CHSCR

Background: Questions have been asked about whether the process of obtaining informed consent from parents to clinical trials on neonates leads to valid consent. We undertook a study in nine European countries to assess this issue and to seek any practical improvements. Methods: Semi-structured interviews were conducted with parents of 200 babies who had been asked for consent to neonatal trials and 107 neonatologists seeking consent. Analysis assessed the validity of the consent process against four components: parental competence; information given; parental understanding; and voluntariness of consent. Findings: 59 of the 200 parents had given valid consent or refusal but the remainder had problems in one or more of the component areas (42 for competence, 43 for information, 44 for understanding, and 21 for voluntariness). The proportions with impaired consent were greatest for research in an emergency situation and for that associated with risk or discomfort greater than standard treatment. Information sheets were little used by parents in deciding whether to consent. Parents highly valued their involvement in the informed consent process, and clinicians generally agreed on the value of the process. Interpretation: Current standards of informed consent to neonatal research projects could be improved. Research personnel should receive guidance on legal and ethical constraints governing the process. Oral and written information should be given at the same time. Parents could be made aware that research projects have been examined by research ethics committees. Little support was found for the argument that informed consent should be relinquished for the parents' own good. Further study is needed to identify which elements of the process are valued by parents and clinicians in a process that has some unavoidable limitations.

There is a growing body of writing, for instance from the nursing profession, espousing an approach to ethics based on care. I suggest that this approach is hopelessly vague and that the vagueness is due to an inadequate analysis of the concept of care. An analysis of 'care' and related terms suggests that care is morally neutral. Caring is not good in itself but only when it is for the right things and expressed in the right way. 'Caring' ethics assumes wrongly that caring is good, thus it can tell us neither what constitutes those right things, nor what constitutes the right way.

The significance of the question 'Is caring a virtue?' lies in the fact that both the ethics of virtue and the ethics of care have been proposed as alternatives to what may be termed 'bioethics'. The ethics of care has been of particular interest to nursing theorists, especially those who want to say that there is a body of distinctively nursing ethical theory which is different from bioethics. In answering the main question there are three supplementary aims: first, to explore the relationship between virtue ethics and the ethics of care, it is suggested that caring is not a virtue, but that the virtues involve caring correctly; second, to give a broad outline of what is meant by an ethics of virtue, including what it means to care correctly; and third, to examine implications of the theory for nursing.

Aim. The aim of this paper is to suggest that the study of ethics and ethical theories can enhance nursing practice. Discussion. Knowledge of ethical theories can be of practical use to nurses in at least three ways. First, it can help nurses uncover to what extent a problem is an ethical one. The questions faced in practice can be empirical, formal or philosophical. Very often, a practical decision requires us to tackle all three types. In the example of a 'Do not attempt resuscitation' order, deciding on whether such an order is appropriate requires us to answer empirical questions such as how likely any attempt is to achieve success. It also requires us to answer formal questions such as whether the law permits such an order in the present circumstance. Finally, it requires us to answer ethical/philosophical questions, such as how we should weigh up quality of life against quantity. Second, it can enable practitioners to develop skills and tools to tackle ethical/philosophical questions. In this paper I describe two such tools: Socratic questioning and Aristotelian dialectic. Third, it can help practitioners to develop the soundness of their ethical values and beliefs. All ethical reasoning requires us to use our values and beliefs, and attending to them enhances the quality of our reasoning. Conclusion. The study of ethics can enhance nursing practice.

My aim is to suggest that there is a case for using a randomised consent design in some neonatal trials. As an example I use the trials of extracorporeal membrane oxygenation (ECMO) in neonates suffering pulmonary hypertension. In some trials the process of obtaining consent has the potential to harm the subject, for example, by disappointing those who end in the control group and by creating additional anxiety at times of acute illness. An example of such were the trials of extracorporeal membrane oxygenation (ECMO) in neonates suffering pulmonary hypertension. Pre-randomised consent could avoid or lessen these harms. However, a number of ethical objections are made to these research designs. They involve denial of information, using people, denial of choice, and 'overselling' of allocated treatment. Furthermore, they are the wrong response; better communication might be the answer, for example. I argue that these objections are not completely persuasive. However, they are enough to suggest caution in the use of such designs.

At least two philosophical criticisms are made of health promotion practice. The first is that some such practice offends against Mill’s liberty principle, that coercion should
not be used against someone for his own good. The second is that health promotion
promotes an ascetic rather than a good life.
I suggest that health promotion practice is vulnerable to these criticisms because of
its flawed, objective view of health concepts, a view in which health judgements are
taken to be facts about people. In fact, health is not a fact but a judgment. However,
this should not lead us to adopt an entirely subjective view. I suggest that judgements
of health can be grounded in Aristotelian views about the function of the parts of the
human organism and ultimately in the function of the organism as a whole. That
function is to live the life of a fully rational animal.
I defend the plausibility of this view and work through its implications for health
promotion. These are that there may be occasions when beneficent coercion is justified
(where an activity severely undermines the human function) and that health promotion
can be practised in a way that promotes a good life.

The main claim of this paper is that the method outlined and used in Aristotle's Ethics is an appropriate and credible one to use in bioethics. Here “appropriate” means that the method is capable of establishing claims and developing concepts in bioethics and “credible” that the method has some plausibility, it is not open to obvious and immediate objection. It begins by suggesting why this claim matters and then gives a brief outline of Aristotle's method. The main argument is made in three stages. First, it is argued that Aristotelian method is credible because it compares favourably with alternatives. In this section it is shown that Aristotelian method is not vulnerable to criticisms that are made both of methods that give a primary place to moral theory (such as utilitarianism) and those that eschew moral theory (such as casuistry and social science approaches). As such, it compares favourably with these other approaches that are vulnerable to at least some of these criticisms. Second, the appropriateness of Aristotelian method is indicated through outlining how it would deal with a particular case. Finally, it is argued that the success of Aristotle's philosophy is suggestive of both the credibility and appropriateness of his method.

My original paper suggested that an ethics of care which failed to specify how, and about what, to care would be devoid of normative and descriptive content. Bradshaw's approach provides such a specification and is, therefore, not devoid of such content. However, as all ethical approaches suggest something about the 'what' and 'how' of care, they are all 'ethics of care' in this broader sense. This reinforces rather than undermines my original conclusion. Furthermore, Bradshaw's 'ethics of care' has philosophical and historical problems which I outline.

Science seems to develop by inducing new knowledge from observation. However, it is hard to find a rational justification for induction. Popper offers one attempt to resolve this problem. Nursing theorists have tended to ignore or reject Popper, often on the false belief that he is a logical positivist (and hence hostile to qualitative research). Logical positivism claims that meaningful sentences containing any empirical content should ultimately be reducible to simple, observation statements. Popper refutes positivism by showing that there are no such simple statements. He is not a positivist. For Popper, the scientist begins with problems and puts forward trial solutions. These are subjected to rigorous testing aimed at falsifying them. A new theoretical position is then reached in which the scientist knows either that the trial solutions are false or that they have not yet been falsified. Science is characterized by the fact that it tests its ideas through attempted falsification. Non-science tests its ideas through attempted refutation. Nursing theory is a mixture of science and non-science. Popper's method requires rigorous testing of theory in both realms. As such, some nursing theory should be discarded. Popper's view faces at least two important criticisms. One is that a scientist can always reject an apparent falsification by instead altering some auxiliary hypothesis (e.g. denying the accuracy of the falsifying observation). Popper can deal with this argument by saying that defence of a theory in this way will eventually break down if the theory is false. The second criticism is that Popper's method does ultimately draw upon induction. This criticism is true, but his method can be usefully adapted. An adapted from of Popper's philosophy of science provides a good basis for nursing theory.

There is increasing recognition in the UK that social science research should generate an evidence base that reflects the ethnic diversity of the population and informs positive developments in public policy and programmes for all. However, describing and understanding ethnic diversity, and associated disadvantage, is far from straightforward. In practice, the ethical and scientific arguments around whether and how to incorporate ethnicity into policy-relevant social research are complex and contentious. In particular, untheorised or insensitive inclusion of data on ethnic 'groups' can have negative consequences. The present investigation begins to explore the extent to which social scientists have access to advice and guidance in this area of research. Specifically, the paper examines how ethnic diversity is explicitly or implicitly considered within the research ethics and scientific standard guidance provided by UK social science Learned Societies to their members. The review found little in the way of explicit attention to ethnic diversity in the guidance documents, but nevertheless identified a number of pertinent themes. The paper compiles and extrapolates these themes to present a tentative set of principles for social scientists to debate and further develop.

This paper reports a literature review on the topic of ethical issues in
in-depth interviews. The review returned three types of article:
general discussion, issues in particular studies, and studies of
interview-based research ethics. Whilst many of the issues discussed
in these articles are generic to research ethics, such as confidentiality,
they often had particular manifestations in this type of research. For
example, privacy was a significant problem as interviews sometimes
probe unexpected areas. For similar reasons, it is difficult to give full
information of the nature of a particular interview at the outset, hence
informed consent is problematic. Where a pair is interviewed (such as
carer and cared-for) there are major difficulties in maintaining
confidentiality and protecting privacy. The potential for interviews to
harm participants emotionally is noted in some papers, although this
is often set against potential therapeutic benefit. As well as these
generic issues, there are some ethical issues fairly specific to in-depth
interviews. The problem of dual role is noted in many papers. It can
take many forms: an interviewer might be nurse and researcher,
scientist and counsellor, or reporter and evangelist. There are other
specific issues such as taking sides in an interview, and protecting
vulnerable groups. Little specific study of the ethics of in-depth
interviews has taken place. However, that which has shows some
important findings. For example, one study shows participants are
not averse to discussing painful issues provided they feel the study is
worthwhile. Some papers make recommendations for researchers.
One such is that they should consider using a model of continuous (or
process) consent rather than viewing consent as occurring once, at
signature, prior to the interview. However, there is a need for further
study of this area, both philosophical and empirical. [291 words]

This paper discusses the use of the concept of 'persons', and its related principle 'respect for persons', in health care ethics. It is suggested that the main use of the concept is in attempts to answer the questions: 'Who owes moral respect?' and 'To whom is it owed?'. An examination of different writers and their use of the concept of 'persons' show it to be unsuccessful in answering the first question, and dangerous and unacceptable in answering the second. Therefore, it is suggested the concept should not be used at all in health care ethics. An alternative idea is suggested, based on the work of Hursthouse (1992).

In this paper, we consider three arguments for the irrelevance of the
doctrine of double effect in end-of-life decision making.The third argument
is our own and, to that extent, we seek to defend it. The first
argument is that end-of-life decisions do not in fact shorten lives and that
therefore there is no need for the doctrine in justification of these decisions.
We reject this argument; some end-of-life decisions clearly shorten
lives.The second is that the doctrine of double effect is not recognized in
UK law (and similar jurisdictions); therefore, clinicians cannot use it as
the basis for justification of their decisions. Against this we suggest that
while the doctrine might have dubious legal grounds, it could be of
relevance in some ways, e.g. in marking the boundary between acceptable
and unacceptable practice in relation to the clinician’s duty to
relieve pain and suffering. The third is that the doctrine is irrelevant
because it requires there to be a bad effect that needs justification. This
is not the case in end-of-life care for patients diagnosed as dying. Here,
bringing about a satisfactory dying process for a patient is a good effect,
not a bad one.What matters is that patients die without pain and suffering.
This marks a crucial departure from the double-effect doctrine; if the
patient’s death is not a bad effect then the doctrine is clearly irrelevant.
A diagnosis of dying allows clinicians to focus on good dying and not to
worry about whether their intervention affects the time of death. For a
patient diagnosed as dying, time of death is rarely important. In our
conclusion we suggest that acceptance of our argument might be problematic
for opponents of physician-assisted death.We suggest one way in
which these opponents might argue for a distinction between such practice
and palliative care; this relies on the double-effect doctrine’s distinction
between foresight and intention.

Bayes’ rule shows how one might rationally change one’s beliefs in the light of evidence. It is the foundation of a statistical method called Bayesianism. In health care research, Bayesianism has its advocates but the dominant statistical method is frequentism.

There are at least two important philosophical differences between these methods. First, Bayesianism takes a subjectivist view of probability (i.e. that probability scores are statements of subjective belief, not objective fact) whilst frequentism takes an objectivist view. Second, Bayesianism is explicitly inductive (i.e. it shows how we may induce views about the world based on partial data from it) whereas frequentism is at least compatible with non-inductive views of scientific method, particularly the critical realism of Popper.

Popper and others detail significant problems with induction. Frequentism’s apparent ability to avoid these, plus its ability to give a seemingly more scientific and objective take on probability, lies behind its philosophical appeal to health care researchers.

However, there are also significant problems with frequentism, particularly its inability to assign probability scores to single events. Popper thus proposed an alternative objectivist view of probability, called propensity theory, which he allies to a theory of corroboration; but this too has significant problems, in particular, it may not successfully avoid induction. If this is so then Bayesianism might be philosophically the strongest of the statistical approaches. The article sets out a number of its philosophical and methodological attractions. Finally, it outlines a way in which critical realism and Bayesianism might work together.

The article examines ethical challenges that arise with clinical lung cancer research focusing
on design, recruitment, conduct and dissemination. Design: problems related to equipoise can arise in lung
cancer studies. Equipoise is an ethics precondition for RCTs and exists where there is insufficient evidence
to decide which of two or more treatments is best. Difficulties arise in deciding what level of uncertainty
constitutes equipoise and who should be in equipoise, for example, patients might not be even where
clinicians are. Patient and public involvement (PPI) can reduce but not remove the problems. Recruitment:
(I) lung cancer studies can be complex, making it difficult to obtain good quality consent. Some techniques
can help, such as continuous consent. But researchers should not expect consent to be the sole protection
for participants’ welfare. This protection is primarily done elsewhere in the research process, for example, in
ethics review; (II) the problem of desperate volunteers: some patients only consent to a trial because it gives
them a 50/50 option of the treatment they want and can be disappointed or upset if randomised to the other
arm. This is not necessarily unfair, given clinical equipoise. However, it should be avoided where possible,
for example, by using alternative trial designs; (III) the so-called problem of therapeutic misconception: this
is the idea that patients are mistaken if they enter trials believing this to be in their clinical best interest. We
argue the problem is misconceived and relates only to certain health systems. Conduct: lung cancer trials
face standard ethical challenges with regard to trial conduct. PPI could be used in decisions about criteria for
stopping rules. Dissemination: as in other trial areas, it is important that all results, including negative ones,
are reported. We argue also that the role of PPI with regard to dissemination is currently under-developed.

Background The incidence of child labour, especially across the developing nations is of global concern. The use of children in employment in developing economies constitutes a major threat to the societies, and concerted efforts are made by the relevant stakeholders towards addressing some of the factors/issues responsible for the menace. Significant risk factors include socio-demographic and economic factors, including poverty, neglect, lack of adequate care, and exposure of children to various grades of violence, parental education status, gender, place of residence, household size, residence's type or size, wealth index, parental survivorship and household size. Objectives This study, therefore, focuses on identifying socio-demographic/economic and geospatial factors associated with child labour participation. Methods We utilised 2014 Demographic and Health Survey (EDHS) from the Ministry health and Population in Egypt, with the record of 20, 560 never married children aged ...