A Confucian View of Personhood and Bioethics

This paper focuses on Confucian formulations of personhood and the implications they may have for bioethics and medical practice. We discuss how an appreciation of the Confucian concept of personhood can provide insights into the practice of informed consent and, in particular, the role of family members and physicians in medical decision-making in societies influenced by Confucian culture. We suggest that Western notions of informed consent appear ethically misguided when viewed from a Confucian perspective.     

Comparative phylogeography of African savannah ungulates

The savannah biome of sub-Saharan Africa harbours the highest diversity of ungulates (hoofed mammals) on Earth. In this review, we compile population genetic data from 19 codistributed ungulate taxa of the savannah biome and find striking concordance in the phylogeographic structuring of species. Data from across taxa reveal distinct regional lineages, which reflect the survival and divergence of populations in isolated savannah refugia during the climatic oscillations of the Pleistocene. Data from taxa across trophic levels suggest distinct savannah refugia were present in West, East, Southern and South-West Africa. Furthermore, differing Pleistocene evolutionary biogeographic scenarios are proposed for East and Southern Africa, supported by palaeoclimatic data and the fossil record. Environmental instability in East Africa facilitated several spatial and temporal refugia and is reflected in the high inter- and intraspecific diversity of the region. In contrast, phylogeographic data suggest a stable, long-standing savannah refuge in the south.     

Impact of Three Years Training on Operations Capacities of Research Ethics Committees in Nigeria

This paper describes a three‐year project designed to build the capacity of members of research ethics committes to perform their roles and responsibilities efficiently and effectively. The project participants were made up of a cross‐section of the membership of 13 Research Ethics Committees (RECs) functioning in Nigeria. They received training to develop their capacity to evaluate research protocols, monitor trial implementation, provide constructive input to trial staff, and assess the trial's success in promoting community engagement in the research. Following the training, technical assistance was provided to participants on an ongoing basis and the project's impacts were assessed quantitatively and qualitatively. Results indicate that sustained investment in capacity building efforts (including training, ongoing technical assistance, and the provision of multiple tools) improved the participants’ knowledge of both the ethical principles relevant to biomedical research and how effective REC should function. Such investment was also shown to have a positive impact on the knowledge levels of other RECs members (those who did not receive training) and the overall operations of the RECs to which the participants belonged. Building the capacity of REC members to fulfill their roles effectively requires sustained effort and investment and pays off by enabling RECs to fulfill their essential mission of ensuring that trials are conducted safely and ethically.     

The impact of reproduction on gambian women: Does controlling for phenotypic quality reveal costs of reproduction?

Life history theory predicts that where resources are limited, investment in reproduction will cause a decline in body condition and ultimately may lower survival rates. We investigate the relationship between reproduction and mortality in women in rural Gambia. We use a number of different measures of reproductive investment: the timing of reproduction, intensity of reproduction, and cumulative reproductive investment (parity). Though giving birth is clearly a risk factor for increased mortality, we find limited evidence that the timing, intensity, or cumulative effects of reproduction have a survival cost. Instead, there is some evidence that women who have invested heavily in reproduction have higher survival than women with lower reproductive investment: both high parity and late age at last reproduction are associated with high survival. The only evidence for any cost of reproduction is that women who have given birth to twins (considered a marker of heavy investment in reproduction) have higher mortality rates than other women, after the age of 50 years. A potential confounding factor may be differences in health between women: particularly healthy women may be able to invest substantially in both reproduction and their own survival, leading to the positive correlations between survival and both parity and age at last birth we observe. To control for differences in health between women, we reanalyze the relationship between reproduction and mortality but include variables correlating with health in our models (height, BMI, and hemoglobin). Even when controlling for health, the positive correlation between investment in reproduction and survival remains unchanged.     

An oath for bioscientists

In this paper, by examining the idea of a Hippocratic Oath for scientists, promoted by Sir Joseph Rotblat, oaths for medical professionals and scientists and the definitions and relationships of different moral norms such as oaths, codes and guidelines, we propose an oath for bioscientists with justifications based on professional and organizational ethics.     

Are open‐Label Placebos Ethical? Informed Consent and Ethical Equivocations

The doctor‐patient relationship is built on an implicit covenant of trust, yet it was not until the post‐World War Two era that respect for patient autonomy emerged as an article of mainstream medical ethics. Unlike their medical forebears, physicians today are expected to furnish patients with adequate information about diagnoses, prognoses and treatments. Against these dicta there has been ongoing debate over whether placebos pose a threat to patient autonomy. A key premise underlying medical ethics discussion is the notion that the placebo effect necessitates patient deception. Indeed, the American Medical Association guidelines imply that placebo treatment necessary entails a form of deception. As a consequence of this assumption, the fulcrum of debate on the use of placebo treatment has hinged on whether that deception is ever justified. Recently performed experiments with open‐label transparently prescribed placebos have begun to challenge the notion that deception is necessary in eliciting the placebo effect and such effects necessarily involve a binary distinction between autonomy and beneficence. In this article we focus on the content of disclosures in distinctive open‐label, transparently disclosed placebo studies and inquire whether they might be said to invoke deception in clinical contexts, and if so, whether the deception is unethical. We find that open placebos may be said to involve equivocation over how placebos work. However, drawing on surveys of patient attitudes we suggest that this equivocation appears to be acceptable to patients. We conclude that open placebos fulfil current American Medical Association guidelines for placebo use, and propose future research directions for harnessing the placebo effect ethically.