Philosophical work on the concept of consent in the past few decades has got to grips with it as a rich notion. We are increasingly sensitive to consent not as a momentary, atomic, transactional thing, but as a complex idea admitting of various qualities and dimensions. In this paper we note that the recognition of this complexity demands a theoretical framework quite different to those presently extant, and we suggest that the enactive approach is one which offers (...) significant value in this regard. In consonance with arguments made by Laurie Penny about how consent is a continuous and dynamic process, we outline how an enactive approach identifies consent as temporally extended (rather than momentarily transactional), and as affected by the skilfulness of the agents involved, the fitness of community provided resources to negotiate the consensual relationship over time, and the unfolding of circumstances in the situation in which the joint action is taking place. We argue that the value of an enactive perspective on consent is in highlighting these complexities, and providing resources to articulate and theorise them in ways that are not open to other current approaches. (shrink)

The fact that Internet companies may record our personal data and track our online behavior for commercial or political purpose has emphasized aspects related to online privacy. This has also led to the development of search engines that promise no tracking and privacy. Search engines also have a major role in spreading low-quality health information such as that of anti-vaccine websites. This study investigates the relationship between search engines’ approach to privacy and the scientific quality of the information they return. (...) We analyzed the first 30 webpages returned searching “vaccines autism” in English, Spanish, Italian, and French. The results show that not only “alternative” search engines but also other commercial engines often return more anti-vaccine pages (10–53%) than Google (0%). Some localized versions of Google, however, returned more anti-vaccine webpages (up to 10%) than Google. Health information returned by search engines has an impact on public health and, specifically, in the acceptance of vaccines. The issue of information quality when seeking information for making health-related decisions also impact the ethical aspect represented by the right to an informed consent. Our study suggests that designing a search engine that is privacy savvy and avoids issues with filter bubbles that can result from user-tracking is necessary but insufficient; instead, mechanisms should be developed to test search engines from the perspective of information quality (particularly for health-related webpages) before they can be deemed trustworthy providers of public health information. (shrink)

Trials with highly unfavourable risk–benefit ratios for participants, like HIV cure trials, raise questions about the quality of the consent of research participants. Why, it may be asked, would a person with HIV who is doing well on antiretroviral therapy be willing to jeopardise his health by enrolling in such a trial? We distinguish three concerns: first, how information is communicated to potential participants; second, participants’ motivations for enrolling in potentially high risk research with no prospect of direct benefit; (...) and third, participants’ understanding of the details of the trials in which they enrol. We argue that the communication concern is relevant to the validity of informed consent and the quality of decision making, that the motivation concern does not identify a genuine problem with either the validity of consent or the quality of decision making and that the understanding concern may not be relevant to the validity of consent but is relevant to the quality of decision making. In doing so, we derive guidance points for researchers recruiting and enrolling participants into their HIV cure trials, as well as the research ethics committees reviewing proposed studies. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of molnupiravir through the large-scale Platform Adaptive trial of Novel antiviRals for eArly treatMent of COVID-19 In the Community randomised control trial. By analysing the ways in which the authorisation and clinical use of molnupiravir complicate standard approaches to clinical equipoise, standard of care and participant consent in the PANORAMIC randomised control trial, we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

In response to the COVID-19 pandemic, large-scale research and pharmaceutical regulatory processes have proceeded at a dramatically increased pace with new and effective, evidence-based COVID-19 interventions rapidly making their way into the clinic. However, the swift generation of high-quality evidence and the efficient processing of regulatory authorisation have given rise to more specific and complex versions of well-known research ethics issues. In this paper, we identify three such issues by focusing on the authorisation of Molnupiravir, a novel antiviral medicine aimed (...) at reducing the ability of SARS-CoV-2 to multiply in the body, for clinical use by the National Health Service in England and the concomitant testing of Molnupiravir through the large-scale PANORAMIC randomised control trial. By analysing the ways in which the authorisation and clinical use of Molnupiravir complicate standard approaches to clinical equipoise, standard of care, and participant consent in the PANORAMIC randomised control trial we will explain some of ethical implications for clinical trials that aim to study the efficacy and safety of new COVID-19 and other therapeutics when conditional authorisation has already been granted and when such treatments have already been made available to patients by national health providers. (shrink)

Background Consent policies for post-mortem organ procurement (OP) vary throughout Europe, and yet no studies have empirically evaluated the ethical implications of contrasting consent models. To fill this gap, we introduce a novel indicator of governance quality based on the ideal of informed support, and examine national differences on this measure through a quantitative survey of OP policy informedness and preferences in seven European countries. -/- Methods Between 2017–2019, we conducted a convenience sample survey of students (n = (...) 2006) in Austria (AT), Belgium (BE), Denmark (DK), Germany (DE), Greece (GR), Slovenia (SI) and Spain (ES), asking participants about their donation preferences, as well as their beliefs and views about the policy in place. From these measures, we computed indices of informedness, policy support, and fulfilment of unexpressed preferences, which we compared across countries and consent systems. -/- Results Our study introduces a tool for analyzing policy governance in the context of OP. Wide variation in policy awareness was observed: Most respondents in DK, DE, AT and BE correctly identified the policy in place, while those in SI, GR and ES did not. Respondents in opt-out countries (AT, BE, ES and GR) tended to support the policy in place (with one exception, i.e., SI), whereas those in opt-in countries (DE and DK) overwhelmingly opposed it. These results reveal stark differences in governance quality across countries and consent policies: We found a preponderance of informed opposition in opt-in countries and a general tendency towards support–either informed or uninformed–in opt-out countries. We also found informed divergence in opt-in countries and a tendency for convergence–either informed or uninformed–among opt-out countries. -/- Conclusion Our study offers a novel tool for analyzing governance quality and illustrates, in the context of OP, how the strengths and weaknesses of different policy implementations can be estimated and compared using quantitative survey data. (shrink)

Background: Several countries have recently changed their model of consent for organ donation from opt-in to opt-out. We undertook a systematic review to determine public knowledge and attitudes towards these models in Europe. Methods: Six databases were explored between 1 January 2008 and 15 December 2017. We selected empirical studies addressing either knowledge or attitudes towards the systems of consent for deceased organ donation by lay people in Europe, including students. Study selection, data extraction, and quality assessment were (...) conducted by two or more reviewers independently. Findings: Awareness of the consent model was lower in opt-out countries than in opt-in countries. A majority of the public agrees with opt-in, regardless of the law in their own country. There are ambivalent attitudes regarding the opt-out system. The public tend to prefer opt-in and mandatory choice over opt-out when several options are offered. Interpretation: The assumption that people in opt-out countries are aware of the legal requirements to be excluded from the pool of potential donors is not supported by the results of this review. This is a concern, since ignorance hinders people's autonomy regarding organ donation decision-making. Higher awareness of consent model in opt-in countries may reflect greater efforts to inform the public through campaigns to motivate donation. Legal moves towards opt-out are at odds with people's expressed preferences. Main limitations of this review are the lack of data from some countries, study population heterogeneity, and methodological shortcomings. (shrink)

In this paper, we illustrate some serious difficulties involved in conveying information about uncertain risks and securing informed consent for risky interventions in a clinical setting. We argue that in order to secure informed consent for a medical intervention, physicians often need to do more than report a bare, numerical probability value. When probabilities are given, securing informed consent generally requires communicating how probability expressions are to be interpreted and communicating something about the quality and quantity of (...) the evidence for the probabilities reported. Patients may also require guidance on how probability claims may or may not be relevant to their decisions, and physicians should be ready to help patients understand these issues. (shrink)

Objectives: Machine learning (ML) has the potential to facilitate “continual learning” in medicine, in which an ML system continues to evolve in response to exposure to new data over time, even after being deployed in a clinical setting. In this article, we provide a tutorial on the range of ethical issues raised by the use of such “adaptive” ML systems in medicine that have, thus far, been neglected in the literature. -/- Target audience: The target audiences for this tutorial are (...) the developers of ML AI systems, healthcare regulators, the broader medical informatics community, and practicing clinicians. -/- Scope: Discussions of adaptive ML systems to date have overlooked the distinction between 2 sorts of variance that such systems may exhibit—diachronic evolution (change over time) and synchronic variation (difference between cotemporaneous instantiations of the algorithm at different sites)—and underestimated the significance of the latter. We highlight the challenges that diachronic evolution and synchronic variation present for the quality of patient care, informed consent, and equity, and discuss the complex ethical trade-offs involved in the design of such systems. (shrink)

While several tests and strategies are recommended for colorectal cancer (CRC) screening, studies suggest that primary care providers often recommend colonoscopy without providing information about its risks or alternatives. These observations raise concerns about the quality of informed consent for screening colonoscopy.

A large proportion of the total global burden of disease is caused by emergency medical conditions. Emergency care research is essential to improving emergency medicine but this research can raise some distinctive ethical challenges, especially with regard to (1) standard of care and risk–benefit assessment; (2) blurring of the roles of clinician and researcher; (3) enrolment of populations with intersecting vulnerabilities; (4) fair participant selection; (5) quality of consent; and (6) community engagement. Despite the importance of research to improve (...) emergency care in low-income and middle-income countries (LMICs) and the widely acknowledged ethical challenges, very little has been written on the ethics of emergency care research in LMICs. This paper examines the ethical and regulatory challenges to conducting emergency care research with human participants in LMICs. We outline key challenges, present potential solutions or frameworks for addressing these challenges, and identify gaps. Despite the ethical and regulatory challenges, conducting high-quality, ethical emergency care research in LMICs is possible and it is essential for global health. (shrink)

Vaccination against various diseases has been widely practised for more than a century and on a more limited scale its use in a variety of forms stretches back far longer. During earlier eras disease spread more slowly along shipping lanes on water and traditional transport routes on land. Today, in an era of air transport, contagion spreads far more rapidly. Travelling far more rapidly (indeed instantaneously) is the spread of misinformation that hinders vaccination which can, in the instance of Covid-19, (...) reduce disease impacts, including rates of severe illness and death. This paper explores the ethical issue of informed consent in the context of the contest between personal choice and the greater public welfare. It also makes reference to a number of low, middle and high income countries where vaccine hesitance, and to a lesser extent refusal, has been fed by misinformation on a scale not previously observed but made possible by the proliferation of modern technology. This campaign of ignorance has further undermined trust in governmental health bodies and their attempts to implement quarantine and other measures such as vaccination that had already been damaged by early variations and vacillation in governmental approaches around the globe due in part to a reluctance by some governments to take actions that would have economic repercussions but also by the necessary evolution of their approaches as more became known about the disease and its variants. The paper examines the historical background and the current situation and finds that more must be done to restore or increase trust levels between citizens and governmental authorities, including the dissemination of high quality accurate information in a form relevant to readers/viewers. While potential side-effects of vaccines must be disclosed to ensure informed consent, their incidence should also be clearly communicated (e.g., in vaccine information statements) so that clients/patients are aware that a risk is 1 in 100 or 1in 1000 or 1 in 2 million etc. Governments are urged to learn from their experience and better prepare for inevitable future pandemics to minimise vaccine hesitancy and refusal and maximise its acceptance where evidence is overwhelming as to the benefit to the community. Informed consent is part of the context of efforts to use vaccination to contain or eradicate any disease. Nevertheless, while better information for clients/patients/consumers may reduce vaccine hesitancy/refusal, it is unlikely that it would but eliminate the need for mandating vaccination in some circumstances for the benefit of the broader community, although strict quarantine of those reluctant to accept it is an alternative but one not generally accepted by those reluctant to be vaccinated. The information war is one that needs to be won to increase the voluntary uptake of vaccination in the context of voluntary informed consent. (shrink)

Background If trials of therapeutic interventions are to serve society's interests, they must be of high methodological quality and must satisfy moral commitments to human subjects. The authors set out to develop a clinical - trials compendium in which standards for the ethical treatment of human subjects are integrated with standards for research methods. Methods The authors rank-ordered the world's nations and chose the 31 with >700 active trials as of 24 July 2008. Governmental and other authoritative entities of the (...) 31 countries were searched, and 1004 English-language documents containing ethical and/or methodological standards for clinical trials were identified. The authors extracted standards from 144 of those: 50 designated as ‘core’, 39 addressing trials of invasive procedures and a 5% sample of the remainder. As the integrating framework for the standards we developed a coherent taxonomy encompassing all elements of a trial's stages. Findings Review of the 144 documents yielded nearly 15 000 discrete standards. After duplicates were removed, 5903 substantive standards remained, distributed in the taxonomy as follows: initiation, 1401 standards, 8 divisions; design, 1869 standards, 16 divisions; conduct, 1473 standards, 8 divisions; analysing and reporting results, 997 standards, four divisions; and post-trial standards, 168 standards, 5 divisions. Conclusions The overwhelming number of source documents and standards uncovered in this study was not anticipated beforehand and confirms the extraordinary complexity of the clinical trials enterprise. This taxonomy of multinational ethical and methodological standards may help trialists and overseers improve the quality of clinical trials, particularly given the globalisation of clinical research. (shrink)

This paper identifies strands of reasoning underlying several theories of democratic authority. It shows why each of them fails to adequately explain or justify it. Yet, it does not claim (per philosophical anarchism) that democratic authority cannot be justified. Furthermore, it sketches an argument for a perspective on the justification of democratic authority that would effectively respond to three problems not resolved by alternative theories—the problem of the expert, the problem of specificity, and the problem of deference. Successfully resolving these (...) problems is at least evidence for the viability of a justification of democratic authority. This perspective integrates procedural concerns with those about the quality of democratic outcomes. It shows that democratic authority, if there is such a thing, requires reliable democratic procedures as the only sort citizens could rationally accept. (shrink)

One interesting aspect of the Hwang-case has been the way in which this affair was assessed by academic journals such as Nature. Initially, Hwang’s success was regarded as evidence for the detrimental effects of research ethics, slowing down the pace of research in Western countries. Eventually, however, Hwang’s debacle was seen as evidence for the importance of ethics in the life sciences. Ironically, it was concluded that the West maintains its prominence in science (as a global endeavour) precisely because it (...) has its ethics in place. Bioethics was now seen as an indispensable part of quality control. In this article, I will claim that the Hwang case rather reveals that there is no reason for complacency and that there are substantial challenges awaiting us. They have to do with major transformations in the way knowledge is produced and research in the life sciences is conducted (such as the increase in pace and scale, globalisation and the growing importance of ICT and bioinformation). These transformations call for a different kind of bioethics. The focus must shift from duties of autonomous researchers concerning visible research subjects (“micro-ethics”) to responsibilities of institutionalised research networks in managing and processing large amounts of bioinformation (“macro-ethics”). Concepts such as transparency, reliability and benefit-sharing will become more important than concepts such as informed consent. Basically, it is a resurgence of the tension between the Kantian and the Hegelian view of ethics. The contours of macro-ethics will be elaborated notably as it is emerging in bioethical debates over biobanking and genetic databanks. (shrink)

Under the current Mental Health Act of England and Wales, it is lawful to perform deep brain stimulation in the absence of consent and independent approval. We argue against the Care Quality Commission's preferred strategy of addressing this problematic issue, and offer recommendations for deep brain stimulation-specific provisions in a revised Mental Health Act.

Is Rousseau an advocate of natural law or not? The purpose of Rehm’s paper is to suggest a positive answer to this controversially discussed question. On the one hand, Rousseau presents a critical history of traditional natural law theory which in his view is based on flawed suppositions: not upon natural, but on artificial qualities of man, and even rationality and sociability are counted among the latter. On the other hand he presents the self-confident manifesto for a fresh start (...) in natural law theory, founded on what to Rousseau’s mind is the true idea of human nature. The paper intends to show that the only natural qualities which can be seen as anthropological constants are those that keep man flexible, namely perfectibility and freedom of will. It is argued that these are exactly the qualities which according to Rousseau serve as the standard of natural law for the system of politics and its laws: Only a state based upon the free consent of individuals can do justice to man’s perfectibility and freedom of will. Rehm stresses that because of perfectibility and freedom of will, this self-commitment has to be revisable, which is why the republic of the “Social Contract” should not have a constitution, or any law that the citizens cannot alter. It is demonstrated that in Rousseau’s view, this republic is the enabling condition of natural liberty. -/- . (shrink)

Difficulty is often treated as blame-mitigating, and even exculpating. But on some occasions difficulty seems to have little or no bearing on our assessments of moral responsibility, and can even exacerbate it. In this paper, I argue that the relevance (and irrelevance) of difficulty with regard to assessments of moral responsibility is best understood via Quality of Will accounts. I look at various ways of characterising difficulty – including via sacrifice, effort, skill and ‘trying’ – and set out to demonstrate (...) that these factors are only blame-mitigating where, and to the extent that, they complicate ascriptions of insufficient concern. Matters become more complex, however, when we turn to difficult circumstances that seem to generate such objectionable attitudes. This is arguably the case with epistemic difficulty and certain instances of moral ignorance. Here I argue that certain difficult circumstances diminish the sense in which false moral beliefs are genuinely revelatory of the agents who hold them. In particular, I draw on the distinction between difficulty that generates objectionable attitudes, and objectionable attitudes that generate difficulty. I argue that the former, but not the latter, can plausibly be viewed as blame mitigating, and that this would apply to (limited) cases of moral ignorance. (shrink)

The odds of encountering a senior citizen selling on the street have increased. The claim that they have no choice but to work and sell on the street, despite the dangers, illnesses, and psychological issues they may face, to provide for their family’s needs is very evident. Therefore, this study explores the quality of life, lived experiences, challenges, and coping mechanisms of senior citizen street vendors in Bulacan, Philippines. The study employed Heideggerian Phenomenology and Interpretative Phenomenological Analysis (IPA). Moreover, the (...) following themes arise (1) Golden years, (2) Socially connected, and (3) Unknown journey. These themes highlighted the experiences and challenges faced by the participants. Moreover, it is highly suggested that local government agencies enhance and strictly monitor the existing program that alleviates mental and physical health concerns and senior citizens' safety and financial assistance. (shrink)

Recent evidence shows significant potential for therapies involving psychedelic substances such as psilocybin and MDMA to improve clinical outcomes for patients experiencing various mental disorders. However, research to date focuses almost exclusively on adults. I argue that adolescents should be included in research into psychedelic therapies. First, I demonstrate the pressing need for novel interventions to address the growing mental health burden of adolescents, and I draw on empirical evidence to show that research into psychedelic therapies presents an opportunity to (...) address this shortfall. Secondly, I argue that psychedelics pose low risk to young patients, particularly relative to existing psychiatric medications. I then address two major concerns specific to adolescent contexts. First, I address the risks of using psychedelic substances at earlier stages of physiological and cognitive development. I note that the lack of understanding of the risks underscores the need for including adolescents in research. I then address the added complexity of consent in the adolescent context. I highlight some additional concerns that should be addressed in an “enhanced” informed consent process for adolescents and defend the view that capable adolescents should be able to consent to psychedelic interventions. I ultimately hold that including adolescents in emerging psychedelic research has the potential to substantiate innovative treatments that could improve their clinical outcomes, long-term mental health and quality of life. (shrink)

Purpose: This article aims to highlight key indicators of residents' quality of life in a specific contemporary building in Kruja, Albania. -/- Design/Method/Approach: A questionnaire with 30 questions was prepared for the inhabitance, and the Binary or Tobit probabilistic models were taken into consideration as part of the methodology, to conclude. The study will further analyze the implications of the inhabitants and their behavior in a specific contemporary building in the city of Kruja. It was examined the statistical significance of (...) each variable (questions) in the models elaborated with EViews 8 software. The stable models that are associated with the “Log-likelihood” statistics were statistically significant at a significance level of p < 5%, or with 95% confidence, based on the model tests. -/- Findings: The study concluded that the most statistically significant quality of life indicators part of the questionnaire is related to the typology of the apartments, methods of cooling during summer, present living conditions, apartment improvement, apartment orientation, and time spent in the living room. Furthermore, the study reveals that most of the quality-of-life indicators (part of the questionnaire) are not statistically important, so they will not be considered part of the models created in the article. The study reveals that increasing the living space and improving orientation is crucial to enhance the satisfaction of apartment inhabitants. When apartment sizes increase and orientation is improved, residents are more likely to opt for fans over air conditioners to reduce electricity costs and avoid installing additional cooling facilities during summer. They believe that better living conditions require larger apartments, additional water supply, increased electrical costs, and more time spent in the living room. The inhabitants also emphasize the importance of reducing moisture levels, decreasing window opening frequency, and increasing time spent with family. Interestingly, a one-degree improvement in summer cooling methods (e.g., switching from air blowers to air conditioning) corresponds to a one-degree improvement in winter heating methods (e.g., switching from gas to electricity), leading to a heightened need for clean electric heating. Overall, the study emphasizes the importance of meeting the physical and spatial needs of the residents to enhance their overall satisfaction and quality of life. Urban policies significantly impact housing affordability, quality, transport systems, environmental sustainability, and social equity, affecting overall living standards and economic growth. Cities must create well-designed policies that consider residents' needs and study findings to ensure sustainable development and citizen welfare. -/- Theoretical Implications: Gujarati’s (Basic Economics) theory was developed in the article. -/- Practical Implications: This study will serve as an indicator to analyze the further improvements that might occur in the specific building (not just in the city of Kruja), considering the main quality of life indicators. -/- Originality/Value: The article will serve as a base for further analysis of resident’s behavior and their social impact in the community in order to be aware of their needs for further developments in the construction field. -/- Research Limitations/Future Research: The findings depend profoundly on the type of building the residents are living in. The research stream that can be inspired by the research is strongly related to mathematical regression models, statistics, and probability. -/- Paper Type: Empirical . (shrink)

In the past years, many students had problems with their finances, especially their expenses for education. Many of the students are affected by the crisis financially, emotionally, and by their wellbeing. That is why the government provides programs that will help the students with their problems with school expenses, and that is through the Tertiary Education Subsidy (TES) of the Commission on Higher Education (CHED). Further, the primary goal of this study is to explore the TES Grantees' lived experiences, challenges, (...) and coping mechanisms. Furthermore, these are the study's findings: (1) The grantees find the TES very helpful regarding finances that will tackle their academic needs, such as tuition fees and school learning materials. (2) Many students value government assistance that motivates them to maintain their grades. (shrink)

As the quality movement in health care now enters its fourth decade, the language of quality is ubiquitous. Practitioners, organizations, and government agencies alike vociferously testify their commitments to quality and accept numerous forms of governance aimed at improving quality of care. Remarkably, the powerful phrase ‘‘quality of care’’ is rarely defined in the health care literature. Instead it operates as an accepted and assumed goal worth pursuing. The status of evidence-based medicine, for instance, hinges on its ability to improve (...) quality of care, and efforts are made by both proponents and detractors to unpack the contents and outcomes of evidence-based practice while the contents of ‘‘quality of care’’ are presumed to be understood. Because the goals of medicine are far from obvious, this paper investigates the neglected term, ‘‘quality of care,’’ in an effort to understand what it is that health care practices are so uncritically assumed to be striving for. Finding lack of consensus on the terminology in the quality literature, I propose that the term operates rhetorically by way of persuasive appeal (and lack of descriptive meaning). Unsatisfied that ‘‘quality of care’’ operates as a mere buzzword in morally contentious debates over resource allocation and duties of care, I implore health care communities to go beyond mere commitments to quality and, instead, to focus attention on the difficult task of specifying what counts as quality care within an economically constrained health care system. (shrink)

Central elements of Roman Catholic treatment ethics include: 1) that rejection of treatment with the intent of hastening death (even for a good end) is ethically equivalent to active euthanasia with the same intent; 2) a distinction between morally obligatory “ordinary” treatment and morally optional “extraordinary treatment”; 3) that the quality of the patient’s life is not be a legitimate basis for rejecting treatment; and 4) that extraordinary treatment is not forbidden, but optional, and that it is the patient or (...) the patient’s legal surrogate–not the doctor– who has the right to choose or reject it. Despite these principles, even in a cultural climate fully sympathetic to Catholic treatment ethics, it is appropriate as a legal matter to maintain the doctrine of informed consent under which it is possible for patients or their surrogates to reject life-preserving treatment, including for unethical reasons. It is normally impossible to enforce in practice in the external forum a differentiation between rejection of treatment for ethically acceptable and ethically unacceptable reasons. By contrast, in cases of direct killing, such as assisting suicide, the intent to cause death is unmistakable (as opposed to accepting an increased risk of death as a foreseeable but unintended consequence of pursuing a good end). In a pluralistic society Catholic ethics cannot be legislatively enforced on the ground that they are compelled by Catholic teaching. However, the basic principles of Catholic treatment ethics may be justified based on logic and widely accepted norms of human equality independently of revelation or ecclesiastical authority. Particularly in protecting the right of individuals to choose and obtain life-saving medical treatment regardless of their “quality of life,” and in suicide prevention, secular law can and should be congruent with key aspects of Catholic health care ethics. (shrink)

This article proposes a novel strategy, one that draws on insights from antidiscrimination law, for addressing a persistent challenge in medical ethics and the philosophy of disability: whether health systems can consider quality of life without unjustly discriminating against individuals with disabilities. It argues that rather than uniformly considering or ignoring quality of life, health systems should take a more nuanced approach. Under the article's proposal, health systems should treat cases where quality of life suffers because of disability-focused exclusion or (...) injustice differently from cases where lower quality of life results from laws of nature, resource scarcity, or appropriate tradeoffs. Decisionmakers should ignore quality-of-life losses that result from injustice or exclusion when ignoring them would improve the prospects of individuals with disabilities; in contrast, they should consider quality-of-life losses that are unavoidable or stem from resource scarcity or permissible tradeoffs. On this proposal, while health systems should not amplify existing injustice against individuals with disabilities, they are not required to altogether ignore the potential effects of disability on quality of life. (shrink)

Abstract: The study aimed to determine the quality of services and its role in enhancing strategic flexibility, from the point of view of the internal beneficiary in non-governmental hospitals in Gaza Strip. The study relied on the descriptive and analytical approach, and the questionnaire was designed as a tool to collect data and consisted of (39) items, and the researchers used the comprehensive survey method, and the number of the study population was (536) individuals, where (434) questionnaires were retrieved, and (...) the recovery rate was (80.97%). The study revealed many results, the most important of which were: the existence of a high degree of approval by the study sample regarding the quality of services, as it was evident through the field of service quality obtaining a relative weight (79.90%), and the results of the study indicated that there is a moderate degree of approval by the members of the study sample. On the strategic flexibility, as it was evident by obtaining the area of strategic flexibility as a whole on a relative weight (60.44%). The results of the study revealed a statistically significant relationship between the quality of services and the strategic flexibility in non-governmental hospitals in Gaza Strip, with a correlation coefficient of 0.490). The results of the study also revealed a statistically significant effect of the quality of services on the strategic flexibility in non-governmental hospitals in Gaza Strip. The study reached many recommendations, the most important of which were: Establishing an effective system to receive patients' complaints in a manner that ensures rapid response and treatment, to achieve continuous communication between patients and the hospital administration, to notify patients of dealing with the complaints they submit, and to work to provide all medical and health specialties in hospitals in place. The study, by making use of medical delegations visiting Gaza Strip, involving them in therapeutic operations, bringing in doctors and specialists from abroad, updating the criteria for measuring services provided to patients on an ongoing basis, based on patients' suggestions and complaints, developing facilities in hospitals, as well as updating medical devices and equipment Used in hospitals periodically and the need to work on appointing young people and people of energy, for vacancies in the hospitals under study, and the need to seek the help of an administrative staff that is distinguished by scientific and practical qualifications, and to work on updating information systems, archiving and networks through which data and information are transferred between departments, and finding mechanisms to be done from During which the information stored can be used to enhance the decision-making process. (shrink)

This chapter explores how far one can go accounting for the moral responsibility implications of several unusual mental conditions using a parsimonious quality-of-will account that relies on the way we talk about moral responsibility in more mundane situations. By contrasting situations involving epistemic irrationality versus cognitive impairment, it becomes clear that the presence of those often (but not always) excuses actions performed by unusual agents. The discussion turns to cases of clinical depression and sketches a way for quality-of-will accounts to (...) approach them. It is also argued that of some of these mental conditions, there is no particular reason to think that they excuse. There is also an argument against regarding the concept "mental disorder" and current DSM categories as critical to agency theory. (shrink)

A variety of mental disorders—including ASD, ADHD, major depression, and anxiety disorder, among others—may directly impact what an agent notices or fails to notice. A recent debate has emphasised the potential significance of such “impairment-derived ignorance,” and argued that failure to account for certain compelling cases would seriously undermine theories which intend to establish the conditions for blameworthy ignorance. In this comment we argue, contra a recent challenge, that Quality of Will (QW) accounts are able to explain the normative significance (...) of impairment-derived ignorance. The plausible, ambivalent results QW accounts yield in difficult cases of impairment-derived ignorance further reveals the explanatory power of such accounts when it comes to blameworthy ignorance. (shrink)

The growth of individuals and society heavily relies on education. Certain hindrances may prompt some students to halt their academic pursuits temporarily. This is known as "Balik-aral." The exploration of the quality of life, lived experiences, and challenges of grade 12 Balik-aral students was undertaken by the authors to break their silence and help them by developing recommendations that could be presented to the school's key stakeholders. A phenomenological approach was used to understand the phenomenon in a study involving five (...) grade 12 balik-aral students from different strands currently enrolled in a public school in Cebu City, Philippines. A structured interview was used to collect data, and significant themes emerged during data analysis using Colaizzi's method. The study revealed several sub-themes, including age disparities and pressure to obtain the diploma while maintaining quality of life. Additionally, key informants emphasized the sense of community and an immersive learning environment in their lived experiences as balik-aral students. Finally, competing priorities and scarcity of resources emerged as significant challenges for those involved in the study. Consequently, the investigation has determined that balik-aral students must be treated equitably to foster their engagement with their peers and enhance their self-assurance, ultimately leading to academic success. (shrink)

This is a corrected version of the final proofs. I've fixed a number of typos, and corrected a blunder in chapter 4. In chapter 4 I say that 'this is this' is analytic, and 'this is not this' is antonymous. This is inconsistent with what I say in chapter 5, and not what I actually think. Rather, 'this is this' is taugologous, and 'this is not this' is contradictory. Analyticity and autnonmy are sense properties while tautologousness and contradictoriness are formal (...) logical properties. Heading, ToC and Index updated accordingly. (Oxford will make these corrections in their online version and in future print runs.). (shrink)

Consent, on a standard theoretical framework, is a way of giving permission or waiving a right. Dougherty’s book is about the ‘scope’ of consent: which acts are permitted by a given act of consent? Along the way, Dougherty offers a view about what consent consists in and why it does its morally transformative work. The book is an exemplar of careful analytic philosophy. Philosophers working on consent in that tradition will find it essential reading. Following (...) are more specific reactions that will, I hope, convey a more specific sense of the book, and also engage and critique it and the tradition it exemplifies. (shrink)

Quality of Zionism`s formation Written by: A.M. Abstract One of the most important discussions in every school of thought is the subject of recognizing the enemies against the given school. Every being in the world should know their enemies in order to be able to secure their survival and provide the necessary means of defend against the enemies. Even the animals follow the same rule; no animal was trapped by the hunter except when it acted ignorantly. Concerning this subject, Imam (...) Khomeini Says no freeman officially recognizes Israel. The Quranic verse (82, surah: Ma`edeh) explains the subject of knowing the enemy and prioritizes it as, “Latajiddana Ashad Al-Nas” The first important enemy is the Jews and if one day the Quran would change the first important enemy changed. Any mention of the Jews in the Quran should be interpreted as the Zionism. The second important enemy is “Al-Ladina Ashraku” which means the polytheists. Another Quranic verse says that the Christians are also the Muslims` enemies, “Wa lan Tarza ankel Yahud Wa la Nasara Hatta Tattabe`a Mellatahom Qol Inna Hada Allah Wa laen Ittabaat Ahwa`ahom Bad Al-Ladi Jaaka Min Al- Elme Ma laka Men Allah-e Men Waliye Wala Nasir” meaning that the Jews and Christians will never be satisfied with you [so that you surrender to their wants] and follow their [distorted] religion. Say: Guidance is only the God`s guidance! And if you follow their desires, after becoming aware of it, there will be neither divine guardians nor any companions for you. (Surah: Baqareh, Verse 120). This article has mostly dealt with the basic formation of the Zionism. The subject has been divided and discussed in 4 categories, namely civil Zionism, Zionism in economy, policy, and religion. The article studies the importance of the Middle East in the viewpoint of “Lord Rochild” and the issue of laying the groundwork for controlling the Middle East as the best option for founding the Jew government. The Zionism`s four mentioned aspects were effective and aimed at creating a powerfull united Zionist government and later and as the result of these efforts the Israel promised state was founded. The author points to the serious problems of Zionism and indicates that the Post-Zionism, who had entered the scene to solve these problems, could not succeed in doing this mission. چگونگی شکل‌گیری و پیدایش صهیونیزم//Quality of Zionism`s formation//تأسیس الصهیونیة و ظهورها Keywords: Zionism, Economic, Political, Cultural and Religious Zionism, Israel, Rothschild, Instantly. (shrink)

Al Mele’s Manipulated Agents: A Window to Moral Responsibility (OUP 2019) is an extraordinarily careful and clear little book. A central recurring element is the use of examples of radical value reversals due to manipulation. In this commentary, I discuss the relevance of these examples to a simple quality of will account of blameworthiness without explicit historical conditions. Such an account, I suggest, can fairly straightforwardly explain how value reversals might mitigate blameworthiness. But I also suggest that the intuition that (...) they completely remove blameworthiness should instead be explained away. (shrink)

Tricycles are one of the most popular, most accessible, and least expensive forms of public transit in the Philippines. In addition to being common modes of transportation, motorcycles, and tricycles also contribute significantly to the livelihoods of millions of Filipinos who rely on them for a living. Hence, this study explores the lived experiences and challenges faced by female tricycle drivers. Employing the Interpretative Phenomenological Analysis, the findings of this study were: The participants strive to assist their husbands in providing (...) for their families. Their motivation comes primarily from their families. They each make every effort to provide a better life for their children. Thus, have faced challenges related to their ability to make ends meet, find time to balance job and family obligations, and encounter discrimination and stereotypes in others, and day-to-day life. Moreover, they evade and disregard the problem and discrimination as a coping mechanism. They feel that if they ignore their problem and focus on achieving their goal of providing for their family, it would eventually disappear. (shrink)

Recent work in the psychology of happiness has led some to conclude that we are unreliable assessors of our lives and that skepticism about whether we are happy is a genuine possibility worth taking very seriously. I argue that such claims, if true, have worrisome implications for procreation. In particular, they show that skepticism about whether many if not most people are well positioned to create persons is a genuine possibility worth taking very seriously. This skeptical worry should not be (...) confused with a related but much stronger version of the argument, which says that all human lives are very bad and not worth starting. I criticize the latter stance, but take seriously the former stance and hope it can be answered in future work. (shrink)

The #MeToo movement generated a feminist insistence that we “believe women.” But the men accused of assault, harassment, and other violations frequently defended themselves with the insistence that they had always “respected women” – sometimes, going so far as to get numerous women to sign letters swearing that these men had always respected them. This common MeToo defense reveals the core inconsistency – and the core entitlement – at the heart of misogyny and sexual injustice: some women deserve respect. But (...) the duty to respect those women relies on an invisible entitlement to disrespect – indeed, to assault, harass, dominate, or exploit – others. This chapter explores consent’s role within the superstructure of misogyny and sexual injustice, arguing what consent is a key apparatus of white supremacy. It argues that consent has been constructed through dynamics of colonial and racist sexual entitlement, mapping some (white) women as deserving of respect and the right to consent, while marking other women as expendable or disposable within the sexual economy. This means not only that consent is historically constructed as white, but also that whiteness, and in particular, white womanhood, is constructed through consent. Thus, white women’s right to consent – or to refuse – is premised upon the inability of other women to do so. In this way, the right to sexual consent does not disrupt the norm of male sexual entitlement. Consent has always been premised on non-consent, from coloniality and slavery to contemporary porn, which offers a vision of the world without proper consent, so that granting consent to actual women is an exceptional practice, an “act of respect.” By including race and class alongside gender in my analysis of consent, I argue that contemporary feminist visions of sexual justice must do more than defend or ameliorate consent, but develop intersectional interrogations of sexual justice that reckon with the complicities of consent. (shrink)

Abstract: The aim of the research is to identify the reality of the quality of health services in light of the Corona Pandemic, and in order to achieve the research objectives, the researchers used the descriptive and analytical approach using a comprehensive survey method for the total research community, whose number reached (110) individuals, while (90) were recovered: The level of health service quality is of relative weight (76%). Among the most important recommendations made by the research: Work to pay (...) a health risk premium to all workers in health centers, in addition to paying attention to training and building work teams in various fields to improve the quality of health services provided. (shrink)

In the debates regarding the ethics of human organoid biobanking, the locus of donor autonomy has been identified in processes of consent. The problem is that, by focusing on consent, biobanking processes preclude adequate engagement with donor autonomy because they are unable to adequately recognise or respond to factors that determine authentic choice. This is particularly problematic in biobanking contexts associated with organoid research or the clinical application of organoids because, given the probability of unforeseen and varying purposes (...) for which a donor’s organoids could be employed and given the different ways in which a donor can relate to her biospecimens, a donor can value her organoids differently in different contexts and her reasons for autonomously permitting use of her cells and tissues in one case may not support an autonomous decision in another. In response, this paper has three aims: firstly, to make the case for why organoid biobanks ought to respect donor autonomy conceived as authentic choice; secondly, to explore the autonomy-respecting limits of established and widely prevalent models of biobank consent; and thirdly, to propose certain conditions that organoid biobanks ought to support or facilitate in order to respect donor autonomy. (shrink)

In 1993 the Law Lords upheld the original conviction of five men under the 1861 Offences Against the Person Act for participating in sado-masochistic practices. Although the five men were fully consenting adults, the Law Lords held that consent did not constitute a defence to acts of violence within a sado-masochistic context. This paper examines the judgements in this case and argues that sado-masochistic practices are no different from the known exceptions cited by the court to the idea that (...) consent is no defence to violence (sport, parental chastisement and surgery). It also argues that if we can make sense of rape as a non-consensual, violent act, expressed through sex, then we can make sense of sado-masochism as a consensual sexual act, expressed through violence. (shrink)

In this peer commentary on L. Syd M. Johnson’s “Inference and Inductive Risk in Disorders of Consciousness,” I argue for the necessity of disability education as an integral component of decision-making processes concerning patients with DOC and, mutatis mutandis, all patients with disabilities. The sole qualification Johnson places on such decision-making is that stakeholders are educated about and “understand the uncertainties of diagnosis and prognosis.” Drawing upon research in philosophy of disability, social epistemology, and health psychology, I argue that this (...) educational qualification is insufficient to address systemic ableism and other forms of epistemic bias in quality of life judgments. (shrink)

In this paper I discuss the nature of consent in general, and as it applies to Carlos Nino’s consensual theory of punishment. For Nino the criminal’s consent to change her legal-normative status is a form of implied consent. I distinguish three types of implied consent: 1) implied consent which is based on an operative convention (i.e. tacit consent); 2) implied consent where there is no operative convention; 3) “direct consent” to the legal-normative (...) consequences of a proscribed act – this is the consent which Nino employs. I argue that Nino’s conception of consent in crime exhibits many common features of “everyday” consent, which justify that it be classed as a form of (implied) consent. h us, Nino is right to claim that the consent in crime is similar to the consent in contracts and to the consent to assume a risk in tort law. (shrink)

Objectives: This study aimed to fill the gap between Vietnamese diabetic patients' needs and care through a qualitative study asking about their experiences with diabetes and quality of care. -/- Methods: Interviews with five diabetic patients were conducted at a tertiary general hospital located in southern Vietnam. The transcribed data were first subjected to quantitative text analysis using KH Coder to identify major categories of frequently used words, followed by a qualitative analysis of selected cases using the Steps for Coding (...) and Theorization (SCAT) method. -/- Results: The major categories of frequently used words were chronic health conditions, services, facilities, insurance, patient-doctor communication, and medication. SCAT analysis of three selected cases identified six themes: “Disregarding the disease at the early stage,” “Fear of complications,” “Satisfaction with hospital services and medical staff,” “Insurance-related problems,” “Long waiting times,” and “Communication barriers between patients and doctors.” Patients were satisfied with improved hospital facilities and services; however, the overloading of one hospital led to long waiting times and communication difficulties with doctors. Difficulties with health insurance were also observed, and patients were rather passive in disease management and needed to be empowered through improved communication with doctors and other care providers. -/- Conclusion: These findings from our trial of introducing a qualitative study into service evaluation suggest that listening to patients can help health providers learn their perspectives and be more responsive to their needs. (shrink)

In this clearly written, impressively researched, and engaging book, Alan Wertheimer makes a distinctive and important contribution to the contemporary literature on the nature and value of consent to sexual relations. Wertheimer’s effort is two-fold. First, and as an informative yet logically distinct backdrop, he provides a specific theory of sexual desire and behavior, viz., evolutionary psychology. Second, he identifies and defends moral and legal principles of valid consent to sex. In chapter-length discussions, Wertheimer shows why matters of (...) consent are significantly more complex than many, including influential feminist scholars, recognize, and in so doing lays the groundwork for the theoretical core of his book: a rights-based theory of sexual coercion. This theory provides powerful grounds for determining when conduct constitutes coercion of the sort that nullifies consent and, when combined with numerous and often-ingenious hypothetical cases, teases out principles of moral and legal consent that are both coherent and reasonable. As a result of this combination of considerations, Wertheimer’s book is unique among recent efforts in this area and the analyses and arguments presented should be of great interest to social psychologists as well as those working in normative ethics and jurisprudence. (shrink)

This study evaluated the quality of educational resources vis-à-vis effective instructional service delivery in Nigerian universities. Particularly, the study was carried out in university of Calabar, using five hundred and nineteen (519) students selected through the simple random sampling technique from the fifteen faculties of the University of Calabar. To achieve the purpose of the study, two hypotheses were formulated. A questionnaire titled quality of educational resources and effectiveness of instructional service delivery questionnaire (QEREISDQ) was developed by the researchers, this (...) was subjected to face and content validity by three experts in measurement and evaluation and Administration of Higher education all in Faculty of Education University of Calabar. A pilot test was carried out using forty students from University of Uyo in Akwa Ibom state to establish the reliability of the instrument. Using the Cronbach’s alpha reliability method, the instrument had a reliability coefficient of α=.79-.85. The instrument was administered to the respondents and retrieved with Zero attrition rate. The data collected was analyzed through means, standard deviation, Pearson product moment correlation and multiple regression analysis. It was revealed among other things that; the quality of educational resources has a significant relationship with effective of instructional service delivery, with the quality of lecturers being the strongest predictor of effective instructional delivery. However, it was also revealed that the quality of library was significantly low and influenced effective instructional delivery negatively. It was therefore, recommended that government and corporate organizations should provide adequate educational resources and promote viral development programmes for lecturers to enhance effective instructional delivery in Nigerian universities. (shrink)

Background: Food-borne outbreaks have been associated with sourcing unsafe food. Therefore, the first preventative strategy should be to source safe food. Even if the sourced food is safe, measures need to be put in place to ensure that it remains safe during the transfer, storage, preparation and serving activities that follow. An understanding of the ship food supply and transfer chain will help to illustrate the points at which the food can become contaminated en route to the point of consumption. (...) Objectives: The study was conducted in selected sea port in the core Niger Delta to assessed the microbiological quality of food served at different ship galley to crew and passengers and compared it to standard. Methods: Samples of food were taken from three (Port Harcourt Area one (PHSP), Warri (WSP) and Koko (KSP)) seaports within the South-South zone for laboratory analysis to uncover food spoilage microorganisms capable of causing disease outbreak among ship which could result to Transborder diseases. Eleven samples of different ready to eat food were collected from the locations, which included cooked rice; fried fish, irish potato porridge, vegetable soup, griki, pepper soup, fried irish potato, salad and bread were collected randomly. The samples were prepared and analyzed using standard procedures. Mean viable counts of aerobic and anaerobic bacteria were determined, ranging from (13×103cfu/g to 78×104 cfu/g) for ready to eat food. Results: Based on the finding KSP I, KSP J and KSP K food samples had the highest bacterial contamination on food while WSP F, WSP G and WSP H food samples had the least with the following isolates Salmonella spp, Nocardia spp, Shigella spp, Listeria spp, Bacillus cereus, Leuconostoc spp, Acinetobacter spp, Acetobacter spp, campylobacter spp, Clostridium spp and Vibrio spp which revealed that the isolates were susceptible to any of these antibiotics Septrin, Chloramphenicol, Gentamycin, Tarvid, Streptomycin, Reflacin, Augumetin, Ceporex, Nalidixic acid, Ampicillin, Ciproflox, Penicillin and Erythromycin. Conclusion: Thus, ships operators and regulatory body are expected to take all practicable measures to ensure that they do not receive unsafe or unsuitable food and maintain adequate food temperature at all time. (shrink)

Is there a role for aesthetic judgements in science? One aspect of scientific practice, the use of thought experiments, has a clear aesthetic dimension. Thought experiments are creatively produced artefacts that are designed to engage the imagination. Comparisons have been made between scientific (and philosophical) thought experiments and other aesthetically appreciated objects. In particular, thought experiments are said to share qualities with literary fiction as they invite us to imagine a fictional scenario and often have a narrative form (Elgin (...) 2014). But philosophical discussions of aesthetics in science have focused mainly on the epistemic role of beauty and elegance when it comes to theories and mathematical proofs, and thought experiments have been widely overlooked. My aim in this chapter is to address how the aesthetic choices scientists make in the design of a thought experiment contribute to its function: to communicate, convince, or explain a theory or phenomenon. A key issue is whether any aesthetic features in science provide anything beyond catching our attention, or are at best, a mere heuristic aid. I respond to accounts that argue this way and show how formulation is important in scientific thought experiments and, similarly to literary fictions, there is more than one way of interpreting a thought experiment scenario. I end by considering which literary examples are most appropriate when making comparisons with thought experiments. As a result, the difference between representations in art and science raised in current discussions is not as stark as it has been made out to be, and science is a more heterogeneous practice than has been allowed. Part of the value of thought experiments in scientific practice includes the qualities they share with literary works. (shrink)

In recent papers, I defend the intrinsic value of the interesting, and the intrinsic disvalue of the boring. My arguments introduce two claims with important implications for discussions of the quality of life. The first is that when it comes to experiences, there’s more value at stake than pleasure alone. The second is that there is value to cognitive engagement itself, even when it is unstructured by desires or reasons. This paper explores the important consequences these conclusions have for how (...) we appraise the quality of life of subjects with dramatically impaired cognitive capacities (such as patients with advanced Alzheimer’s and patients in a persistent vegetive state). I examine whether such groups are capable of experiencing the interesting and, by extension, what degrees of self-awareness are required to experience the kind of cognitive engagement at stake in interesting experiences. (shrink)

In this article, I examine the possible thought experimenting qualities of Soren Kierkegaard's novel Fear and Trembling and in which way it can be explanatory. Kierkegaard's preference for pseudonyms, indirect communication, Socratic interrogation, and performativity are identified as features that provide the narrative with its thought experimenting quality. It is also proposed that this literary fiction functions as a Socratic-theological thought experiment due to its influences from both philosophy and theology. In addition, I suggest three functional levels of the (...) fictional narrative that, in different ways, influence its possible explanatory force. As a theoretical background for the investigation, two accounts of literary cognitivism are explored: Noel Carroll's Argument Account and Catherine Elgin's Exemplification Account. In relation to Carroll's proposal, I conclude that Fear and Trembling develops a philosophical argumentation that is dependent on the reader's own existential contribution. In relation to Elgin's thought, the relation between truth and explanatory force is acknowledged. At the end of the article, I argue that it is more accurate to see the explanatory force of Fear and Trembling in relation to its exploratory function. (shrink)

This article examines one of the sources of David Benatar’s anti-natalism. This is the view that ‘all procreation is [morally] wrong.’ (Benatar and Wasserman, 2015:12) One of its sources is the claim that each of our lives is objectively bad, hence bad whether we think so or not. The question I will pose is whether the constraints of metaphysical naturalism allow for an objective devaluation of human life sufficiently negative to justify anti-natalism. My thesis is that metaphysical naturalism does not (...) have the resources to support such a negative evaluation. Metaphysical naturalism is the view that causal reality is exhausted by nature, the space-time system and its contents. The gist of my argument is that the ideal standards relative to which our lives are supposed to be axiologically substandard cannot be merely subjective expressions of our desires and aversions; they must be (i) objectively binding standards that are (ii) objectively possible in the sense of concretely realizable. The realizability condition, however, cannot be satisfied on metaphysical naturalism; ergo, failure to meet these ideal standards cannot show that our lives are objectively bad. (shrink)