WHOSE GENOME PROJECT?

The human genome project is a multinational project aimed at obtaining a detailed map and a complete DNA sequence of the human genome. It will have many scientific, medical, economic, ethical, legal, and social implications. A fundamental question to ask is "Whose genome project is it?" We can answer this question from different perspectives, and this aids our thinking about the issues that arise from the project. We can think of who proposed the idea, who should fund the research, who should perform the research, whose genome is mapped and sequenced, who should own the data, who should benefit from the results, and who should make these decisions. We can also compare the answers to these ethical questions with what is occurring in practice.     

Examination of the carboxylesterase phenotype in human liver

Carboxylesterases (CES) metabolize esters. Two CES isoforms are expressed in human liver (CES1 and CES2) and liver extracts are used in reaction phenotyping studies to discern interindividual metabolic variation. We tested the hypothesis that an individual's CES phenotype can be characterized by reporter substrates/probes that interrogate native CES1 and CES2 activities in liver and immunoblotting methods. We obtained 25 livers and found that CES1 is the main hydrolytic enzyme. Moreover, although CES1 protein levels were similar, we observed large interindividual variation in bioresmethrin hydrolysis rates (17-fold), a pyrethroid metabolized by CES1 but not CES2. Bioresmethrin hydrolysis rates did not correlate with CES1 protein levels. In contrast, procaine hydrolysis rates, a drug metabolized by CES2 but not CES1, were much less variant (3-fold). Using activity-based fluorophosphonate probes (FP-biotin), which covalently reacts with active serine hydrolases, CES1 protein was the most active enzyme in the livers. Finally, using bioorthogonal probes and click chemistry methodology, the half-life of CES 1 and 2 in cultured HepG2 cells was estimated at 96 h. The cause of the differential CES1 activities is unknown, but the underlying factors will be important to understand because several carboxylic acid ester drugs and environmental toxicants are metabolized by this enzyme.     

NAVIGATING THE MURKY INTERSECTION BETWEEN CLINICAL AND ORGANIZATIONAL ETHICS: A HYBRID CASE TAXONOMY

Ethical challenges that arise within healthcare delivery institutions are currently categorized as either clinical or organizational, based on the type of issue. Despite this common binary issue‐based methodology, empirical study and increasing academic dialogue indicate that a clear line cannot easily be drawn between organizational and clinical ethics. Disagreement around end‐of‐life treatments, for example, often spawn value differences amongst parties at both organizational and clinical levels and requires a resolution to address both the case at hand and large‐scale underlying system‐level confounders. I refer to issues that contain elements of both clinical and organizational issues as hybrids and propose a new taxonomy to characterize hybrid cases. I contend that salient contextual features of an ethical issue, such as where it is identified, who it impacts and where it is ideally resolved in relation to its scope of impact, should inform procedure. Implementation of a Hybrid taxonomy viewing ethical issues as existing on a continuum furthers that end. The primary goals are to 1) systematize thinking about ethical issues that arise within healthcare delivery institutions and 2) allow the content of the ethical challenge to drive the process, rather than continuing to rely on the traditional binary issue‐based choice. Failure to capture the complexity of hybrid situations perpetuates incomplete information and ultimately an inchoate resolution that creates more questions than answers.     

The human genome project: Towards an analysis of the empirical,ethical, and conceptual issues involved

In this paper I claim that the goal of mapping and sequencing the human genome is not wholly new, but rather is an extension of an older project to map genes, a central aim of genetics since its birth. Thus, the discussion about the value of the HGP should not be posed in global terms of acceptance or rejection, but in terms of how it should be developed. The first section of this paper presents a brief history of the project. The second section distinguishes among four kinds of issues relevant to an evaluation of the HGP: those economic and organizational issues related to the feasibility of the project; the ethical questions arising in the development of the project and the application of the data gathered; the empirical issues relevant to the scientific value of the project; and conceptual issues like reductionism and determinism relevant to understand the nature and scope of the project. In a third section, I analyze in detail whether the HGP and, more generally, molecular biology is reductionistic.     

Ethical issues and GenomEUtwin.

The post-genomic era is witnessing a proliferation of large-scale and population based genetic and genomic research projects. Many countries have or are establishing research biobanks and, as with GenomEUtwin, there is great interest in building multinational projects that link genotypic and phenotypic information from different centers. Clearly, the conduct of these projects raises multiple ethical issues, and the knowledge generated will continually recast the ethical, legal and social implications (ELSI) of such research. Maximising the scientific profit from this work while minimizing the risks to the participants requires full integration of ethics components into the structure and functioning of these projects. GenomEUtwin is organized around five intellectual cores, including an Ethics Core which operates across the entire project. This paper describes the role of the Ethics Core and presents an overview of the guidelines on which the principles followed in GenomEUtwin are based. We outline the major ethical concerns of our project and highlight complexities arising from diverse national legislations. Finally, the role of empirically based ethics research is discussed for understanding the ethical, legal, social and economic implications of human genetics and genomics research.     

Inclusion of Ethical Issues in Dementia Guidelines: A Thematic Text Analysis

Background

Clinical practice guidelines (CPGs) aim to improve professionalism in health care. However, current CPG development manuals fail to address how to include ethical issues in a systematic and transparent manner. The objective of this study was to assess the representation of ethical issues in general CPGs on dementia care.

Methods and Findings

To identify national CPGs on dementia care, five databases of guidelines were searched and national psychiatric associations were contacted in August 2011 and in June 2013. A framework for the assessment of the identified CPGs'' ethical content was developed on the basis of a prior systematic review of ethical issues in dementia care. Thematic text analysis and a 4-point rating score were employed to assess how ethical issues were addressed in the identified CPGs. Twelve national CPGs were included. Thirty-one ethical issues in dementia care were identified by the prior systematic review. The proportion of these 31 ethical issues that were explicitly addressed by each CPG ranged from 22% to 77%, with a median of 49.5%. National guidelines differed substantially with respect to (a) which ethical issues were represented, (b) whether ethical recommendations were included, (c) whether justifications or citations were provided to support recommendations, and (d) to what extent the ethical issues were explained.

Conclusions

Ethical issues were inconsistently addressed in national dementia guidelines, with some guidelines including most and some including few ethical issues. Guidelines should address ethical issues and how to deal with them to help the medical profession understand how to approach care of patients with dementia, and for patients, their relatives, and the general public, all of whom might seek information and advice in national guidelines. There is a need for further research to specify how detailed ethical issues and their respective recommendations can and should be addressed in dementia guidelines. Please see later in the article for the Editors'' Summary     

Reducing the Ecological Impact of Field Research

Researchers and students at biological field stations, especially in remote areas, are subject to leaving “footprints,” as we conduct research, work, and live in sensitive ecosystems. These footprints include travel, personal trash and waste, and field equipment (e.g. flagging, tree markers, plot markers, trail markers, monitoring devices, etc.). In this commentary, we argue that the field of primatology's commitment to minimum impact research should be more explicitly and visibly integrated into our ethical protocols with regard to field research and instruction in sensitive environments. We review current ethical codes and potential solutions to reducing our “researcher footprints” while conducting fieldwork. Using Costa Rica as an example, we address how sustainable fieldwork differs among varying cultural contexts and argue that researchers should be made responsible and accountable for how our presence, research, and teaching might impact the environment. We conclude by recommending a set of guidelines to be added to ethical protocols regarding research design, station policies, and the conduct of research and teaching in the field. Am. J. Primatol. 75:1‐9, 2013. © 2012 Wiley Periodicals, Inc.     

A Mathematical Model of Force Generation by Flexible Kinetochore-Microtubule Attachments

Important mechanical events during mitosis are facilitated by the generation of force by chromosomal kinetochore sites that attach to dynamic microtubule tips. Several theoretical models have been proposed for how these sites generate force, and molecular diffusion of kinetochore components has been proposed as a key component that facilitates kinetochore function. However, these models do not explicitly take into account the recently observed flexibility of kinetochore components and variations in microtubule shape under load. In this paper, we develop a mathematical model for kinetochore-microtubule connections that directly incorporates these two important components, namely, flexible kinetochore binder elements, and the effects of tension load on the shape of shortening microtubule tips. We compare our results with existing biased diffusion models and explore the role of protein flexibility inforce generation at the kinetochore-microtubule junctions. Our model results suggest that kinetochore component flexibility and microtubule shape variation under load significantly diminish the need for high diffusivity (or weak specific binding) of kinetochore components; optimal kinetochore binder stiffness regimes are predicted by our model. Based on our model results, we suggest that the underlying principles of biased diffusion paradigm need to be reinterpreted.     

A Mathematical Model of Force Generation by Flexible Kinetochore-Microtubule Attachments

Important mechanical events during mitosis are facilitated by the generation of force by chromosomal kinetochore sites that attach to dynamic microtubule tips. Several theoretical models have been proposed for how these sites generate force, and molecular diffusion of kinetochore components has been proposed as a key component that facilitates kinetochore function. However, these models do not explicitly take into account the recently observed flexibility of kinetochore components and variations in microtubule shape under load. In this paper, we develop a mathematical model for kinetochore-microtubule connections that directly incorporates these two important components, namely, flexible kinetochore binder elements, and the effects of tension load on the shape of shortening microtubule tips. We compare our results with existing biased diffusion models and explore the role of protein flexibility inforce generation at the kinetochore-microtubule junctions. Our model results suggest that kinetochore component flexibility and microtubule shape variation under load significantly diminish the need for high diffusivity (or weak specific binding) of kinetochore components; optimal kinetochore binder stiffness regimes are predicted by our model. Based on our model results, we suggest that the underlying principles of biased diffusion paradigm need to be reinterpreted.     

Module one: introduction to research ethics

This module will introduce you to the ethical concepts underlying applied ethical decision-making in the area of research involving human participants. We will also learn what the issues are that people involved in research on research ethics are concerned with. Ethics without an understanding of historical and legal context makes arguably little sense. It is for this reason that this module will begin with a brief history of research ethics and ends with a brief overview of the relevant national and international guidelines pertaining to ethical issues in research involving human participants.     

Anticipatory Functions, Digital-Analog Forms and Biosemiotics: Integrating the Tools to Model Information and Normativity in Autonomous Biological Agents

We argue that living systems process information such that functionality emerges in them on a continuous basis. We then provide a framework that can explain and model the normativity of biological functionality. In addition we offer an explanation of the anticipatory nature of functionality within our overall approach. We adopt a Peircean approach to Biosemiotics, and a dynamical approach to Digital-Analog relations and to the interplay between different levels of functionality in autonomous systems, taking an integrative approach. We then apply the underlying biosemiotic logic to a particular biological system, giving a model of the B-Cell Receptor signaling system, in order to demonstrate how biosemiotic concepts can be used to build an account of biological information and functionality. Next we show how this framework can be used to explain and model more complex aspects of biological normativity, for example, how cross-talk between different signaling pathways can be avoided. Overall, we describe an integrated theoretical framework for the emergence of normative functions and, consequently, for the way information is transduced across several interconnected organizational levels in an autonomous system, and we demonstrate how this can be applied in real biological phenomena. Our aim is to open the way towards realistic tools for the modeling of information and normativity in autonomous biological agents.     

Developing a ‘moral compass tool’ based on moral case deliberations: A pragmatic hermeneutic approach to clinical ethics

Although moral case deliberation (MCD) is evaluated positively as a form of clinical ethics support (CES), it has limitations. To address these limitations our research objective was to develop a thematic CES tool. In order to assess the philosophical characteristics of a CES tool based on MCDs, we drew on hermeneutic ethics and pragmatism. We distinguished four core characteristics of a CES tool: (a) focusing on an actual situation that is experienced as morally challenging by the user; (b) stimulating moral inquiry into the moral concepts, questions and routines in the lived experience of the CES tool user; (c) stimulating moral learning by exploring other perspectives; and (d) incorporating contextual details. We provide an example of a CES tool developed for moral dilemmas over client autonomy. Our article ends with some reflections on the normativity of the CES tool, other application areas and the importance of evaluation studies of CES tools.     

Beyond accountability for reasonableness

This paper is a critique of Norman Daniels' and James Sabin's 'Accountability for Reasonableness' framework for making priority-setting decisions in health care in the face of widespread disagreement about values. Accountability for Reasonableness has been rapidly gaining worldwide acceptance, arguably to the point of becoming the dominant paradigm in the field of health policy. The framework attempts to set ground rules for a procedure that ensures that whatever decisions result will be fair, reasonable, and legitimate to the extent that even those who would be adversely affected will have reason to abide by them. I argue that the framework's four conditions are inadequate to this task. While we certainly require a fair and legitimate procedure for making priority setting decisions in health care despite a lack of consensus on relevant ethical and political issues, we must significantly revise the four conditions, and we cannot avoid facing our substantive disagreements head on if we hope to arrive at decisions that would (and should) be acceptable to everyone. I offer two suggestions. First, there is need for greater public involvement in all stages of deliberation. Second, we should give up on the idea that we can simplify the task of democratic deliberation by disallowing particular kinds or reasons and types of reasoning. Reasons of all kinds should be on the table, but then should be judged on their merits, such as consistency, plausibility and explanatory power, without any regard for their alleged sources of authority.     

Towards the bibliography of life

This paper discusses how we intend to take forward the vision of a Bibliography of Life in the ViBRANT project. The underlying principle of the Bibliography is to provide taxonomists and others with a freely accessible bibliography covering the whole of life. Such a bibliography has been achieved for specific study areas within taxonomy, but not for "life" as a whole.The creation of such a comprehensive tool has been hindered by various social and technical issues. The social concerns focus on the willingness of users to contribute to the Bibliography. The technical concerns relate to the architecture required to deliver the Bibliography. These issues are discussed in the paper and approaches to addressing them within the ViBRANT project are described, to demonstrate how we can now seriously consider building a Bibliography of Life. We are particularly interested in the potential of the resulting tool to improve the quality of bibliographic references. Through analysing the large number of references in the Bibliography we will be able to add metadata by resolving known issues such as geographical name variations. This should result in a tool that will assist taxonomists in two ways. Firstly, it will be easier for them to discover relevant literature, especially pre-digital literature; and secondly, it will be easier for them to identify the canonical form for a citationThe paper also covers related issues relevant to building the tool in ViBRANT, including implementation and copyright, with suggestions as to how we could address them.     

Ethics and Epistemology in Big Data Research

Biomedical innovation and translation are increasingly emphasizing research using “big data.” The hope is that big data methods will both speed up research and make its results more applicable to “real-world” patients and health services. While big data research has been embraced by scientists, politicians, industry, and the public, numerous ethical, organizational, and technical/methodological concerns have also been raised. With respect to technical and methodological concerns, there is a view that these will be resolved through sophisticated information technologies, predictive algorithms, and data analysis techniques. While such advances will likely go some way towards resolving technical and methodological issues, we believe that the epistemological issues raised by big data research have important ethical implications and raise questions about the very possibility of big data research achieving its goals.     

Conceptualizing communities as natural entities: a philosophical argument with basic and applied implications

Recent work has suggested that conservation efforts such as restoration ecology and invasive species eradication are largely value-driven pursuits. Concurrently, changes to global climate are forcing ecologists to consider if and how collections of species will migrate, and whether or not we should be assisting such movements. Herein, we propose a philosophical framework which addresses these issues by utilizing ecological and evolutionary interrelationships to delineate individual ecological communities. Specifically, our Evolutionary Community Concept (ECC) recognizes unique collections of species that interact and have co-evolved in a given geographic area. We argue this concept has implications for a number of contemporary global conservation issues. Specifically, our framework allows us to establish a biological and science-driven context for making decisions regarding the restoration of systems and the removal of exotic species. The ECC also has implications for how we view shifts in species assemblages due to climate change and it advances our understanding of various ecological concepts, such as resilience.     

A multi-indicator framework for mapping cultural ecosystem services: The case of freshwater recreational fishing

Despite recent interest, ecosystem services are not yet fully incorporated into private and public decisions about natural resource management. Cultural ecosystem services (CES) are among the most challenging of services to include because they comprise complex ecological and social properties and processes that make them difficult to measure, map or monetize. Like others, CES are vulnerable to landscape changes and unsustainable use. To date, the sustainability of services has not been adequately addressed and few studies have considered measures of service capacity and demand simultaneously. To facilitate sustainability assessments and management of CES, our study objectives were to (1) develop a spatially explicit framework for mapping the capacity of ecosystems to provide freshwater recreational fishing, an important cultural service, (2) map societal demand for freshwater recreational fishing based on license data and identify areas of potential overuse, and (3) demonstrate how maps of relative capacity and relative demand could be interfaced to estimate sustainability of a CES. We mapped freshwater recreational fishing capacity at the 12-digit hydrologic unit-scale in North Carolina and Virginia using a multi-indicator service framework incorporating biophysical and social landscape metrics and mapped demand based on fishing license data. Mapping of capacity revealed a gradual decrease in capacity eastward from the mountains to the coastal plain and that fishing demand was greatest in urban areas. When comparing standardized relative measures of capacity and demand for freshwater recreational fishing, we found that ranks of capacity exceeded ranks of demand in most hydrologic units, except in 17% of North Carolina and 5% of Virginia. Our GIS-based approach to view freshwater recreational fishing through an ecosystem service lens will enable scientists and managers to examine (1) biophysical and social factors that foster or diminish cultural ecosystem services delivery, (2) demand for cultural ecosystem services relative to their capacity, and (3) ecological pressures like potential overuse that affect service sustainability. Ultimately, we expect such analyses to inform decision-making for freshwater recreational fisheries and other cultural ecosystem services.     

Society and ethics - the genetics of disease

Established guidance for the protection of human subjects in research has provided the framework for research and clinical practice in genetics. Three key principles to emerge are the requirements for consent, privacy and confidentiality. However, recent research on genetic susceptibility to common diseases indicates that it may be more difficult to decide if and when genetic testing will be appropriate. Risks of disease may be low and interventions may not be available. Today, debate is primarily focussed on ethical issues raised by the use and storage of genetic information. One of the earliest experiences of genetic testing for some people is likely to be in the area of pharmacogenetics. Debate about ethical issues has been focused on the implications of patient stratification, particularly with regard to the availability of medicines for small groups and the significance of racial variation in response to medicines. The possible use of personal genetic information by insurance companies and employers has also been an issue that legislators have taken seriously.     

Zika,contraception and the non‐identity problem

The 2016 outbreak of the Zika arbovirus was associated with large numbers of cases of the newly‐recognised Congenital Zika Syndrome (CZS). This novel teratogenic epidemic raises significant ethical and practical issues. Many of these arise from strategies used to avoid cases of CZS, with contraception in particular being one proposed strategy that is atypical in epidemic control. Using contraception to reduce the burden of CZS has an ethical complication: interventions that impact the timing of conception alter which people will exist in the future. This so‐called ‘non‐identity problem’ potentially has significant social justice implications for evaluating contraception, that may affect our prioritisation of interventions to tackle Zika. This paper combines ethical analysis of the non‐identity problem with empirical data from a novel survey about the general public's moral intuitions. The ethical analysis examines different perspectives on the non‐identity problem, and their implications for using contraception in response to Zika. The empirical section reports the results of an online survey of 93 members of the US general public exploring their intuitions about the non‐identity problem in the context of the Zika epidemic. Respondents indicated a general preference for a person‐affecting intervention (mosquito control) over an impersonal intervention (contraception). However, their responses did not appear to be strongly influenced by the non‐identity problem. Despite its potential philosophical significance, we conclude from both theoretical considerations and analysis of the attitudes of the community that the non‐identity problem should not affect how we prioritise contraception relative to other interventions to avoid CZS.     

Healthcare professionals as gatekeepers in research involving refugee survivors of sexual torture: An examination of the ethical issues

This paper examines the ethical issues that arise when healthcare providers act as gatekeepers to research involving vulnerable populations. Traumatised refugees serve as an example of this subset of research participants. Highlighting the particular vulnerabilities of this group, we argue that specific ethical considerations are required that go beyond the conventional research approaches. While gatekeeping responds to some of those vulnerabilities, it risks wronging through unwarranted paternalism. Instead, we will propose that a relational ethics of justice and care serves as a more appropriate framework for responding to the challenges of research involving traumatised refugees. Specifically, such a framework allows us to reflect more deeply on the role of the gatekeeper. In conclusion, we recommend that clinicians and researchers collaborate with survivors’ advisory groups in the development of specific research ethical guidelines.