Infectious diseases, security and ethics: the case of HIV/AIDS

Securitization of infectious diseases may involve suspension of ordinary human rights and liberties. In the event of an epidemic, therefore, it is important to limit the occasions upon which draconian disease control measures are implemented in the name of security. The term 'security', moreover, should not be used too loosely if it is to retain force and meaning in political discourse. It may be argued that the bar for disease securitization should be set high so that it is limited to contexts involving rapidly spreading pathogens. Such an approach, however, would rule out securitization of more slowly spreading, endemic diseases such as HIV/AIDS. An advantage of characterizing HIV/AIDS as a security threat in developing countries, where the burden of the disease is concentrated, is that this is likely to mobilize resources needed to improve the situation there. That is, if HIV/AIDS is convincingly framed as a security threat, then governments may recognize self-interested reasons to ramp up control measures. Following consideration of arguments for narrow (excluding HIV/AIDS) versus broad (including HIV/AIDS) conceptions of security, we conclude that the legitimacy of 'securitizing' HIV/AIDS ultimately turns on empirical and semantic issues, and we emphasize the importance of distinguishing (1) the nature of the threat posed by HIV/AIDS and (2) the measures required to address that threat.     

Women at the Crossroads: A Prostitute Community's Response to AIDS in Urban Senegal

Women at the Crossroads:. Prostitute Community's Response to AIDS in Urban Senegal. Michelle Lewis Renaud. Amsterdam: Gordon and Breach, 1997. 172 pp.     

Limb patterning: reports of model's death exaggerated

The progress zone model for the specification of positional values for patterning the proximodistal axis of the vertebrate limb has been questioned, but the results can be largely reconciled with the old model.     

Synthetic biology: enormous possibility,exaggerated perils

The following essay was written by a freshman undergraduate student majoring in Bioengineering at the University of Maryland, Mr. Zachary Russ. Mr. Russ was one of 94 students who submitted a 1000 to 1200 word essay to the 3rd Annual Bioethics Essay Contest sponsored by the Institute of Biological Engineering (IBE). A group of professionals in Biological Engineering assessed and ranked the essays in a blinded process. Five semi-finalists were invited to present their essays at a session at the annual meeting of IBE in Chapel Hill, NC on March 8, 2008. Five judges scored the presentations at the annual meeting and selected Mr. Russ's contribution as the overall winner (1st Place). Below is his essay.     

Methods of ethics and the descent of man: Darwin and Sidgwick on ethics and evolution

Darwin’s treatment of morality in The Descent of Man has generated a wide variety of responses among moral philosophers. Among these is the dismissal of evolution as irrelevant to ethics by Darwin’s contemporary Henry Sidgwick; the last, and arguably the greatest, of the Nineteenth Century British Utilitarians. This paper offers a re-examination of Sidgwick’s response to evolutionary considerations as irrelevant to ethics and the absence of any engagement with Darwin’s work in Sidgwick’s main ethical treatise, The Methods of Ethics. This assessment of Sidgwick’s response to Darwin’s work is shown to have significance for a number of ongoing controversies in contemporary metaethics.     

New perspectives on the evolution of exaggerated traits

The scaling of body parts is central to the evolution of morphology and shape. Most traits scale proportionally with each other and body size such that larger adults are essentially magnified versions of smaller ones. This pattern is so ubiquitous that departures from it – disproportionate scaling between trait and body size – pique interest because it can generate dramatically exaggerated traits. These extreme morphologies are frequently hypothesized to result from sexual selection and their study has a long history, with several hypotheses seeking to explain their evolution. Despite this effort, surprisingly little progress has been made in demonstrating the forms of selection that produce different scaling patterns or in identifying the mechanisms that underlie the expression and evolution of scaling relationships. Here we review recent insights regarding the proximate mechanisms that regulate and integrate trait growth and that offer a new framework for studying the evolution of morphological scaling.     

Playing God and the ethics of divine names: an Islamic paradigm for biomedical ethics

The notion of 'playing God' frequently comes to fore in discussions of bioethics, especially in religious contexts. The phrase has always been analyzed and discussed from Christian and secular standpoints. Two interpretations exist in the literature. The first one takes 'God' seriously and playing 'playfully'. It argues that this concept does state a principle but invokes a perspective on the world. The second takes both terms playfully. In the Islamic Intellectual tradition, the Sufi concept of 'adopting divine character traits' provides a legitimate paradigm for 'playing God'. This paradigm is interesting because here we take both terms 'God' and 'playing' seriously. It is significant for the development of biomedical ethics in contemporary Islamic societies as it can open new vistas for viewing biotechnological developments.     

Barriers and challenges in clinical ethics consultations: the experiences of nine clinical ethics committees

Clinical ethics committees have recently been established in nearly all Norwegian hospital trusts. One important task for these committees is clinical ethics consultations. This qualitative study explores significant barriers confronting the ethics committees in providing such consultation services. The interviews with the committees indicate that there is a substantial need for clinical ethics support services and, in general, the committee members expressed a great deal of enthusiasm for the committee work. They also reported, however, that tendencies to evade moral disagreement, conflict, and 'outsiders' are common in the hospitals. Sometimes even the committees comply with some of these tendencies. The committees agree that there is a need to improve their routines and procedures, clarify the committees' profile and field of responsibility, to make the committees well-known, to secure adequate operating conditions, and to develop organizational integration and support. Various strategies to meet these challenges on a local, regional or national level are also explored in this paper.     

Misdiagnosis-related harm quantification through mixture models and harm measures

Investigating and monitoring misdiagnosis-related harm is crucial for improving health care. However, this effort has traditionally focused on the chart review process, which is labor intensive, potentially unstable, and does not scale well. To monitor medical institutes' diagnostic performance and identify areas for improvement in a timely fashion, researchers proposed to leverage the relationship between symptoms and diseases based on electronic health records or claim data. Specifically, the elevated disease risk following a false-negative diagnosis can be used to signal potential harm. However, off-the-shelf statistical methods do not fully accommodate the data structure of a well-hypothesized risk pattern and thus fail to address the unique challenges adequately. To fill these gaps, we proposed a mixture regression model and its associated goodness-of-fit testing. We further proposed harm measures and profiling analysis procedures to quantify, evaluate, and compare misdiagnosis-related harm across institutes with potentially different patient population compositions. We studied the performance of the proposed methods through simulation studies. We then illustrated the methods through data analyses on stroke occurrence data from the Taiwan Longitudinal Health Insurance Database. From the analyses, we quantitatively evaluated risk factors for being harmed due to misdiagnosis, which unveiled some insights for health care quality research. We also compared general and special care hospitals in Taiwan and observed better diagnostic performance in special care hospitals using various new evaluation measures.