections: Enhancing Protections for Research Subjects and Reducing Burden, Delay, and Ambiguity for Investigators.” Some of the most significant proposed changes concern the use of biospecimens in research. Because research involving biological materials begins with an initial interaction with an individual, such research falls squarely within the human (...) subjects research regulatory framework known as the “Common Rule,” which applies to research conducted or funded by the HHS and the other signatory agencies and departments. However, as described in detail below, much biospecimen research may fall within exemptions and exceptions under the Common Rule and, thus, may be conducted without consent. The ANPRM proposes requiring written consent for research use of biospecimens, even if the biospecimens were initially collected for a purpose other than research or have been stripped of identifiers. (shrink)

Advances in science and technology have created a plethora of medical therapies in various forms including drugs, devices, and equipment. Many of these therapies are not curative, however, and patients sometimes find themselves being more burdened than benefited by them. These situations result in ethical dilemmas for which the bioethicist is sometimes consulted to resolve. Using philosophical principles of maximizing good, minimizing harm, being just, and respecting the values of others, the bioethicist counsels patients, families, and hospital (...) personnel, sometimes functioning as advocate, arbitrator, negotiator, mediator, and teacher. (shrink)

Advances in science and technology have created a plethora of medical therapies in various forms including drugs, devices, and equipment. Many of these therapies are not curative, however, and patients sometimes find themselves being more burdened than benefited by them. These situations result in ethical dilemmas for which the bioethicist is sometimes consulted to resolve. Using philosophical principles of maximizing good, minimizing harm, being just, and respecting the values of others, the bioethicist counsels patients, families, and hospital (...) personnel, sometimes functioning as advocate, arbitrator, negotiator, mediator, and teacher. (shrink)

ABSTRACT The just distribution of benefits and burdens of healthcare, at least in the contemporary Philippine context, is an issue that gravitates towards two opposing doctrines of welfarism and ‘free enterprise.’ Supported largely by popular opinion, welfarism maintains that social welfare and healthcare are primarily the responsibility of the government. Free enterprise (FE) doctrine, on the other hand, maintains that social welfare is basically a market function and that healthcare should be a private industry that operates under competitive conditions with (...) minimal government control. I will examine the ethical implications of these two doctrines as they inform healthcare programmes by business and government, namely: (a) the Devolution of Health Services and (b) the Philippine Health Maintenance Organization (HMO). I will argue that these doctrines and the health programmes they inform are deficient in following respects: (1) equitable access to healthcare, (2) individual needs for premium healthcare, (3) optimal utilisation of health resources, and (4) the equitable assignment of burdens that healthcare entails. These respects, as considerations of justice, are consistent with an operational definition of ‘power’ proposed here as ‘access to and control of resources.’. (shrink)

Eleven previously published essays presenting a moderately unified argument in favor of the general conception of what Jonas calls the "Philosophy of Life," as well as detailed arguments pointing in the direction of a non-dualistic, realistic, and non-naturalistic philosophy of mind. The "nons" are deliberately placed, as Jonas spends the better part of the book questioning the tenability of dualistic and, especially, materialistic and mechanistically oriented theories of mind. With extraordinary historical sensitivity—at times threatening to dissolve a problem by laying (...) bare the conceptual confusions which surrounded its origins—and with a better than working knowledge of biology and physiology, not to mention anthropology, Jonas argues, on the one hand, that the clues to the dynamism and structure of mind are to be found in such organic features as sentience, motility, and emotion: e.g., the conceptual strands that unite in the notions of causality and truth are rooted in the respective experiences of force and resistance, and vision. On the other hand, Jonas argues for the irreducibility of the subject-object structure of man's relation to nature on the grounds that this is the necessary burden of subjectivity. In all, the book is an impressive performance.—E. A. R. (shrink)

The Pacific Islands are estimated to have among the highest global burdens of hearing loss, however, hearing health services are limited throughout this region. The provision of hearing aid is desirable, but should be delivered in accordance with WHO recommendations of appropriate and locally sustainable services. Large-scale hearing aid donation programmes to the Pacific Islands raise ethical questions that challenge these recommendations.The aim of this paper is to consider the ethical implications of large-scale hearing aid donation programmes to Samoa, a (...) nation of the Pacific Islands. Evaluation of both ‘Western’ and ‘Pacific Island’ perspectives reveals important cross-cultural differences regarding attitudes to donation programmes. We attempt to offer possible solutions that satisfy both ethical frameworks, and which should enable us to deliver an effective hearing health service for Samoa. These solutions may be translational and benefit other Pacific Island nations in a similar context. (shrink)

Alcohol use disorder is a burden to society creating social and health problems. Detection of AUD and its effects on the brain are difficult to assess. This problem is enhanced by the comorbid use of other substances such as nicotine that has been present in previous studies. Recent machine learning algorithms have raised the attention of researchers as a useful tool in studying and detecting AUD. This work uses AUD and controls samples free of any other substance use to (...) assess the performance of a set of commonly used machine learning classifiers detecting AUD from resting state functional network connectivity derived from independent component analysis. The cohort used included 51 alcohol dependent subjects and 51 control subjects. Despite alcohol, none of the 102 subjects reported use of nicotine, cannabis or any other dependence or habit formation substance. Classification features consisted of whole brain rsFNC estimates undergoing a feature selection process using a random forest approach. Features were then fed to 10 different machine learning classifiers to be evaluated based on their classification performance. A neural network classifier showed the highest performance with an area under the curve of 0.79. Other good performers with similar AUC scores were logistic regression, nearest neighbor, and support vector machine classifiers. The worst results were obtained with Gaussian process and quadratic discriminant analysis. The feature selection outcome pointed to functional connections between visual, sensorimotor, executive control, reward, and salience networks as the most relevant for classification. We conclude that AUD can be identified using machine learning classifiers in the absence of nicotine comorbidity. (shrink)

A key public health measure has received far too little attention over the course of the Covid‐19 pandemic: paid sick leave policies that encourage people at risk of spreading disease to stay home rather than come to work. The United States is one of the only developed countries that fails to guarantee paid sick leave at the federal level, leaving a patchwork of state and private policies that undersupply time off when people are contagious and protect top wage earners at (...) wildly disproportionate rates compared with what workers with lower incomes experience. Other countries have shown that sick leave mandates are neither unjustified burdens on employers nor gratuitous giveaways to employees. In fact, sick leave saves on health care costs by making employees less likely to infect coworkers, to be absent for longer themselves, or to need treatment in expensive hospital emergency departments. Nationally guaranteed sick leave is urgently needed to promote public health. (shrink)

Philosophical counselling, Ran Lahav and others claim, helps clients deepen their philosophical self‐understanding. The counsellor's role is the minimalist one of providing the client with the philosophical tools needed for reflective self‐evaluation. Respect for the client's autonomy entails refraining from intervening with substantive moral criticism, theories, and methods; the client's ways of working out fundamental questions like ‘Who am I and what do I really want?’cannot be assessed by the counsellor in terms of their truth‐value, but only in terms (...) of whether they reflect the client's autonomous choice to express him/herself in a certain way. I argue that this view, which is informed by an anti‐realist account of self and life‐history, undermines the distinction between self‐knowledge and self‐deception. Once interpretive and criteriological free rein is given to the client, and once personal, pragmatic and aesthetic considerations take precedence over truth‐value, then the way is left open to clients to generate the most morally convenient self‐interpretation to suit their current needs. I defend the view that truth matters in philosophical counselling; more specifically, that there is a basic distinction between true and false forms of self‐understanding. To do this, I offer a broadly realist account of self and reflective self‐evaluation. If this is right, then philosophical counsellors shoulder a significant burden of responsibility in helping their clients achieve an accurate, defensible, action‐guiding and truth‐oriented self‐understanding. (shrink)

Over the past decade there has been a burgeoning of work in philosophy of religion that has drawn upon and been oriented by “continental” sources in philosophy—associated with figures such as Martin Heidegger, Jacques Derrida, Emmanuel Levinas, Jean-Luc Marion, Gilles Deleuze, and others. This is a significant development and one that should be welcomed by the community of Christian philosophers. However, in this dialogue piece I take stock of the field of “continental philosophy of religion” and suggest that the (...) field is developing some un-healthy patterns and habits. The burden of the paper is to suggest a prescription for the future health of this important field by articulating six key practices that should characterize further scholarship in continental philosophy of religion. (shrink)

Philosophers of language have lavished attention on names and other singular referring expressions. But they have focused primarily on what might be called lexicalsemantic character of names and have largely ignored both what I call the lexicalsyntactic character of names and also what I call the pragmatic significance of the naming relation. Partly as a consequence, explanatory burdens have mistakenly been heaped upon semantics that properly belong elsewhere. This essay takes some steps toward correcting these twin lacunae. When we properly (...) distinguish that which belongs to the lexical-syntactic character of names, from that which belongs to the lexical semantic character of names, from that which rests on the pragmatics of the naming relation, we lay to rest many misbegotten claims about names and their presumed semantic behavior. For example, though many believe that Frege’s puzzle about the possibility of informative identity statements motivates a move away from a referentialist semantics for names, I argue that the very possibility of Frege cases has its source not in facts about the lexical-semantic character of names but in facts about the lexical-syntax of the naming relation. If I am right, Frege cases as such are insufficient to justify the introduction of the distinction between sense and reference. In a similar vein, I offer a new diagnosis of the widely misdiagnosed felt invalidity of the substitution of coreferring names within propositional attitude contexts. That felt invalidity has been taken 1 to justify the conclusion that an embedded referring expression must be playing some semantic role either different from or additional to its customary semantic role of standing for its reference. I argue, to the contrary, that failures of substitutivity have their source not in the peculiar semantic behavior of embedded expressions but entirely in certain pragmatic principles. (shrink)

Over the past decade, teaching and learning in virtual worlds has been at the forefront of many higher education institutions around the world. The DEHub Virtual Worlds Working Group (VWWG) consisting of Australian and New Zealand higher education academics was formed in 2009. These educators are investigating the role that virtual worlds play in the future of education and actively changing the direction of their own teaching practice and curricula. 47 academics reporting on 28 Australian higher education institutions present an (...) overview of how they have changed directions through the effective use of virtual worlds for diverse teaching and learning activities such as business scenarios and virtual excursions, role-play simulations, experimentation and language development. The case studies offer insights into the ways in which institutions are continuing to change directions in their teaching to meet changing demands for innovative teaching, learning and research in virtual worlds. This paper highlights the ways in which the authors are using virtual worlds to create opportunities for rich, immersive and authentic activities that would be difficult or not possible to achieve through more traditional approaches. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Christians and Buddhists: Together in HopeCardinal Francis ArinzeDear Buddhist Friends,1. On the occasion of Vesakh, which celebrates important events in the life of Buddha, I wish to express to you, in my capacity as president of the Pontifical Council for Interreligious Dialogue, the best wishes of Catholics throughout the world.2. I am happy to say that ongoing dialogue between Buddhists and Christians is distinguished by efforts to meet at (...) the level of religious experience. Both Buddhism and Christianity emphasize the “contemplative dimension” in their practice of religion. Since 1979, through the “Intermonastic Spiritual Exchange” and the “Monastic Hospitality Programme,” Buddhists and Christians who are committed to a contemplative life through their respective monastic disciplines have engaged in encounters where in-depth dialogue is possible. This effort is truly commendable.3. It is hope of new life that has been at the source of our dialogue, although our understanding of this new life differs. For us Christians, the new life is to be sought and found only in Jesus Christ. Jesus indicated the way when he said: “I am the way, the truth and the life” (John 14:6). He taught us not only not to engage in revenge, but to defeat evil with good. He said: “You have learnt how it was said: Eye for eye and tooth for tooth. But I say this to you: offer the wicked man no resistance. On the contrary, if anyone hits you on the right creek, offer him the other as well” (Matthew 5:38–39). This makes me think of Ven. Maha Ghosananda’s rendering of one of the teachings of Buddha: “When we are wronged, we must set aside all resentment and say, ‘My mind will not be disturbed. Not one angry word will escape from my lips; I will remain kind and friendly, with loving thoughts and no secret malice.’”4. Hope rescues us from discouragement. We are enabled to begin anew by perceiving around us numerous “signs of hope”: the growing solidarity among people in our time, especially with the poor and destitute, the desire for justice and peace, voluntary service, the return of the search for transcendence, an awareness of human dignity and of the rights that flow from it, attention to the environment, and so on. I wish to mention here a particular sign of hope, which Pope John Paul II has underlined—namely, interreligious dialogue.5. People of hope are, at the same time, realists who do not close their eyes to reality with all its positive and negative aspects. We cannot turn a blind eye to the [End Page 199] dramatic crises of our world: the wars between different countries, civil wars, terrorism in all its forms, injustice that is forever widening the gap between rich and poor, hunger, the lack of shelter, unemployment—especially among the youth, globalization without solidarity, the heavy burden of external debt, the problem of drugs, immorality, abortion. The list could be extended. Nevertheless, the small lamp of hope must always remain alight, shining on the paths leading humanity to a better future.6. We Christians and Buddhists, embarked on our respective spiritual paths, can work together to give increased hope to humanity. Yet first we must accept our differences and show each other mutual respect and true love. This will render us more credible, and we shall be for humanity a further sign of hope in addition to those that exist already.7. It is in this spirit that I convey to you once again, dear Buddhist friends, my best wishes for the feast of Vesakh.Cardinal Francis ArinzePontifical Council for Interreligious DialogueCopyright © 1999 The University of Hawai’i Press... (shrink)

The present piece focuses on the influence of Plotinus' understanding of time and eternity as articulated in Plotinus' third and fifth Enneads upon Mīr Dāmād's (d. 1631–2) conception of eternity, perpetuity, and time found in his Book of Blazing Brands (Kitab al‐Qabasāt). Although Mīr Dāmād's conception of eternity, perpetuity, and time resembles that of Plotinus' cosmology and ontology, he departs from Plotinus' hypostases in establishing strict parameters for each domain. Unlike Plotinus, Mīr Dāmād argues that the realm of eternity is (...) reserved for God alone, while the realm of Perpetuity contains the Platonic Forms. For Mīr Dāmād, the realm of time is an effect of the realm of Perpetuity and a tool for human beings to understand how to measure events in the temporal world. Unlike many other Shī'ite philosophers, Mīr Dāmād's articulation of these three cosmological realms incorporates thought found in the works of both prominent Sunni and Shī'ite scholars such as Ibn Sīnā, Abū Ḥāmid al‐Ghāzālī, Suhrawardī, and Naṣīr al‐Dīn Ṭūsī. Although his most successful student, Mullā Ṣadrā Shirazī, had ultimately disagreed with his teacher's cosmological doctrine, he remained influenced by the multitude of sources that his teacher had used. (shrink)

When payment is offered for controlled human infection model research, ethical concerns may be heightened due to unfamiliarity with this study design as well as perceptions—and misperceptions—regarding risk. Against this backdrop, we commend Grimwade et al 1 for their careful handling of the relevant issues, coupling empirical and conceptual approaches. We agree with foundational elements of the authors’ analysis, including the acceptability of payment for research risk.1 However, in our view, it is preferable to treat payment for risk as a (...) discretionary incentive to achieve adequate recruitment and retention, rather than compensation owed as a matter of fairness. Grimwade et al 1 note that although their ‘Payment for Risk Model’ was ‘created specifically in the context of CHIM research, it has the potential to inform payment in other areas of medical research.’ We agree and would go further: we do not need a special payment framework for CHIMs because there is nothing so novel about them compared with other types of research as to demand a distinct approach. Any successful payment framework must address the following ethical issues: preserving informed consent ; treating participants fairly ; encouraging adequate recruitment and retention; avoiding deception by participants; and preserving public trust.2 Some of these issues may have particular salience in the context of CHIMs, but this study design does not demand consideration of entirely distinct ethical factors when evaluating offers of payment.2 We also agree with Grimwade et al 1 about several other key points.2 Given the burdens involved and …. (shrink)

Objectives: The mental health legislation of most developed countries includes either a dangerousness criterion or an obligatory dangerousness criterion (ODC). A dangerousness criterion holds that mentally ill people may be given treatment without consent if they are deemed to be a risk to themselves or others. An ODC holds that mentally ill people may be given treatment without consent only if they are deemed to be a risk to themselves or others. This paper argues that the dangerousness criterion (...) is unnecessary, unethical and, in the case of the ODC, potentially harmful to mentally ill people and to the rest of the community. Methods: We examine the history of the dangerousness criterion, and provide reasoned argument and empirical evidence in support of our position. Results: Dangerousness criteria are not required to balance the perceived loss of autonomy arising from mental health legislation. Dangerousness criteria unfairly discriminate against the mentally ill, as they represent an unreasonable barrier to treatment without consent, and they spread the burden of risk that any mentally ill person might become violent across large numbers of mentally ill people who will never become violent. Mental health legislation that includes an ODC is associated with a longer duration of untreated psychosis, and probably contributes to a poorer prognosis and an increase risk of suicide and violence in patients in their first episode of psychosis. Conclusions: Dangerousness criteria should be removed from mental health legislation and be replaced by criteria that focus on a patient’s capacity to refuse treatment. (shrink)