Synthetic biology, patenting, health and global justice

The legal and moral issues that synthetic biology (SB) and its medical applications are likely to raise with regard to intellectual property (IP) and patenting are best approached through the lens of a theoretical framework highlighting the “co-construction” or “co-evolution” of patent law and technology. The current situation is characterized by a major contest between the so-called IP frame and the access-to-knowledge frame. In SB this contest is found in the contrasting approaches of Craig Venter’s chassis school and the BioBricks school. The stakes in this contest are high as issues of global health and global justice are implied. Patents are not simply to be seen as neutral incentives, but must also be judged on their effects for access to essential medicines, a more balanced pattern of innovation and the widest possible social participation in innovative activity. We need moral imagination to design new institutional systems and new ways of practising SB that meet the new demands of global justice.     

Medical validity in Eastern and Western traditions

When comparing biomedical treatments and traditional treatments from China and India, validity is established by a randomized placebo-controlled trial (RPCT). While the advantages of RPCT are uncontestable, its requirements handicap validation of treatments from Eastern traditions, which are integrated within a worldview that encompasses natural philosophy, theology, empirically based clinical experience, and spiritual and moral tenets. RPCT evolved during a time when comparatively little was known about Eastern medical traditions; about the effects of emotional, cognitive, and cultural factors on healing; or about the evolutionary biology and psychology of innate mind/body mechanisms, such as those producing placebo responses, which may constitute evolved adaptations naturally selected during human evolution. A fair way of both securing the advantages provided by RPCT and balancing them with a methodology that ensures safe and efficacious treatments from other traditions can be facilitated by examining medical validity in light of generalizations from evolutionary psychology and the cultural study of medicine.     

Islamic medical ethics: a primer

Modern medical practice is becoming increasingly pluralistic and diverse. Hence, cultural competency and awareness are given more focus in physician training seminars and within medical school curricula. A renewed interest in describing the varied ethical constructs of specific populations has taken place within medical literature. This paper aims to provide an overview of Islamic Medical Ethics. Beginning with a definition of Islamic Medical Ethics, the reader will be introduced to the scope of Islamic Medical Ethics literature, from that aimed at developing moral character to writings grounded in Islamic law. In the latter form, there is an attempt to derive an Islamic perspective on bioethical issues such as abortion, gender relations within the patient-doctor relationship, end-of-life care and euthanasia. It is hoped that the insights gained will aid both clinicians and ethicists to better understand the Islamic paradigm of medical ethics and thereby positively affect patient care.     

The Moral Stereotypes of Liberals and Conservatives: Exaggeration of Differences across the Political Spectrum

We investigated the moral stereotypes political liberals and conservatives have of themselves and each other. In reality, liberals endorse the individual-focused moral concerns of compassion and fairness more than conservatives do, and conservatives endorse the group-focused moral concerns of ingroup loyalty, respect for authorities and traditions, and physical/spiritual purity more than liberals do. 2,212 U.S. participants filled out the Moral Foundations Questionnaire with their own answers, or as a typical liberal or conservative would answer. Across the political spectrum, moral stereotypes about “typical” liberals and conservatives correctly reflected the direction of actual differences in foundation endorsement but exaggerated the magnitude of these differences. Contrary to common theories of stereotyping, the moral stereotypes were not simple underestimations of the political outgroup''s morality. Both liberals and conservatives exaggerated the ideological extremity of moral concerns for the ingroup as well as the outgroup. Liberals were least accurate about both groups.     

Spiritual Struggles and Interleukin-6: Assessing Potential Benefits and Potential Risks

The purpose of this study is to evaluate the relationship between spiritual struggles and levels of interleukin-6 (IL-6) with a subsample (N = 943) of participants who took part in a nationwide survey. This study, which was completed in 2014, was conducted in the United States. Spiritual struggles refer to difficulties that a person may encounter with his or her faith and include having a troubled relationship with God, encountering difficulties with religious others, and being unable to find a sense of ultimate meaning in life. Based on the notion that spiritual struggles may be associated with personal growth as well physical health problems, it was hypothesized that there is a nonlinear relationship between the two: levels of IL-6 will decline at relatively low levels of spiritual struggles, but levels of IL-6 will increase as spiritual struggles become more severe. The findings support this hypothesis and suggest there is a quadratic relationship between spiritual struggles and IL-6. The clinical implications of these findings are discussed.     

患者的道德权利在医患纠纷中的重要性

近年来医患冲突不断发生,一系列由伦理道德而引发的医疗纠纷事件反映了我国医院管理存在的问题。患者及家属的观念偏移、医患双方信息不对等、医务人员态度不佳以及医疗资源分配不均等问题均是医患冲突的影响因素。我们通过分析患者的道德权利在医患关系中重要地位,认为医务人员应当树立"以人为本"的服务理念,重视患者及家属的社会心理需求,促进医学道德的发展,构建和谐的医患关系。     

Reproduction as spiritual kin work: Orthodoxy, ivf, and the moral economy of motherhood in greece

Bringing gender and kinship studies together with an anthropology of religion, in this article I demonstrate how urban Greek couples and clinical practitioners in the middle 1990s proceeded with in vitro fertilization (IVF) in the absence of government regulations, and did so with reference to cultural beliefs and social relations consistent with Greek Orthodox religious practice. Drawing on ethnographic observations at an Athens IVF clinic as well as on interviews with former patients, I argue that Athenian women, in particular, engage IVF as a kind of spiritual kin work, normalizing the use of medical techniques with reference to ideologies of motherhood that treat it as a woman’s moral achievement and as a source of womanly suffering. Since the period of ethnographic research described here, and despite disapproval of the Greek Orthodox Church, legislation regulating the use of IVF and other methods of medically assisted reproduction has become law. This article reconciles how the Church can officially reject medically assisted means of reproduction that Athenian users have normalized with reference to spiritual beliefs and practices.     

Why Do You Believe in God? Relationships between Religious Belief,Analytic Thinking,Mentalizing and Moral Concern

Prior work has established that analytic thinking is associated with disbelief in God, whereas religious and spiritual beliefs have been positively linked to social and emotional cognition. However, social and emotional cognition can be subdivided into a number of distinct dimensions, and some work suggests that analytic thinking is in tension with some aspects of social-emotional cognition. This leaves open two questions. First, is belief linked to social and emotional cognition in general, or a specific dimension in particular? Second, does the negative relationship between belief and analytic thinking still hold after relationships with social and emotional cognition are taken into account? We report eight hypothesis-driven studies which examine these questions. These studies are guided by a theoretical model which focuses on the distinct social and emotional processing deficits associated with autism spectrum disorders (mentalizing) and psychopathy (moral concern). To our knowledge no other study has investigated both of these dimensions of social and emotion cognition alongside analytic thinking. We find that religious belief is robustly positively associated with moral concern (4 measures), and that at least part of the negative association between belief and analytic thinking (2 measures) can be explained by a negative correlation between moral concern and analytic thinking. Using nine different measures of mentalizing, we found no evidence of a relationship between mentalizing and religious or spiritual belief. These findings challenge the theoretical view that religious and spiritual beliefs are linked to the perception of agency, and suggest that gender differences in religious belief can be explained by differences in moral concern. These findings are consistent with the opposing domains hypothesis, according to which brain areas associated with moral concern and analytic thinking are in tension.     

A strategy to end parole dependency

This article explores the moral, political, economic and philosophical reasons for the expansion of the prisoner re-entry industry in the United States over the last several years. Tracing the influence of the military-industrial-prison complex and its mindset of “crackpot-cynical” realism rooted in a fear-based model of human nature, it argues that the very system and policies set up to control the “problem” of crime has led to an exacerbation of it, creating an ever-expanding, permanent “industry” that has traumatized both ‘ruler and ruled’ in a never-ending cycle of pain, mistrust, moral numbness and dysfunctional dependency. The article attempts to unite political and spiritual progressives and begin the mobilization necessary for radical structural and moral changes harkening back to the dissensus politics and ‘spiritual toughness’ of the civil rights and welfare rights tradition of the 1950s, 1960s and 1970s.     

Biocultural Factors in School Achievement for Mopan Children in Belize

Mayan children in Belize face a number of challenges to school success. Their families are the poorest of the poor, and the Mopan children in this study exhibit poor growth and poor school achievement. But a direct relationship between growth and school achievement was evident only for current nutritional status, not for nutritional history. A combination of quantitative and qualitative data revealed that school achievement for these Mopan children may relate more to family attributes and attitudes than to health and nutritional status. The strongest predictors of school achievement were father's literacy and grade level in school.     

Patients and borders, money and mission: responding to medically needy persons from other countries who lack financial resources

When financially impoverished persons from resource-poor countries travel to resource-rich countries to seek medical treatment, health-care professionals and hospital administrators must decide how to respond. These financially impoverished "medical travelers" are medically no different from financially impoverished citizens or immigrants, but their national residence and purpose of travel may cause them to be seen as having a lower degree of standing within the communities that hospitals are expected to serve. In responding to such persons, health-care professionals and administrators encounter tension between the mission-driven intention to provide care and a budget-driven intention to protect operating margins. Responses require practical wisdom and a readiness to wrestle with tensions related to objectives (charitable versus financial), role-specific obligations (clinicians versus administrators), and contrasting moral frameworks. There are also challenges of reconciling plural moral values, setting moral priorities, and considering whether national borders should constrain our view of persons as neighbors. Finding a way forward amidst many tensions is hard moral work, but it may be facilitated by granting a moral imperative to physical proximity, respecting role-fidelity among clinicians and administrators, furthering candid moral dialogue, and promoting a presumption to treat whenever it is feasible to do so.     

Why psychiatric conditions are special: an evolutionary and cross-cultural perspective

In non-Western and premodern societies, approaches to sickness involved moral considerations laden with existential and spiritual implications. Healers and physicians had access to this aspect of their patient's lives, were expected to use it constructively, and often did so. The contemporary biomedical theory of disease no longer assigns to illness such metaphysical connotations. While general physicians are permitted - perhaps even advised - to avoid involvement in morally laden dialogues tied to illness and the self, such dilemmas are more prominent and qualitatively different in psychiatry, as psychiatric conditions often entail changes in self-conception, psychological disaffection, unacceptable behavior, and untoward personal reactions to social circumstances. Manifestations of psychiatric conditions can overwhelm an individual's control in areas of cognition, emotion, autonomy, social responsibility, behavior, and body functions - exactly those matters that "modern" individualistic minds are supposed to master. Consequently, psychiatric conditions challenge basic presuppositions of the modern, secular credo about personhood, disease, and behavior. They comprise a species of human problems ontologically distinct from the conditions handled by other medical disciplines.     

The Absorption Hypothesis: Learning to Hear God in Evangelical Christianity

ABSTRACT  In this article, we use a combination of ethnographic data and empirical methods to identify a process called "absorption," which may be involved in contemporary Christian evangelical prayer practice (and in the practices of other religions). The ethnographer worked with an interdisciplinary team to identify people with a proclivity for "absorption." Those who seemed to have this proclivity were more likely to report sharper mental images, greater focus, and more unusual spiritual experience. The more they prayed, the more likely they were to have these experiences and to embrace fully the local representation of God. Our results emphasize learning, a social process to which individuals respond in variable ways, and they suggest that interpretation, proclivity, and practice are all important in understanding religious experience. This approach builds on but differs from the approach to religion within the culture-and-cognition school.     

Prospective survey of performance of medical students during preclinical years.

The performance during the preclinical course of 517 students who had applied to this medical school for admission in 1981 and who had been accepted by the school or by another British medical school was analysed in relation to variables measured at the time of application to find factors that predicted success in the preclinical course, whether students chose to take an intercalated degree, and the class achieved in the intercalated degree. Thirty one of the 507 students who entered medical school withdrew from the course or failed their examinations; these students were particularly likely not to have an A level in a biological science. O level grades were of minimal predictive value for performance during the preclinical course. A level grades discriminated between successful and unsuccessful students but had too low a specificity or sensitivity to be of use in individual prediction. Mature entrants performed better overall than school leavers. Background variables accounted for only 14.2% of the variance in performance, implying that motivation and personality may be more important in determining performance. The 80 students who chose to take an intercalated degree were more likely to be men and not to be mature entrants; for a further 50 students intercalated degrees were obligatory. Performance in the intercalated degree related to performance during the preclinical course and to assessments made at the selection interview but not to achievement at O or A level.     

Beyond the surgeon's skill

The scientific attainments of medical science have advanced greatly in this generation. The art of the practice of medicine has not kept pace. The kindly spirit, unselfish service, and spiritual uplift which were characteristic of most physicians in the "horse-and-buggy days" are needed more today than they were a generation ago. A combination of medical science and spiritual counseling will do much to relieve the sufferings of mind and body. The personal physician-patient relationship and the building up of the patient's confidence in his physician are a most important aspect of the physician's duty. A belief in God and a knowledge of the availability of help from above is of great benefit to both physician and patient.     

Taking care of patients--does it matter whether the physician is a woman?

Researchers have recently begun to compare male and female physicians'' attitudes toward patients, medical knowledge, and practice styles. Although women start medical school with more "humanistic views," the conservative effect of medical socialization on both male and female students attenuates these differences. While some studies suggested that men are more scientifically knowledgeable, recent studies showed no significant differences in physicians'' medical knowledge. Male and female physicians also had comparable diagnostic and therapeutic behavior. In the intimate world of physicians and patients, however, there were notable differences. Women physicians seemed better able to communicate sensitivity and caring to patients, which may account for the common perception that women are more caring and empathic physicians. Medical educators may wish to study more closely female physicians'' communication styles to identify these behaviors and inculcate them into all physicians.     

Hyper Talk: Sampling the Social Construction of ADHD in Everyday Language

This article examines the ways that meanings about the concept Attention Deficit Hyperactivity Disorder (ADHD) are socially constructed within the everyday language use of lay persons. The 224 language events referencing ADHD, including media sources, were recorded in journals by student assistants. These data reveal five patterned ways that lay persons appropriate and interpret discourses originating in medical and school communities of practice. Conclusions raise issues about the moral opportunities and responsibilities afforded and occluded by specific discourse practices.     

Spiritist Psychiatric Hospitals in Brazil: Integration of Conventional Psychiatric Treatment and Spiritual Complementary Therapy

In Brazil, during the XX century, dozens of Spiritist psychiatric hospitals emerged seeking to integrate conventional medical treatment with complementary spiritual therapy. This combined inpatient treatment is largely found in Brazil, where many psychiatric hospitals stem from the Spiritist movement. The present report describes the use of these spiritual practices, their operating structure, health professionals involved, modalities of care, and institutional difficulties in integrating spiritual practices with conventional treatment in six leading Brazilian Spiritist psychiatric hospitals. These hospitals combine conventional psychiatric treatment with voluntary-based spiritual approaches such as laying on of hands (“fluidotherapy”), lectures regarding spiritual and ethical issues, intercessory prayer, spirit release therapy (“disobsession”) and “fraternal dialogue”. The non-indoctrination and optional nature of these spiritual complementary therapies seem to increase acceptance among patients and their family members. In conclusion, the Spiritist psychiatric hospitals in Brazil have, for more than half a century, provided an integrative approach in the treatment of psychiatric disorders, associating conventional and spiritual treatments, more specifically Spiritist therapy. The lack of standardized treatment protocols and scientific studies remain a barrier to assessing the impact of this integrative approach on patients’ mental health, quality of life, adherence, and perceived quality of treatment.     

Pollution and Intimacy in a Transcendent Ethics of Care: A Case of Aged-care in India

In India, where children’s care of ageing parents is seen as practical and sacred, animated by notions of seva (selfless service), the outsourcing of elder care causes considerable concern. Meanwhile, carers’ work in old-age homes is treated as transactional, and their moral claims about this work are either overlooked or criticised. While gendered, socio-economic circumstances compel the women we discuss in this paper to care-work at an old-age home in Pune, they also understood this work as a register for the spiritual striving normally reserved for higher classes and castes. Accordingly, notions of polluting and non-polluting bodily waste inform the sense of kin-like intimacy through which they frame their labour. Attending to the institutional, spiritual, emotional and bodily registers of these carers’ work, we argue for a transcendent ethics of care, a conceptualisation that contributes to broader understandings of marginalisation and moral imagination in an ordinary ethics of care.     

Moving beyond bioethics: history and the search for medical humanism

From both within and without bioethics, growing criticism of the predominant methods and practices of the field can be heard. These critiques tend to lament an emphasis on logically derived rules and philosophical theories that inadequately capture how and why people have the moral attitudes they do, and they urge the use of more empirically grounded social sciences--history, sociology, and anthropology--to draw attention to the complex factors behind such attitudes. However, these critiques do not go far enough, as they do not question why debate over ethical categories should have such a central role in voicing concerns about medicine. The importance of using other forms of inquiry, especially that of history, to examine aspects of medical practice and the emergence of bioethics itself is not simply to refine bioethical moral analysis. Instead, history can be employed to counter the preoccupation with translating concerns about medicine into moral terms and to move towards what is more sorely needed: a true medical humanism.