Do Obligations Follow the Mind or Body?

Do you persist as the same person over time because you keep the same mind or because you keep the same body? Philosophers have long investigated this question of personal identity with thought experiments. Cognitive scientists have joined this tradition by assessing lay intuitions about those cases. Much of this work has focused on judgments of identity continuity. But identity also has practical significance: obligations are tagged to one's identity over time. Understanding how someone persists as the same person over time could provide insight into how and why moral and legal obligations persist. In this paper, we investigate judgments of obligations in hypothetical cases where a person's mind and body diverge (e.g., brain transplant cases). We find a striking pattern of results: In assigning obligations in these identity test cases, people are divided among three groups: "body-followers," "mind-followers," and "splitters"-people who say that the obligation is split between the mind and the body. Across studies, responses are predicted by a variety of factors, including mind/body dualism, essentialism, education, and professional training. When we give this task to professional lawyers, accountants, and bankers, we find they are more inclined to rely on bodily continuity in tracking obligations. These findings reveal not only the heterogeneity of intuitions about identity but how these intuitions relate to the legal standing of an individual's obligations.

Professionalism, Organizationalism and Sur-moralism: Three ethical systems for physicians

Over the last 50 years, the term professionalism has undergone a widespread expansion in its use and a semantic shift in its meaning. As a result, it is at risk of losing its descriptive and analytical value and becoming instead simply an empty evaluative label, a fate described by C. S. Lewis as 'verbicide' (Lewis 1967). This article attempts to rescue professionalism from this fate by down-sizing its extension and reassigning some of its work to two other ethical domains, introduced as the neologisms organizationalism and sur-moralism. Professionalism is defined as a morality based in system of obligations that are assumed by physicians over the course of their professional training and which primarily refer to two groups: patients and colleagues, including trainees. Organizationalism is also a morality, but the obligations are owed to the employing organization and on different grounds. A third ethical domain, here called sur-moralism, comprises actions that are not based in obligations. They are discretionary and potentially meritorious; they cannot be required by the profession or organization. This article presents a conceptual model of the three ethical domains and the shifting borders between them. One practical benefit of this typology is that physicians can more accurately understand the nature and sources of obligations that they are asked to accept, and when necessary prioritize them. Another is that physicians will be able to describe the potential tension between the three domains and understand how and why the borders between them can move. Both should help physicians to be more ethically oriented to their work settings.

[Digital data management in the orthodontic practice: legal obligations]

The digital era opens up the field of possibilities: web, e-mail, networks, optical fingerprints, digital storage... It will then be possible to optimize the use of the digital tool for both data collection and storage, information transfer, restitution, implementation of electronic signature, preservation of digital model... However, it must not alter the practitioner's care for his patients. Indeed, securing patients' medical data is an integral part of their care. Even if it is immaterial, their protection as to be effective, even at the physical level. The aim of this article is to list our obligations towards the virtual tool, the management modalities to avoid any prejudice. The research of the texts was carried out on Legifrance, CNIL, Pubmed and the jurisprudence. The authorization to collect data and the possibility to transfer them to a third part is mandatory. The conservation of these data in adequate conditions, both physical and digital, is essential to avoid the loss of the data and the consequent sanctions. The security of medical data requires the protection of the premises, computers and the Internet tool. The implementation of regulated protocols is the only guarantee of data security and good faith in front of the judge in case of loss. It requires the involvement of the entire healthcare team to implement effective procedures.

Obligations in the Anthropocene

The Anthropocene is a term described by Earth Systems Science to capture the recent rupture in the history of the Earth where human action has acquired the power to alter the Earth System as a whole. While normative conclusions cannot be logically derived from this descriptive fact, this paper argues that law and philosophy ought to develop responses that are ordered around human beings. Rather than arguing for legal rights or extending rights to nature, this paper focuses on obligations. Drawing on Hans Jonas, it argues that obligations are a more appropriate tool for cultivating human plurality, restraining human action and protecting future generations.

[Knowledge and attitude about Pharmacovigilance practices of pharmacy professionals of community pharmacy and hospital pharmacy in Spain.]

OBJECTIVE

The justification of the study was to assess the degree of knowledge of Spanish pharmacists in the field of Pharmacovigilance, their degree of notification of adverse drug reactions and their need for training, establishing the differences between community pharmacy pharmacist and those of hospital pharmacy.

METHODS

A questionnaire with twelve questions on Pharmacovigilance was designed. The distribution and collection of the questionnaires were carried out via online in collaboration with the Official Colleges of Pharmacists and the Spanish Society of Hospital Pharmacy during the period from November 2018 to June 2019. The target population were the pharmacists registered or belonging to the Spanish Society of Hospital Pharmacy. The results were processed using a descriptive and analytical analysis. The qualitative variables were presented with their frequency distribution and the quantitative with their mean and standard deviation.

RESULTS

99% of hospital pharmacists said they had evidence of suspected adverse reactions and 96.9% of them ever reported. 73.5% of community pharmacists stated that they had knowledge of suspected adverse reactions but only 48.7% confirmed that they notified them. In general, the pharmacists surveyed agreed on the importance of Pharmacovigilance and believed that the quality of treatments could be improved and the Spanish health system would be saved if Pharmacovigilance was applied more.

CONCLUSIONS

Our results indicated that hospital pharmacists report much more adverse drug reactions than community pharmacist does. It also hospital pharmacists who know best the obligations they have with Pharmacovigilance. The surveyed pharmacists thought that the development of actions in Pharmacovigilance would increase the adherence of pharmaceutical professionals to the notification and would imply improvements in the quality of treatments, the rational use of medications and patient safety.

Image of the new vaccination obligation through the media

INTRODUCTION

Vaccination campaigns always go hand by hand with controversies about their safety and usefulness. The widespread perception of vaccines as dangerous induces a decrease in the population immunization coverage, which led The French Ministry of Health to add 8 new mandatory vaccines to the 3 existing ones. The objective of this study is to analyze the information conveyed by the media and received by the French population about this new legislation.

METHOD

The newspaper articles and television and radio programs were selected from the media with the highest audience rate from January 2016 to May 2018. They were analyzed according to the grounded theory, up to data saturation, with double coding.

RESULTS

The qualitative analysis included 38 written press articles, 18 radio programs and 18 television programs. After coding, several themes emerged. Discussions about the usefulness of vaccination, trust in vaccines, vaccination coverage, and the cost of measure were controversial in the media. Questions about ethics were also mentioned. The description of anti-vaccines by journalists and some doctors conveyed a negative image while reminding their strong mobilization through social media. The law and its implementation details were frequently reminded across the different media.

DISCUSSION-CONCLUSION

Traditional media give opposing views on immunization obligations. Vaccination is supported by a majority of doctors. Parents share their fears and concerns about vaccination and its adverse effects. An effort regarding public communication seems necessary in order to reassure the population. The study of other media, such as the Internet, could help to deepen this study.

WASP (Write a Scientific Paper): Special cases of selective non-treatment and/or DNR

Fetuses at low gestational age limit of viability, neonates with life threatening or life limiting congenital anomalies and deteriorating acutely ill newborn babies in intensive care, pose taxing ethical questions on whether to forego or stop treatment and allow them to die naturally. Although there is essentially no ethical difference between end of life decision between neonates and other children and adults, in the former, the fact that we are dealing with a new life, may pose greater problems to staff and parents. Good communication skills and involvement of all the team and the parents should start from the beginning to see which treatment can be foregone or stopped in the best interests of the child. This article deals with the importance of clinical ethics to avoid legal and moral showdowns and discusses accepted moral practice in this difficult area.

WASP (Write a Scientific Paper): Ethics approval for a research study (1)

Past experience in science has thought us the importance of ethics in research. Research is important to the advancement of medicine and therefore good clinical practice in research maintains public trust which otherwise is not only lost but may cause science to seem negative. The rights of participants in the research trial are discussed. This includes knowledge and information about the research itself, the obligations of the researchers and the rights of participants during the research. The EU Directive on Good Clinical Practice in research trials is reviewed, including the twelve principles of the directive. The function and composition of Research Ethics Committees is discussed in the context of protecting patients and participants, asserting quality and monitoring of the research, qualifications of the scientists and liability.

Examination of the roles and capacities of duty bearers responsible for protecting the human rights to adequate food, nutritional health and wellbeing in Ugandan children's homes

BACKGROUND

The majority of Ugandan children face vulnerability and malnutrition. As a State Party to international human rights treaties, Uganda has legal obligations of guaranteeing the fundamental rights and the best interest of the nation's children. Despite being protected under international and national law, Uganda is not providing adequate child protection, including safeguarding children's food security. Numerous privately owned and unregulated children's homes face this problem. The overall aim of the study was to examine to what extent children's homes' operations are consistent with the right to adequate food, nutritional health and wellbeing of children.

METHODS

We performed a qualitative role- and capacity analysis of duty bearers with human rights duties towards children living in children's homes. We studied three groups of duty bearers: caretakers working in private children's homes, State actors working in government and its institutions, and non-State actors working in civil society organizations. A human rights based approach guided all aspects of the study. An analysis of the roles, performance and capacities of duty bearers was employed, with individual face-to-face structured qualitative in-depth interviews, self-administered structured questionnaires, and a structured observational study, as well as a desk review of relevant literature.

RESULTS

The State of Uganda's efforts to respect and realize its obligations towards children living in children's homes is inadequate. There are numerous capacity gaps among the duty bearers, and the concepts of human rights and the best interest of the child are not well understood among the duty bearers.

CONCLUSION

The efforts of the State of Uganda to realize its human rights obligations towards children in children's homes are lacking in important areas. Hence the State does not fulfill its minimum obligations under the International Covenant on Economic, Social and Cultural Rights to ensure all children freedom from hunger. There is a need for capacity development at all levels in the Ugandan state and the international society to delimit capacity gaps in order to realize these human rights' obligations.

Understanding the futility of countries' obligations for health rights: realising justice for the global poor

BACKGROUND

Although health is a right of all individuals without any distinction, the realisation of this right has remained very difficult for the marginalised populations of poor countries. Inequitable distribution of health opportunities globally is a major factor in explaining why this is the case. Whereas the Protection, Promotion and Fulfilment of the health rights of poor country citizens are a joint responsibility of both domestic and external governments, most governments flout their obligations. So far disproportionate effort has been dedicated to reaffirming and interpreting these obligations as opposed to investigating the fundamental question regarding why these obligations have nevertheless remained largely unfulfilled. Further the normative question regarding what ought to be done about the shortcomings of current obligations has been largely ignored.

METHODS

We conduct a critical content analysis of existing literature on efforts towards the realisation of the health rights of marginalised populations in our attempt to ascertain their capacity to guarantee basic health opportunities to marginalised populations. In our analysis we treat issues of 'health rights' and 'justice in global health' as having unity of purpose - guaranteeing basic health opportunities to the marginalised populations.

RESULTS

We identify two sets of reasons for the failure of present obligations for global distributive justice in general: a set of 'superficial reasons' and a set of 'fundamental reasons' which account for the superficial reasons.

DISCUSSION

In order to overcome these reasons we propose a strategy which consists in specifying a number of minimum and less-demanding obligations for both external and domestic governments to guarantee to all individuals a certain threshold of health goods and services. We argue that these minimum obligations can be freely accepted and fully complied with or enforced with "a thin system of enforcement" without significant threat to national sovereignty and autonomy.

CONCLUSION

The futility of countries' obligations for the health rights of the global poor as is the case with global distributive injustice is because of lack of political will to specify and enforce such obligations. Minimum obligations should be specified and enforced with a "thin system" which is consistent with principles of national sovereignty and autonomy.

Naturalization Ceremonies and the Role of Immigrants in the American Nation

Although immigration is an essential element in the American national story, it presents difficulties for constructing national membership and national identity in terms of shared intrinsic values. In this paper, I analyze speeches made at naturalization ceremonies during two time periods (1950-1970 and 2003-present) in order to examine the evolving roles of immigrants, as articulated to immigrants themselves. Naturalization ceremonies are a unique research site because the usually implied nationalist content is made explicit to brand new members of the nation. I find a shift in the framing from immigrants as potential liabilities and weak links in the earlier period to immigrants as morally superior redeemers of the American nation in the later period. I discuss the significance of this shift and the relationship between the roles presented at naturalization ceremonies and the discourse found elsewhere in the public sphere.