The paper''s broad aim is to provide a wider understanding of a complex virtue, "meekness". This interest is pragmatic. Contemporary research by Collins (2001) has identified "meekness" as a personal quality for highest-level leadership at great businesses, a theme identifiable also in religious and ancient philosophical narratives. Two strands of enquiry are pursued. Firstly, features of "meekness" are inferred by reference to Plato, Aristotle and Xenophon, as also to the gospel writer, Matthew, source of the title''s quotation. It concludes that (...) "meekness" is not about powers foregone but "powers controlled and exercised with discernment". The second strand addresses whether there are intrinsic differences between the ethics of business and religious activities. Narrative of a New Testament incident, apparently condemning traders, is briefly explored as a case study. Closer examination points how an inappropriate fusing of regulatory and commercial roles had created market abuses. The timeless account warns against inadequately controlled powers and provides an enduring example of how "the meek" should respond assertively against unethical conduct and avoid it themselves. While the paper acknowledges that there may be distinctive "guardian" and "commercial" syndromes for ethical prioritisation, a spiritual virtue, such as "meekness", transcends individual and organisational purposes, being aspirational for any activities that involve providing services and being accountable. (shrink)

The problem this article is concerned with is the failure ofmany large organizations in formerly socialist countries and inpublic sectors of market economies to make effective, peaceful,and ethical transformation from command to market responsiveorganization and privatization. There are at least threeimportant behavioral causes of this problem. First, organizationtransformation is blocked because the organization tries tochange "all at once" before the organization has learned how toact successfully in a new for the organization environment as amarket responsive instead of a command (...) organization (Churchman,1971; Quinn, 1980; Nystrom and Starbuck, 1984; Mintzberg andWaters, 1985; Mintzberg, 1994; Goldman, 1994). Second,organization transformation is blocked because "all at oncechange" stimulates so much fear and political opposition thatchange is politically not possible (Argyris and Schon, 1974;Argyris, 1990; Goldman, 1994; Sachs, 1992). Third, organizationtransformation is blocked because the "guardian" ethics syndromeof command organization is less appropriate for market responsiveorganization than a "commercial" ethics syndrome (Jacobs, 1992;Harris, 1995). Gradual intrapreneurship (Burgelman, 1983; Nielsenet al., 1985) can serve as a peaceful and ethical transitionstrategy. Intrapreneurship can help bridge some of thecontradictions between "commercial" vs. "guardian" ethicssyndromes (Jacobs, 1992; Nielsen, 1996). (shrink)

Standards of excellence in the sphere of work are often taken to be at odds with our ethical obligations in general. In an age of commerce little attention is paid to how the manner in which things are done impacts on the agent's character. Jane Jacobs' phenomenology of our moral intuitions about the public world of work reveal two frameworks, the 'commercial moral syndrome' stressing fairness, and the 'guardian moral syndrome' emphasizing loyalty. In the latter set of (...) values we have a way of countering the bias of contemporary culture. This is best understood as a modified Aristotelian approach. The example of adversarial advocacy in the legal profession is taken as an illustration. (shrink)

Standards of excellence in the sphere of work are often taken to be at odds with our ethical obligations in general. In an age of commerce little attention is paid to how the manner in which things are done impacts on the agent's character. Jane Jacobs' phenomenology of our moral intuitions about the public world of work reveal two frameworks, the 'commercial moral syndrome' stressing fairness, and the 'guardian moral syndrome' emphasizing loyalty. In the latter set of (...) values we have a way of countering the bias of contemporary culture. This is best understood as a modified Aristotelian approach. The example of adversarial advocacy in the legal profession is taken as an illustration. (shrink)

The huge potential of biobanks/genetic databases for the research community has been recognised across jurisdictions in both publicly funded and commercial sectors. But although there is tremendous potential there are likewise potential difficulties. The long-term storage of personal health information and samples poses major challenges. This is an area is fraught with ethical and legal uncertainties. Biobanks raise many questions of the control of rights, of consent, of privacy and confidentiality and of property in human material. It is (...) thus unsurprising then that there has been a lively debate as to how biobanks should operate, the boundaries of participation and what governance structure, if any they should adopt, a debate which has been engaged in across the academic community and by funders and researchers alike. This paper asks despite the good intentions can ad hoc ethics and ethics and governance committees long term provide an effective solution to the legal and regulatory challenges arising from biobanks. (shrink)

Surveillance is essential for communicable disease prevention and control. Traditional notification of demographic and clinical information, about individuals with selected infectious diseases, allows appropriate public health action and is protected by public health and privacy legislation, but is slow and insensitive. Big data–based electronic surveillance, by commercial bodies and government agencies, which draws on a plethora of internet- and mobile device–based sources, has been widely accepted, if not universally welcomed. Similar anonymous digital sources also contain syndromic information, which can (...) be analysed, using customised algorithms, to rapidly predict infectious disease outbreaks, but the data are nonspecific and predictions sometimes misleading. However, public health authorities could use these online sources, in combination with de-identified personal health data, to provide more accurate and earlier warning of infectious disease events—including exotic or emerging infections—even before the cause is confirmed, and allow more timely public health intervention. Achieving optimal benefits would require access to selected data from personal electronic health and laboratory records and the potential to re-identify individuals found to be involved in outbreaks, to ensure appropriate care and infection control. Despite existing widespread digital surveillance and major potential community benefits of extending its use to communicable disease control, there is considerable public disquiet about allowing public health authorities access to personal health data. Informed public discussion, greater transparency and an ethical framework will be essential to build public trust in the use of new technology for communicable disease control. (shrink)

The rapidly changing field of genetics affects society through advances in health-care and through implications of genetic research. This study addresses the impacts of new genetic discoveries and technologies on different segments of today's society. The book begins with a chapter on genetic complexity, and subsequent chapters discuss moral and ethical questions arising from today's genetics from the perspectives of health care professionals, the media, the general public, special interest groups and commercial interests.

BackgroundObtaining consent has become a standard way of respecting the patient’s rights and autonomy in clinical research. Ethical guidelines recommend that the child’s parent/s or authorised legal guardian provides informed consent for their child’s participation. However, obtaining informed consent in paediatric research is challenging. Parents become vulnerable because of stress related to their child’s illness. Understanding the views held by guardians and researchers about the consent process in Malawi, where there are limitations in health care access and research (...) literacy will assist in developing appropriate consent guidelines.MethodsWe conducted 20 in-depth interviews with guardians of children and research staff who had participated in paediatric clinical trial and observational studies in acute and non-acute settings in the Southern Region of Malawi. Interviews were audio-recorded, transcribed verbatim, and thematically analysed. Interviews were compared across studies and settings to identify differences and similarities in participants’ views about informed consent processes. Data analysis was facilitated by NVIVO 11 software.ResultsAll participants across study types and settings reported that they associated participating in research with therapeutic benefits. Substantial differences were noted in the decision-making process across study settings. Guardians from acute studies felt that the role of their spouses was neglected during consenting, while staff reported that they had problems obtaining consent from guardians when their partners were not present. Across all study types and settings, research staff reported that they emphasised the benefits more than the risks of the study to participants, due to pressure to recruit. Participants from non-acute settings were more likely to recall information shared during the consent process than participants in the acute setting.ConclusionThe health care context, culture and research process influenced participants’ understanding of study information across study types and settings. We advise research managers or principal investigators to define minimum requirements that would not compromise the consent process and conduct study specific training for staff. The use of one size fits all consent process may not be ideal. More guidance is needed on how these differences can be incorporated during the consent process to improve understanding and delivery of consent.Trial registration Not applicable. (shrink)

Critics of transnational commercial surrogacy frequently call our attention to the race, class, and cultural background of surrogates in the global South. Consider the following sampling from the critics: "the women having babies for rich Westerners have been pimped by their husbands and are powerless to resist" (Bindel 2011); our "rules of decency seem to differ when the women in question are living in abject poverty half a world away" (Warner 2008); and we should worry that "women of color (...) are easier to commodify" (Smerdon 2008, 51-52). Critics suggest—rightly, in my view—that the race, class, and culture of Southern surrogates matter to the moral acceptability of transnational surrogacy. But how, precisely, do .. (shrink)

In the United States at this time, no uniform federal law exists regarding commercial surrogacy, and state statutory schemes vary vastly, ranging from criminalization to legal recognition with contract enforcement. The authors examine how commercial surrogacy agencies utilize the Internet as a means for attracting parents and surrogates by employing emotional cultural rhetoric. By inducing both parents and surrogates to their jurisdiction, agencies circumvent vast discrepancies in state statutory regulative schemes and create a distinct interstate business, absent an (...) efficient regulatory framework or legal recourse in some circumstances. The authors propose a uniform federal regulatory scheme premised upon regulating interstate business transactions to create accountability and legal remedies for both the parents and the surrogate. (shrink)

Critics of commercial societies complain that the free-market system of property rights and freedom of contract tends to commodify relationships and erode the bonds of personal and civic friendship. I argue that this thesis rests on a misunderstanding of both markets and friendship. As voluntary, reciprocal relationships, market relationships and friendship share important properties. So-called market norms, such as instrumentality and fungibility, come in varying degrees and characterize not only market, but also non-market, relationships, including friendship. Further, although market (...) relationships are primarily instrumental, the individuals involved are not. Both the virtues of markets and their vices have their counterparts in friendship. Like all relations and activities that exercise important human capacities and play an important role in a meaningful life, market relations and activities are essentially structured and supported by ethical norms and, in turn, support these norms. For these and other reasons, market societies are not only not inimical to friendship, they create a more secure matrix for civic and personal friendship, as well as for other important values like art, science, or philosophy, than any other developed form of society. (shrink)

In July of 2005, Indianapolis witnessed streaming headlines in the local newspaper attempting to distill the confusion surrounding the adoption of two premature infants by an adoptive parent. Thirteen articles and opinion pieces introduced the public to a murky legal and ethical transaction. Stating his overwhelming desire to have children, a New Jersey schoolteacher hired the services of a local attorney. The attorney procured a South Carolina woman for a compensated gestational surrogacy contract. Under the contract, the surrogate and (...) the attorney would meet in Indiana to complete the execution of the contract and transfer parental rights via adoption after the birth of the twins. (shrink)

Recent events in Western Australia culminating in the Royal Commission into Commercial Activities of Government and Other Matters 1992, and the subsequent publication of the Report, highlighted the fact that the commercial activities of the State Government in Western Australia had been in disarray for some time. However, in spite of some early interest in the outcomes of the Report, the general reaction by the public was largely one of disinterest. This paper traces some of the events which (...) took place after the main hearings. A number of leading citizens felt that some action was warranted. In brief, a series of lectures on different apects of business ethics were planned and given to business students at Curtin Business School. This paper highlights some of the observations made during this series of lectures. (shrink)

Critics of commercial societies complain that the free-market system of property rights and freedom of contract tends to commodify relationships, thus eroding the bonds of personal and civic friendship. I argue that this thesis rests on a misunderstanding of both markets and friendship. As voluntary, reciprocal relationships, market relationships and friendship share important properties. Like all relations and activities that exercise important human capacities and play an important role in a meaningful life, market relations and activities are essentially structured (...) and supported by ethical norms and, in turn, support these norms. The so-called norms of the market, such as instrumentality and fungibility, come in varying degrees and characterize not only market, but also nonmarket, relationships, including friendship. Furthermore, although market relationships are primarily instrumental, the individuals involved are not. The virtues of markets have their counterparts in friendship, as do their vices. For these and other reasons, market societies are not only not inimical to friendship, they create a more secure matrix for civic and personal friendship, as well as for other important values such as art, science, or philosophy, than any other developed form of society. Key Words: commercial societies • friendship • moral norms • virtues • vices. (shrink)

The pioneering work on environmental regulation in Sweden and that country's leading position in sustainability rankings has paradoxically passed almost unnoticed by academics. To this fact should be added, the scant attention given to the Nordic banking system. Becoming immersed into the realm of Swedish commercial banking ethics, we have focused on one of the top three commercial banks in the country, to map its corporate sustainability policies (CSP) and the compliance of the lending business process (LBP) to (...) these policies. A descriptive-explanatory research framework utilises a critical case with a phronetic design. Data collected through interviews was manipulated under the thematic analysis method. We found a unique understanding of act-utilitarianism, in which, policies and practices are set to prevent financial risks and environment rebounds, as they are symbiotic. This allowed us to enlarge the body of knowledge on Nordic banking's sustainable governance and design the green lending model (GLM). (shrink)

A high standard of planetary protection is important for astrobiology, though the risk for contamination can never be zero. It is therefore important to find a balance. If extraterrestrial life has a moral standing in its own right, it will also affect what we have to do to protect it. The questions of how far we need to go to protect extraterrestrial life will be even more acute and complicated when the time comes to use habitable worlds for commercial (...) purposes. There will also be conflicts between those who want to set a world aside for more research and those who want to give the green light for development. I believe it is important to be proactive in relation to these issues. The aim of my project is therefore to identify, elucidate, and if possible, suggest solutions to potential conflicts between astrobiology, planetary protection, and commercial use of space. (shrink)

The federal and corporate initiative to technologize education has transformed schools, colleges, and universities into a new frontier for the computer industry. While educational institutions have maintained an equivocal relationship with markets and the state, they had striven to preserve a simulacrum of independence until the early 1980s. Then, neoconservative ideologies and their accompanying discourse on restructuring education discovered in the computer the ideal neutral tool to promote, in its virtual clothes, their gospel. The Clinton administration and big corporations, taking (...) advantage of the myth of the computer and the new vocabulary associated with computers, launched a massive program of wiring schools. The process, still unfolding at a rapid pace, poses grave problems for the teaching profession and the role of schools in society. The author argues that the unethical ways in which computers force their ways into many educational institutions, the values they embody, the contexts of their multiple usages, the hyperfragmentation and increasing commodification of knowledge that they cause through online education, the vocationalization of education, and the atomization of teachers are likely to shrink pedagogical and democratic possibilities both at local and global levels. (shrink)

Company directors and executives seek legal advice outside the company on a regular basis. This advice is meant to be given within the context of the lawyers’ professional obligations and ethical practise. What clients may not appreciate is there is often a conflict of interest between the lawyers’ professional and ethical concerns and the legal advice business. If lawyers follow their business interests, their advice may be incomplete especially in relation to the ethical consequences of that advice. (...) This could lead to a compromise of the clients’ commercial interests and even raise doubts in relation to the legality of the clients’ proposed course of action. (shrink)

This section is focused on some areas of concern which were identified in The Report of the Royal Commission into Commercial Activities of Government and Other Matters (1990–1992). In the Report a number of situations were examined in which some individuals acted without recourse to any ethical guidelines. Most of the people mentioned in the Report held responsible positions in either Government or the private sector, and all were very well known in the community. The Report of the (...) Royal Commission made a number of findings of serious impropriety on the part of several individuals, although there was comparatively little evidence of illegal or corrupt conduct. This section shows what happened to a governmental system in an Australian state when a number of Ministers and their advisors placed their personal or party advantage over their constitutional obligation to act in the community''s interests.Those who cannot remember the past are condemned to repeat it. (shrink)

This article reviews the literature on prenatal screening for Down’s syndrome. To be evidence based, medicine and nursing have to take account of research evidence and also of how this evidence is processed through the influence of prevailing social and moral attitudes. This review of the extensive literature examines how appropriate widely-held understandings of Down’s syndrome are, and asks whether or not practitioners and prospective parents have access to the full range of moral arguments and social evidence on the matter. (...) Highly valued ideals of justice, personal autonomy, parental choice, women’s control over their reproduction and of avoiding harm can all tend towards negative rather than neutral approaches to Down’s syndrome. This article considers how ethics and prenatal screening policies and practice that take greater account of social evidence of disability could use moral arguments that inform rather than determine the choices of people who use prenatal services. (shrink)

Various authors, for instance Elizabeth Anderson, Rosemary Tong, Mary Warnock and Margaret Brazier have argued that commercial surrogate motherhood is exploitative and that it should be prohibited. Their arguments are unconvincing. Exploitation is a more complex notion than it is usually presented as being. Unequal bargaining power can be a cause of exploitation but the exercise of unequal bargaining power is not inevitably or inherently exploitative. Exploitation concerns unfair and/or unjust strategies - rather than the exercise of power as (...) such. Commercial surrogate motherhood is not necessarily exploitative. Furthermore, not all transactions which are exploitative should be made illegal. (shrink)

We conducted a cross-sectional survey of a random sample of 1943 spouses of home-dwellers with Alzheimer’s disease (AD) to examine the prevalence of court-appointed guardians or financial powers of attorney for persons with AD, related factors and the need for information about these issues among caregiving families. The questionnaire consisted questions on variables of demographic characteristics, disability, symptoms and care needs of the person with dementia, the strain of caregiving, the use of court-appointed legal guardians or powers of attorney, as (...) well as discussions about these issues—and the need for them—with a doctor. The response rate was 77% and the mean ages of those with AD and caregivers were 80.2 and 78.2 years, respectively. The use of legal guardians was rare (4.3%), while the use of financial powers of attorney was more common (37.8%). Only 9.9% of the couples had discussed these issues with their doctor, whereas 47.9% expressed a need for it. The factors associated with the use of these legal arrangements were related to the severity of dementia, including experiencing dementia symptoms for more than 3 years, poor functioning, incontinence and behavioural symptoms. There is a clear need for information on medico-legal issues related to dementia among caregivers of AD patients. If held soon after the diagnosis, such discussions could support the autonomy of these persons in spite of AD and enable them to plan for the future as they wish. (shrink)

The Vioxx drug recall and other cases of withdrawals of approved pharmaceutical products as a result of reports of serious harm to users indicate that there are many problems associated with the process of getting these products to the end user the ordinary person in the street. The problems include those related to drug/medical device research and development, clinical trials, presentation and publication of research results, approval by regulatory authorities, preparation of clinical practice guidelines, marketing of products by commercial (...) companies and post-marketing surveillance. This article discusses threats to the integrity of each of these processes and argues that the steady stream of drug recalls indicates the existence of a systemic problem. It concludes with a discussion of possible solutions to these problems. (shrink)

May you sell your vote? May you sell your kidney? May gay men pay surrogates to bear them children? May spouses pay each other to watch the kids, do the dishes, or have sex? Should we allow the rich to genetically engineer gifted, beautiful children? Should we allow betting markets on terrorist attacks and natural disasters? Most people shudder at the thought. To put some goods and services for sale offends human dignity. If everything is commodified , then nothing is (...) sacred. The market corrodes our character. Or so most people say. In Markets without Limits , Jason Brennan and Peter Jaworski give markets a fair hearing. The market does not introduce wrongness where there was not any previously. Thus, the authors claim, the question of what rightfully may be bought and sold has a simple answer: if you may do it for free, you may do it for money. Contrary to the conservative consensus, they claim there are no inherent limits to what can be bought and sold, but only restrictions on how we buy and sell. (shrink)

This study proposes a conceptual model to explain persistent, accepted-as-normal corporate wrongdoing (hereafter banality of wrongdoing), particularly for high performance organizations. The model describes five explanatory variables: the culture of competition, ends-biased leadership, missionary zeal, legitimizing myth, and the corporate cocoon. Our thesis is that the nature of competition drives both legitimate and illegitimate goal-seeking to adopt an iconoclastic (rule-breaking) orientation. High performance organizations are favorable hosts for wrongdoing because high performance requires aggressive behavior at the ethical margins of (...) what is acceptable. The way leadership reacts to competition sets the stage for ethical or unethical cultures to develop. Ends-biased leadership will project strong vision, using ideology and legitimizing myth as tools to inspire and motivate. The resulting missionary zeal justifies using questionable means because of the perceived value of the end. One critical method for building strong culture is creating a sense of being separate and apart from the ordinary. This cocoon effect may create a self-referential value system that is significantly at odds with mainstream culture and in which wrongdoing is banal. We intend an empirical study of the variables described in this model. (shrink)

This article argues that a particular metaphysical model permeates cultural practices surrounding pregnancy: the foetal container model. Widespread uncritical reliance on this view of pregnancy has been highly detrimental to women's liberty and reproductive autonomy. In this article, I extend existing critiques of the medical treatment of pregnant women to the context of the burgeoning commercial surrogacy industry. In doing so, I aim to show that our philosophical analysis in both spheres is constrained by the presupposition that the foetus (...) and pregnant woman are metaphysically and ethically distinct entities. By exploring the similarities and differences between the expectations placed on pregnant women in these two spheres, I show that the foetal container model is not a homogeneous understanding of pregnancy applied consistently across contexts; rather, it has been used to justify various practices and attitudes toward pregnancy and pregnant women through different moral frameworks, in the service of different overarching aims. (shrink)

Lawyers and the legal system have been much criticized in recent years. Despite popular perceptions, the legal system contains numerous mechanisms and rules designed to ensure fair results. This paper shows how the legal system tries to implement, in commercial transactions, the ethical principles of truthfulness and fairness. The Anglo-American development of Equity Courts is reviewed briefly. Several examples of the Law's enforcement of ethical principles are presented, in four different legal areas: Contracts, Securities, Goods, and Real (...) Estate. The intent here is to present an overview of the problem, with area-specific illustrations, rather than a comprehenisve examination of the cases in just one area. (shrink)

This essay will focus on the moral issues relating to surrogacy in the global context, and will critique the liberal arguments that have been offered in support of it. Liberal arguments hold sway concerning reproductive arrangements made between commissioning couples from wealthy nations and the surrogates from socioeconomically weak backgrounds that they hire to do their reproductive labor. My argument in this paper is motivated by a concern for controlling harms by putting the practice of globalized commercial surrogacy into (...) the context of care ethics. As I will argue, the unstable situations into which children of global surrogacy arrangements are born is symbolic of the crisis of care that the practice raises. Using the Baby Manji case as my touch point, I will suggest that liberalism cannot address the harms experienced by Manji and children like her who are created through the global practice of assisted reproductive technology. I will argue that, if commissioning couples consider their proposed surrogacy contracts from a care ethics point of view, they will begin to think relationally about their actions, considering the practice from an ethical lens, not just an economic or contractual one. (shrink)

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced (...) a tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

This paper is an exploration of a current environmental issue dividing two industries in the UK. The issue is offshore wind farms, and the industries are commercial fishing and wind energy. The controversy over offshore wind farms highlights three core issues of conflict: the adequacy of stakeholder consultation processes; the right to compensation for loss of livelihood; and the lack of adequate data. We find that the characterisations that developers, regulators, and fishers hold of each other critically inform their (...) positions on these issues. We examine the weak bargaining position of fishers, and the ‘power game’ that is played out between them and developers. We conclude that offshore wind farm development would be better managed if stakeholder consultation was more extensive, compensation claims were standardised, and scientific data were more readily available, but that in the meantime, fishers could improve their bargaining power by mobilising potential allies. (shrink)

This paper is an exploration of a current environmental issue dividing two industries in the UK. The issue is offshore wind farms, and the industries are commercial fishing and wind energy. The controversy over offshore wind farms highlights three core issues of conflict: the adequacy of stakeholder consultation processes; the right to compensation for loss of livelihood; and the lack of adequate data. We find that the characterisations that developers, regulators, and fishers hold of each other critically inform their (...) positions on these issues. We examine the weak bargaining position of fishers, and the 'power game' that is played out between them and developers. We conclude that offshore wind farm development would be better managed if stakeholder consultation was more extensive, compensation claims were standardised, and scientific data were more readily available, but that in the meantime, fishers could improve their bargaining power by mobilising potential allies. (shrink)

This commentary on “Her Own Decision: Impairment and Authenticity in Adolescence” by Campbell, Derrington, Hester, and Lew adds further consideration of obligations for guardians and physicians of minors who struggle in making serious decisions regarding medical treatment.

New brain-computer interface and neuroimaging techniques are making differentiation less ambiguous and more accurate between unresponsive wakefulness syndrome patients and patients with higher cognitive function and awareness. As research into these areas continues to progress, new ethical issues will face physicians of patients suffering from total locked-in syndrome, characterized by complete loss of voluntary muscle control, with retention of cognitive function and awareness detectable only with neuroimaging and brain-computer interfaces. Physicians, researchers, ethicists and hospital ethics committees should be aware (...) of and prepared to handle ethical issues unique to these totally locked-in patients. Several thought experiments are discussed, to highlight potential ethical dilemmas surrounding surrogate decision-making, autonomy, end-of-life care, and pediatric care, which will be unique to total LIS patients. These, along with other ethical problems especially relevant to total LIS patients, merit further discussion among physicians, researchers, ethicists and hospital ethics committees, to facilitate consensus regarding these issues, and improve patient care. (shrink)

In this paper, the ethical, legal, and social implications of Thailand’s surrogacy regulations from both domestic and global perspectives are explored. Surrogacy tourism in Thailand has expanded since India strengthened its visa regulations in 2012. In 2015, in the wake of a major scandal surrounding the abandonment of a surrogate child by its foreign intended parents, a law prohibiting the practice of surrogacy for commercial purposes was enacted. Consequently, a complete ban on surrogacy tourism was imposed. However, some (...) Thai physicians and surrogate mothers cross into neighboring countries to provide foreign clients with the commercial surrogacy services that are forbidden in Thailand. Under this legislation, the needs of Thai couples who are unable to conceive are accommodated by legally accessible, non-commercial surrogacy services; however, there is currently no provision in place aimed at protecting the rights and interests of surrogate mothers and children. It is widely believed that the abolition of surrogacy tourism, an industry that give rise to several major scandals, and legal access to surrogacy by Thai couples were the Thai government’s primary goal in implementing this legislation. (shrink)

Zemyarska MS. Is it ethical to provide IVF add-ons when there is no evidence of a benefit if the patient requests it? J Med Ethics 2019;45:346–50. doi: 10.1136/medethics-2018-104983. The Acknowledgements section of ….

Harvey and Gurvir’s Law is a bill proposed to the Legislative Assembly of Ontario (Canada) to reduce stigma and bias associated with Down syndrome, by developing and disseminating quality information about Down syndrome in the context of prenatal testing.

There are complex considerations when planning to disclose an attenuated psychosis syndrome diagnosis. In this review, we evaluate ethical, legal, and clinical perspectives as well as caveats related to full, non- and partial disclosure strategies, discuss societal implications, and provide clinical suggestions. Each of the disclosure strategies is associated with benefits as well as costs/considerations. Full disclosure promotes autonomy, allows for the clearest psychoeducation about additional risk factors, helps to clarify and/or correct previous diagnoses/treatments, facilitates early intervention and bolsters (...) communication between providers but there are important considerations involving heritability, comorbidity, culture, and stigma. Non-disclosure advances nonmaleficence by limiting stigma and stress, and confusion in a sensitive developmental period but is complicated by varying patient preferences and the possibility that, as new treatments without adverse effects become available, the risk with false positives no longer justifies the accompanying loss of autonomy. Partial disclosure balances ethical considerations by focusing on symptoms instead of labels, but evidence that laypersons may interpret this information as a pseudo-diagnosis and that symptoms alone also contribute to stigma limits the efficacy of this approach. In addition, there are notable societal considerations relating to disclosure involving conservatorship, the reach of insurance companies, and discrimination. We advocate a hybrid approach to disclosure and recommend future research aimed at understanding the effects of stigma on clinical course and a renewed focus on those help-seeking cases that do not transition but remain clinically relevant. (shrink)

Transcranial direct current stimulation (tDCS) is a brain stimulation technique known for its relative safety and minimal invasiveness. tDCS has demonstrated efficacy as a potential treatment for certain neurological disorders, such as Parkinson’s disease, and has been shown to enhance a range of cognitive abilities under certain contexts. As a result, this technique has captured the interest of both the research community and the public at large. However, efforts to gather information about the effects of tDCS on the brain are (...) still in their infancy, leading to concerns about informed consent as it pertains to the possible risks associated with tDCS treatment. The ability to purchase tDCS equipment in the form of commercial, direct-to-consumer devices, generates even more cause for ethical concern, given the unknowns surrounding this technology and its potential broader societal impact. Previous research has touched on the many ethical issues raised by the emergence of this technology, including under what circumstances its use is justifiable and appropriate. In this paper, we survey recent normative and empirical works pertaining to the ethics of tDCS with the goal of summarizing the current state of ethical debate surrounding its use in the contexts of both therapy and cognitive enhancement, with a particular emphasis on the latter. Our analysis of the collected research finds that issues pertaining to user safety are paramount within existing scholarship; that tDCS use in children is an emerging area of concern entailing special considerations; and that regulatory bodies and legal agencies have struggled to implement appropriate, impactful regulation pertaining to tDCS and related technologies in order to balance public welfare against individual autonomy. This analysis will facilitate future efforts to develop bioethical approaches to tDCS by highlighting the ethical dimensions of tDCS prioritized in existing literature and identifying areas where further ethical consideration is needed. (shrink)