Cluster randomization and political philosophy

In this paper, I will argue that, while the ethical issues raised by cluster randomization can be challenging, they are not new. My thesis divides neatly into two parts. In the first, easier part I argue that many of the ethical challenges posed by cluster randomized human subjects research are clearly present in other types of human subjects research, and so are not novel. In the second, more difficult part I discuss the thorniest ethical challenge for cluster randomized research--cases where consent is genuinely impractical to obtain. I argue that once again these cases require no new analytic insight; instead, we should look to political philosophy for guidance. In other words, the most serious ethical problem that arises in cluster randomized research also arises in political philosophy.     

Contentious connections: infrastructure,dignity, and collective life in Accra,Ghana

Infrastructural systems have emerged as productive ethnographic sites for analysing political subjectivities and rationalities. Through the case of shared electricity and prepaid meters in the compound housing system of Accra, Ghana, I suggest that infrastructures’ political potential lies in their imaginative and hermeneutic abilities to foster desires for dignity, sustain well-being, and question moral ideals of collective life. In contrast to recent anthropological work that has emphasized the material basis of infrastructures as ‘techno-political’ devices materializing certain logics of rule and governance, I reclaim a poetics of sociality whereby infrastructures mobilize a politics of (unwanted) collective life. Through the ‘electricity stories’ circulated by tenants, I chart how the moral economy of infrastructure in a context of collective precarity redistributes marginalization and freedom in ways that always exceed political rationales of energy reforms and policies.     

German law on circumcision and its debate: How an ethical and legal issue turned political

The article aims to illuminate the recent debate in Germany about the legitimacy of circumcision for religious reasons. The aim is both to evaluate the new German law allowing religious circumcision, and to outline the resulting conflict between the surrounding ethical and legal issues. We first elucidate the diversity of legal and medical views on religious circumcision in Germany. Next we examine to what extent invasive and irreversible physical interventions on infant boys unable to given their consent should be carried out for non‐medical reasons. To this end, the potential benefits and harms of circumcision for non‐medical reasons are compared. We argue that circumcision does not provide any benefits for the ‘child as a child’ and poses only risks to boys. We then set out to clarify and analyse political (rather than ethical) justifications of the new circumcision law. We demonstrate through this analysis how the circumcision debate in Germany has been transformed from a legal and ethical problem into a political issue, due at least in part to Germany's unique historical context. Although such a particular political sensibility is entirely comprehensible, it raises particular problems when it comes to framing and responding to medical ethical issues – as in the case of religious circumcision.     

Imagining the Highway: Anticipating Infrastructural and Environmental Change in Belize

ABSTRACT

This article examines the social and political, as well physical, construction of infrastructure, by attending to the implications of a highway yet to be built. In southern Belize, where the development of rural road networks figures strongly in historical narratives of political and environmental change, the recent paving of a major domestic highway has had distinctive implications for livelihoods and land rights among the predominantly Maya population of rural Toledo district. At the time of research, a plan for a new paved highway to the Guatemalan border animated longstanding debates over territoriality, environment and development, even as the details remained elusive. Bringing political ecology into conversation with attention to the perception of sensory environments, and the affective power of anticipation, I argue for extending anthropological conversations about infrastructure to encompass the meanings and consequences of imagined infrastructures for the ways people encounter, experience and enact social and environmental change.     

Teaching Medical Ethics to Meet the Realities of a Changing Health Care System

The changing context of medical practice—bureaucratic, political, or economic—demands that doctors have the knowledge and skills to face these new realities. Such changes impose obstacles on doctors delivering ethical care to vulnerable patient populations. Modern medical ethics education requires a focus upon the knowledge and skills necessary to close the gap between the theory and practice of ethical care. Physicians and doctors-in-training must learn to be morally sensitive to ethical dilemmas on the wards, learn how to make professionally grounded decisions with their patients and other medical providers, and develop the leadership, dedication, and courage to fulfill ethical values in the face of disincentives and bureaucratic challenges. A new core focus of medical ethics education must turn to learning how to put ethics into practice by teaching physicians to realistically negotiate the new institutional maze of 21st-century medicine.     

A Rule-Based Decision Support System for Critical Infrastructure Management

This article presents a new rule-based decision support system for critical infrastructure management based on the interdependencies among critical infrastructures. Unlike the conventional flood front prediction model, the new failure front prediction model consists of both physical parameters and interdependencies among infrastructures, which is represented by a multi-level complex network. This study employs advanced computation methods to build tools for better understanding emergent behavior of water security infrastructure systems for use in developing superior preparedness and response strategies. This study highlights the important role played by the interdependencies among the infrastructures in failure front prediction.     

The Italian Way to Stem Cell Research: Rethinking the Role of Catholic Religion in Shaping Italian Stem Cell Research Regulations

Stem cell research regulations are highly variable across nations, notwithstanding shared and common ethical concerns. Dominant in political debates has been the so‐called embryo question. However, the permissibility of human embryonic stem cell (hESC) research varies among national regulatory frameworks. Scholars have explained differences by resorting to notions of political culture, traditions of ethical reasoning, discursive strategies and political manoeuvring of involved actors. Explanations based on the role of religion or other cultural structural variables are also employed. This paper analyses the emerging of the Italian regulatory framework on stem cell research using an analytical framework that considers the interplay between cultural structural features, political culture, traditions of ethical reasoning, institutional settings and the discursive and political agency of the actors involved. It aims also to explain the role of Roman Catholic Church in shaping the Italian stem cell research regulation not by treating religion as an autonomous causal factor, but through the analysis of the agency of Catholic and allied actors in the Italian political culture and institutional setting.     

European research infrastructures for the development of nanobiotechnologies

Research infrastructures are essential for top-level academic and industrial research activities. Throughout the successive framework programmes (FPs) of the EU, actions have been gradually developed to support researchers in accessing top-level European research infrastructures located outside their own country and also to better coordinate and integrate these infrastructures Europe-wide, enabling better research services. At the same time, research infrastructures pave the way for the development of scientific and technological advances. Under the sixth Framework Programme (FP6; 2002-2006), for example, nanobiotechnologies have benefited from these European actions through three approaches: the support of multi-disciplinary pan-European infrastructures; the support of pan-European infrastructures dedicated to biology but with usage in multiple domains of biology; and the funding of integrated centers for nanobiotechnologies. The seventh Framework Programme (FP7; 2007-2013) will reinforce these actions toward research infrastructures, with particular attention to the emergence of new ones as well as to the provision of important strategic research services in fields such as nanobiotechnologies.     

Ethics and severe pandemic influenza: maintaining essential functions through a fair and considered response

The response to severe pandemic influenza will be managed by experts in public health and infectious disease and by government officials to whom the public will turn for information and direction. Nonetheless, there remain important ethical considerations that can shape what goals are given priority, how scarce resources are distributed, how the public is included, and how we treat the most vulnerable in our response to a pandemic. This article assumes that the secondary consequences of severe pandemic influenza could be greater than deaths and illness from influenza itself. Response plans, then, must consider threats to societal as well as medical infrastructures. While some have suggested that scarce medical countermeasures be allocated primarily to first responders and then to the sickest, we suggest that an ethical public health response should set priorities based on essential functions. An ethical response also will engage the public, will coordinate interdependent sectors as a core preparedness priority, and will address how plans affect and can be understood by the least well off.     

Science and society: protecting crop genetic diversity for food security: political, ethical and technical challenges

Crop genetic diversity - which is crucial for feeding humanity, for the environment and for sustainable development - is being lost at an alarming rate. Given the enormous interdependence of countries and generations on this genetic diversity, this loss raises critical socio-economic, ethical and political questions. The recent ratification of a binding international treaty, and the development of powerful new technologies to conserve and use resources more effectively, have raised expectations that must now be fulfilled.     

Realizing responsibility. Institutional routines,critical intervention,and the “big” questions in the controversy over non-invasive prenatal testing in Germany

NIPT has become a matter of controversy in Germany over the past years, there is now a widespread concern that it raises fundamental social and ethical questions. Starting from the assumption that responsible governance requires governance actors to address these questions, the article examines how the main governance actors realized their responsibility in the sense of conceiving and performing it. Building on the pragmatic sociology of critique, we study how actors are doing responsibility within a given institutional and political context. We show that critical interventions disrupted institutional routines and caused governance actors to struggle with conflicting commitments of complying with institutional rules and exercising responsibility by taking social and ethical considerations into account. Whereas these conflicting commitments posed a predicament for political decision-makers, who solved it through shifting responsibility for social and ethical issues elsewhere, there was no such predicament for the producers; for them, routine and responsibility converged.     

Can we develop ethically universal embryonic stem-cell lines?

Human embryonic stem-cell (hESC) research faces opposition from those who object to the destruction of human embryos. Over the past few years, a series of new approaches have been proposed for deriving hESC lines without injuring a living embryo. Each of these presents scientific challenges and raises ethical and political questions. Do any of these methods have the potential to provide a source of hESCs that will be acceptable to those who oppose the current approaches?     

Research advances by using interoperable e-science infrastructures

Computational simulations and thus scientific computing is the third pillar alongside theory and experiment in todays science. The term e-science evolved as a new research field that focuses on collaboration in key areas of science using next generation computing infrastructures (i.e. co-called e-science infrastructures) to extend the potential of scientific computing. During the past years, significant international and broader interdisciplinary research is increasingly carried out by global collaborations that often share a single e-science infrastructure. More recently, increasing complexity of e-science applications that embrace multiple physical models (i.e. multi-physics) and consider a larger range of scales (i.e. multi-scale) is creating a steadily growing demand for world-wide interoperable infrastructures that allow for new innovative types of e-science by jointly using different kinds of e-science infrastructures. But interoperable infrastructures are still not seamlessly provided today and we argue that this is due to the absence of a realistically implementable infrastructure reference model. Therefore, the fundamental goal of this paper is to provide insights into our proposed infrastructure reference model that represents a trimmed down version of ogsa in terms of functionality and complexity, while on the other hand being more specific and thus easier to implement. The proposed reference model is underpinned with experiences gained from e-science applications that achieve research advances by using interoperable e-science infrastructures.     

Ethical concerns in the research and treatment of complex disease

Research on and treatment of complex diseases raise familiar ethical issues concerning informed consent, privacy, confidentiality, insurability, employability and social stigma. Consideration of the family as the unit of study, or point of medical intervention, presents some additional twists to these common ethical concerns. In addition, complex diseases present particular ethical challenges because different social and political incentives accompany placing emphasis on either the genetic or the environmental components of the diseases (e.g. in allocating research funds or ascribing responsibility for illness).     

Public health ethics: asylum seekers and the case for political action

This paper is a case study in public health ethics. It considers whether there is a basis in ethics for political action by health professionals and their associations in response to inhumane treatment. The issue arises from Australia's treatment of asylum seekers and the charge that this treatment has been both immoral and inhumane. This judgement raises several questions of broader significance in bioethics and of significance to the emerging field of public health ethics. These questions relate to the role of health professionals in response to inhumane treatment of people in their charge; to the discipline of public health in light of a growing recognition of its ethical basis; and the role of public health and bioethical associations in response to ethical issues arising in a political context. It is argued that, in serious cases of humanitarian and human rights abuses affecting health and well-being, there is a case for political action by health professionals, academic and professional institutions, and associations of public health and ethics.     

‘Bridges to cash’: channelling agency in mobile money

Encountered by mobile money professionals – industry and philanthropic actors seeking to bring mobile phone‐enabled financial products to poor people in the ‘developing world’ – the authors move together with new collaborators to inquire into a problem they had been grappling with for some time. This is the problem of agency; specifically, the agency of ‘mobile money agents’, the people ‘on the ground’ or ‘in the field’ who form a crucial function in permitting others to put cash into an electronic money transfer system and pull cash out of it. These ‘human ATMs’ or ‘bridges to cash’ become the object of analytical scrutiny for mobile money experts and anthropologists. This article takes that analytical scrutiny – and not mobile money agents themselves – as its object. It seeks to understand how ‘agency’ inflects debates over money, its meaning and its pragmatics, and its transformation in new communicative infrastructures, and how it might inform anthropology and political struggles over money and payment.     

Bioethics: power and injustice: IAB presidential address

A major focus within the modern bioethics debate has been on reshaping power relationships within the doctor-patient relationship. Empowerment of the vulnerable has been achieved through an emphasis on human rights and respect for individual dignity. However, power imbalances remain pervasive within healthcare. To a considerable extent this relates to insufficient attention to social injustice. Such power imbalances together with the development of new forms of power, for example through new genetic biotechnology, raise the spectre of increasing social injustice. Attention will be drawn to the need to extend the bioethics debate to include ethical considerations regarding public health. Changes in political philosophy will also be required to reshape international power relations and improve population health.     

BEYOND SUN,SAND, AND STITCHES: ASSIGNING RESPONSIBILITY FOR THE HARMS OF MEDICAL TOURISM

Medical tourism (MT) can be conceptualized as the intentional pursuit of non‐emergency surgical interventions by patients outside their nation of residence. Despite increasing popular interest in MT, the ethical issues associated with the practice have thus far been under‐examined. MT has been associated with a range of both positive and negative effects for medical tourists' home and host countries, and for the medical tourists themselves. Absent from previous explorations of MT is a clear argument of how responsibility for the harms of this practice should be assigned. This paper addresses this gap by describing both backward looking liability and forward looking political responsibility for stakeholders in MT. We use a political responsibility model to develop a decision‐making process for individual medical tourists and conclude that more information on the effects of MT must be developed to help patients engage in ethical MT.     

Setting priorities,can Britain learn from Sweden?

The Swedish government recently published a report on priorities in health care. It was written by a cross party group of politicians and drew extensively on the views of the public, health professionals, experience of earlier local exercises in priority setting, and research based evidence. It laid down an ethical framework for approaching issues of health care rationing. Underpinning the framework are the principles of human dignity, need and solidarity, and cost efficiency. The Swedish approach thus contrasts with the British experience of many local initiatives but an absence of national political guidance. The absence of political consensus on many aspects of social policy in the United Kingdom is a major obstacle to developing an agreed ethical framework within which decision makers in the National Health Service can work.     

How Distinctive is Genetic Information?

There is extensive discussion of the ethical, social, economic and political issues associated with the use of technologies based on DNA techniques. Many of these debates are premised on the assumption that DNA, and the genetic information that may be derived from it, have unique features which raise new social and ethical issues. In this paper it is argued that several of the features associated with DNA which are sometimes regarded as unique are shared with other biological materials. Others owe more to the cultural image of DNA and some of the metaphors used to discuss it in biology and in wider debates than to the biological properties of DNA. The paper discusses the concepts of genetic material and genetic information and the social construction of DNA in relation to forensic DNA databases, paternity testing and genetic testing for disease. The paper concludes by suggesting that there are seven areas where issues related to DNA and genetic information are at least relatively distinct.