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1.
Anthony Wrigley 《Bioethics》2015,29(7):478-487
The concept of vulnerability has been subject to numerous different interpretations but accounts are still beset with significant problems as to their adequacy, such as their contentious application or the lack of genuine explanatory role for the concept. The constant failure to provide a compelling conceptual analysis and satisfactory definition leaves the concept open to an eliminativist move whereby we can question whether we need the concept at all. I highlight problems with various kinds of approach and explain why a satisfactory account of vulnerability is unlikely ever to be offered if we wish the concept to play a genuinely explanatory role in bioethical contexts. I outline why an eliminativist position should be taken with regard to this concept in light of these concerns but mitigate some of the severity of this position by arguing that we can still make sense of retaining our widespread use of the term by viewing it as nothing more than a useful pragmatic linguistic device that acts as a marker to draw attention to certain kinds of issue. These issues will be entirely governed by other, better understood ethical concepts and theories. 相似文献
2.
Florencia Luna 《Developing world bioethics》2019,19(2):86-95
“Vulnerability” is a key concept for research ethics and public health ethics. This term can be discussed from either a conceptual or a practical perspective. I previously proposed the metaphor of layers to understand how this concept functions from the conceptual perspective in human research. In this paper I will clarify how my analysis includes other definitions of vulnerability. Then, I will take the practical‐ethical perspective, rejecting the usefulness of taxonomies to analyze vulnerabilities. My proposal specifies two steps and provides a procedural guide to help rank layers. I introduce the notion of cascade vulnerability and outline the dispositional nature of layers of vulnerability to underscore the importance of identifying their stimulus condition. In addition, I identify three kinds of obligations and some strategies to implement them. This strategy outlines the normative force of harmful layers of vulnerability. It offers concrete guidance. It contributes substantial content to the practical sphere but it does not simplify or idealize research subjects, research context or public health challenges. 相似文献
3.
Horn L 《Developing world bioethics》2007,7(3):119-127
The concept of 'vulnerability' is well established within the realm of research ethics and most ethical guidelines include a section on 'vulnerable populations'. However, the term 'vulnerability', used within a human research context, has received a lot of negative publicity recently and has been described as being simultaneously 'too broad' and 'too narrow'. The aim of the paper is to explore the concept of research vulnerability by using a detailed case study - that of mineworkers in post-apartheid South Africa. In particular, the usefulness of Kipnis's taxonomy of research vulnerability will be examined. In recent years the volume of clinical research on human subjects in South Africa has increased significantly. The HIV and TB pandemics have contributed to this increase. These epidemics have impacted negatively on the mining industry; and mining companies have become increasingly interested in research initiatives that address these problems. This case study explores the potential research vulnerability of mineworkers in the context of the South African mining industry and examines measures that can reduce this vulnerability. 相似文献
4.
Harrosh S 《Bioethics》2012,26(9):493-498
Moral disagreements often revolve around the issue of harm to others. Identifying harms, however, is a contested enterprise. This paper provides a conceptual toolbox for identifying harms, and so possible wrongdoing, by drawing several distinctions. First, I distinguish between four modes of human vulnerability, forming four ways in which one can be in a harmed state. Second, I argue for the intrinsic disvalue of harm and so distinguish the presence of harm from the fact that it is instrumental to or constitutive of a valued act, practice or way of life. Finally, I distinguish between harm and wrongdoing, arguing that while harm is a normative concept requiring justification, not all harmed states are automatically unjustified. The advantage of this view is that it refocuses the moral debate on the normative issues involved while establishing a common basis to which both sides can agree: the presence of harm to others. 相似文献
5.
Xiao-Meng Wang Xi-Ru Zhang Zhi-Hao Li Wen-Fang Zhong Pei Yang Chen Mao 《The journal of gene medicine》2021,23(5):e3312
With the explosive growth of medical information, it is almost impossible for healthcare providers to review and evaluate all relevant evidence to make the best clinical decisions. Meta-analyses, which summarize all existing evidence and quantitatively synthesize individual studies, have become the best available evidence for informing clinical practice. This article introduces the common methods, steps, principles, strengths and limitations of meta-analyses and aims to help healthcare providers and researchers obtain a basic understanding of meta-analyses in clinical practice and research. 相似文献
6.
The concept of vulnerability is widely used in research ethics to signal attention to participants who require special protections in research. However, this concept is vague and under‐theorized. There is also growing concern that the dominant categorical approach to vulnerability (as exemplified by research ethics regulations and guidelines delineating vulnerable groups) is ethically problematic because of its assumptions about groups of people and is, in fact, not very guiding. An agreed‐upon strategy is to move from categorical towards analytical approaches (focused on analyzing types and sources of vulnerability) to vulnerability. Beyond this agreement, however, scholars have been advancing competing accounts of vulnerability without consensus about its appropriate operationalization in research ethics. Based on previous debates, we propose that a comprehensive account of vulnerability for research ethics must include four components: definition, normative justifications, application, and implications. Concluding that no existing accounts integrate these components in a functional (i.e., practically applicable) manner, we propose an integrative and functional account of vulnerability inspired by pragmatist theory and enriched by bioethics literature. Using an example of research on deep brain stimulation for treatment‐resistant depression, we illustrate how the integrative‐functional account can guide the analysis of vulnerability in research within a pragmatist, evidence‐based approach to research ethics. While ultimately there are concerns to be addressed in existing research ethics guidelines on vulnerability, the integrative‐functional account can serve as an analytic tool to help researchers, research ethics boards, and other relevant actors fill in the gaps in the current landscape of research ethics governance. 相似文献
7.
生态脆弱性评价与预测研究进展 总被引：6，自引：0，他引：6
如何定义和观测生态脆弱性,如何对生态脆弱性进行客观评价和有效预测,对于维持生态系统稳定、实现区域可持续发展有着重要的理论参考价值.本文在分析国内外相关研究进展的基础上,讨论了生态脆弱性的研究方向、研究尺度和研究方法等问题,并对生态脆弱性评价和预测进行了总结.当前生态脆弱性研究中,存在着研究框架不完善,研究方法不统一,以及研究尺度与精度之间难协调等问题.未来生态脆弱性研究应关注:1)进一步增加生态脆弱性研究的广度和深度;2)生态脆弱性研究与其他学科的交叉与融合;3)利用“3S”技术建立更加系统和完善的集脆弱性动态监测、综合评价和趋势预测为一体的生态脆弱性研究体系;4)生态脆弱性应对政策的研究. 相似文献
8.
Esa Koskela Pinja Juutistenaho Tapio Mappes Tuula A. Oksanen 《Evolutionary ecology》2000,14(2):99-109
According to parental investment theory, nest defence activity should be related to the reproductive value of the offspring. Alternative hypotheses suggest that defence activity may, for example, depend upon the conspicuousness of the young. Studies concerning this topic have been carried out almost exclusively on birds and experimental data on the diversity of organisms is lacking. Bank voles Clethrionomys glareolus were used to study the effects of the number and age of offspring upon the pup defence activity of mothers. Male bank voles are infanticidal and thus an adult male was used as a predator. Defence trials were conducted in the laboratory and filmed for subsequent analysis. Litter sizes were divided into three treatment groups: reduced (−2 pups), control (±0 pups) and enlarged (+2 pups). In order to study the effect of offspring age upon maternal defence activity the trials were conducted twice: when the pups were 3 and 8 days old. Defence activity increased with the number of offspring and enlarged litters were most actively defended. This result supports parental investment theory and conclusions drawn by earlier studies of birds. However, in contrast to the conclusions of earlier studies, older offspring were defended less than the younger ones. Whilst new-born pups are totally defenceless against predators their vulnerability decreases as they age. Therefore, we suggest that maternal aggression in female bank voles is related to the value as well as to the vulnerability of the offspring. The validity of this explanation and the determinants of parental investment decisions in small mammals in general deserve further study. This revised version was published online in July 2006 with corrections to the Cover Date. 相似文献
10.
Christopher Leintz 《Bioethics》2014,28(5):263-268
Globalization, political upheavals, and Western economic struggles have caused a geographical reprioritization in the realm of drug development and human clinical research. Regulatory and cost hurdles as well as a saturation of research sites and subjects in Western countries have forced the pharmaceutical industry to place an unprecedented level of importance on emerging markets, injecting Western corporate initiatives into cultures historically and socially isolated from Western‐centric value systems. One of the greatest recipients of this onslaught of Western business and research practices is the Russian Federation. Namely, market forces are dictating a focused research initiative in the traditional emerging markets, but this focus may be at the expense of individual and societal dignity. 相似文献
11.
海绵窦脑膜瘤虽多为良性肿瘤,但由于其解剖位置的特殊性,往往可累及颈内动脉、Ⅲ~Ⅵ对颅神经甚至垂体等重要结构,表现出类似恶性肿瘤的生物学行为。由于其毗邻颅内重要结构,手术全切难度高。近年来,随着CT、MR等现代影像技术的发展及广泛应用,以及对海绵窦解剖的认识、显微外科和颅底外科技术的发展,海绵窦脑膜瘤在术前诊断、评估及手术治疗等方面已取得了长足进步。然而,由于此区解剖复杂,手术难度大,在治疗方法上还存在一定的争议。我们对海绵窦脑膜瘤目前诊断及治疗策略的进展进行简要概述。 相似文献
12.
Eric Chwang 《Bioethics》2015,29(6):431-439
The Code of Federal Regulations permits harmful research on children who have not agreed to participate, but I will argue that it should be no more permissive of harmful research on such children than of harmful research on adults who have not agreed to participate. Of course, the Code permits harmful research on adults. Such research is not morally problematic, however, because adults must agree to participate. And, of course, the Code also permits beneficial research on children without needing their explicit agreement. This sort of research is also not problematic, this time because paternalism towards children may be justifiable. The moral problem at the center of this paper arises from the combination of two potential properties of pediatric research, first that it might be harmful and second that its subjects might not agree to participate. In Section 2 of this article I explain how the Code permits harmful research on non‐agreeing children. Section 3 contains my argument that we should no more permit harmful research on non‐agreeing children than on non‐agreeing adults. In Section 4, I argue that my thesis does not presuppose that pediatric assent has the same moral force that adult consent does. In Section 5, I argue that the distinction between non‐voluntary and involuntary research is irrelevant to my thesis. In Section 6, I rebut an objection based on the power of parental permission. In Section 7 I suggest how the Code of Federal Regulations might be changed. 相似文献
13.
Outsourcing clinical trials sponsored by pharmaceutical companies from industrialized countries to low‐ (middle)‐income countries – summarized as transnational biomedical research (TBR) – has lead to many concerns about ethical standards. Whether study participants are particularly vulnerable is one of those concerns. However, the concept of vulnerability is still vague and varies in its definition. Despite the fact that important international ethical guidelines such as the Declaration of Helsinki by the World Medical Association or the Ethical Guidelines for Biomedical Research Involving Human Subjects by the Council of International Organizations of Medical Sciences refer to vulnerability as ethical principle, each of their approaches are different. To overcome these shortcomings, we analyze and unite different approaches of vulnerability and develop practical criteria in order to operationalize the concept especially for the context of TBR. These criteria refer to the context of a study as well as the characteristics and the current living situation of study participants. Based on a case study of an HIV‐vaccine‐trial conducted in India we demonstrate how those criteria can be applied in a retrospective way to identify potential ethical conflicts. The criteria can also indicate a prospective function for ethical pre‐assessment. For this, we provide an outlook for three major topics: 1. Vulnerability as a normative concept: Different ways of protection; 2. The relevance of transparency and 3. Vulnerability as an instrument to increase decision participation of human subjects. 相似文献
14.
Jansen and Wall suggest a new way of defending hard paternalism in clinical research. They argue that non‐therapeutic research exposing people to more than minimal risk should be banned on egalitarian grounds: in preventing poor decision‐makers from making bad decisions, we will promote equality of welfare. We argue that their proposal is flawed for four reasons. First, the idea of poor decision‐makers is much more problematic than Jansen and Wall allow. Second, pace Jansen and Wall, it may be practicable for regulators to uncover the values that a potential research participant holds when agreeing to enter a research project, so their claim that we must ban such research projects for all if we are to ban them for poor decision‐makers looks to be unmotivated. Third, there seem to be cases where the liberty to enter the sort of research project Jansen and Wall discuss is morally weighty, and arguably should outweigh concerns of egalitarian distribution. Fourth, banning certain types of research, which seem on the face of it to offer an unfavourable risk‐benefit ratio, would have unwelcome consequences for all clinical research, which Jansen and Wall do not recognize. 相似文献
15.
肿瘤已成为危及全人类生命的重大疾病,虽然常规治疗手段如手术及放疗/化疗等不断发展,但对某些复发、难治性恶性肿瘤仍然束手无策,亟需安全、有效可行的治疗手段。在肿瘤基因治疗领域,能在肿瘤细胞内大量自我复制并选择性杀伤肿瘤细胞的溶瘤病毒(Oncolytic virus)逐渐崭露头角,目前溶瘤病毒抗瘤治疗备受关注。其中溶瘤麻疹病毒疫苗株(MV-Edm)因其可靠的安全性和优良的溶瘤效果已进入几项临床试验,为推动其临床转化奠定了基础,期望为肿瘤患者带来治疗上的突破。本文就目前溶瘤麻疹病毒的临床研究与转化进展的相关研究成果进行综述。 相似文献
16.
To give valid informed consent to participate in clinical research, potential participants should understand the risks, potential benefits, procedures, and alternatives. Potential participants also should understand that they are being invited to participate in research. Yet it is unclear what potential participants need to understand to satisfy this particular requirement. As a result, it is unclear what additional information investigators should disclose about the research; and it is also unclear when failures of understanding in this respect undermine the validity of potential participants' informed consent. An analysis of individuals' interests suggests that potential participants need to understand three additional facts to understand that they are being invited to participate in research: 1) research contribution : those who enroll in the study will be contributing to a project designed to gather generalizable knowledge to benefit others in the future; 2) research relationship : the investigators will rely on participants' efforts to gather the generalizable knowledge to benefit others; and 3) research impact : the extent to which participating in the study will alter what participants do and what happens to them. 相似文献
17.
多肽在包括细胞增殖分化、免疫防御、肿瘤病变等在内的生命活动过程中起着至关重要的作用。自 1953 年首个人工合成的具有生物活性的多肽问世至今,全球上市的多肽药物有 80 多个,有大量多肽药物进入临床研究。多肽类药物具有独特的优势：活性显著、特异性强、毒性较弱,在体内不易产生蓄积,与其他药物的相互作用比较少。综述了目前国内外多肽药物的发展情况,希望对从事多肽类药物研发的同行有所帮助。 相似文献
18.
随着社会经济高速发展,人们面临的社会竞争和心理压力加大,导致抑郁症逐渐成为现代社会的常见及高发疾病,所以临床上对 抗抑郁新药的需求日益增长。概述近年来欧美上市的抗抑郁新药和目前临床III期在研的部分抗抑郁小分子药物的合成工艺及临床研究进 展。 相似文献
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20.
高温热浪不仅给自然生态系统造成不可逆转的冲击,也对人类经济社会与健康产生巨大的负面影响。西方学者历来重视高温热浪相关研究,并产生了丰硕的成果。首先梳理了西方高温热浪研究的脉络,即从指标测度上明析其内涵;从对比模拟角度分析其产生的机理;从空间格局上总结其分布与规律;从复合系统层面探讨其影响;从流行病学角度解析其对健康的危害。其次,指出了趋势判断、机理解析、影响评估、脆弱性评估、风险感知、适应分析等未来关注的矛盾与焦点。在此基础上,提出了西方高温热浪研究对中国的启示,包括:拓展典型区域的实证研究;关注脆弱群体与欠发达地区;重视健康尤其是心理健康的影响;注重研究领域拓展;尝试多学科视角融合等。 相似文献