bluuebunny/crossref_metadata_2025 huggingface dataset:
LiveCandida albicansSuppresses Production of Reactive Oxygen Species in Phagocytes
Authors: Wellington Melanie , Dolan Kristy , Krysan Damian J.
Published: November 2008

Production of reactive oxygen species (ROS) is an important aspect of phagocyte-mediated host responses. Since phagocytes play a crucial role in the host response toCandida albicans, we examined the ability ofCandidato modulate phagocyte ROS production. ROS production was measured in the murine macrophage cell line J774 and in primary phagocytes using luminol-enhanced chemiluminescence. J774 cells, murine polymorphonuclear leukocytes (PMN), human monocytes, and human PMN treated with liveC. albicansproduced significantly less ROS than phagocytes treated with heat-killedC. albicans. Live C.albicansalso suppressed ROS production in murine bone marrow-derived macrophages from C57BL/6 mice, but not from BALB/c mice. LiveC. albicansalso suppressed ROS in response to external stimuli.C. albicansandCandida glabratasuppressed ROS production by phagocytes, whereasSaccharomyces cerevisiaestimulated ROS production. The cell wall is the initial point of contact betweenCandidaand phagocytes, but isolated cell walls from both heat-killed and liveC. albicansstimulated ROS production. Heat-killedC. albicanshas increased surface exposure of 1,3-β-glucan, a cell wall component that can stimulate phagocytes. To determine whether surface 1,3-β-glucan exposure accounted for the difference in ROS production, liveC. albicanscells were treated with a sublethal dose of caspofungin to increase surface 1,3-β-glucan exposure. Caspofungin-treatedC. albicanswas fully able to suppress ROS production, indicating that suppression of ROS overrides stimulatory signals from 1,3-β-glucan. These studies indicate that liveC. albicansactively suppresses ROS production in phagocytes in vitro, which may represent an important immune evasion mechanism.
Toll-Like Receptor Prestimulation Increases Phagocytosis ofEscherichia coliDH5α andEscherichia coliK1 Strains by Murine Microglial Cells
Authors: Ribes Sandra , Ebert Sandra , Czesnik Dirk , Regen Tommy , Zeug Andre , Bukowski Stephanie , Mildner Alexander , Eiffert Helmut , Hanisch Uwe-Karsten , Hammerschmidt Sven , Nau Roland
Published: November 2008

Meningitis and meningoencephalitis caused byEscherichia coliare associated with high rates of mortality. When an infection occurs, Toll-like receptors (TLRs) expressed by microglial cells can recognize pathogen-associated molecular patterns and activate multiple steps in the inflammatory response that coordinate the brain's local defense, such as phagocytosis of invading pathogens. An upregulation of the phagocytic ability of reactive microglia could improve the host defense in immunocompromised patients against pathogens such asE. coli. Here, murine microglial cultures were stimulated with the TLR agonists Pam3CSK4(TLR1/TLR2), lipopolysaccharide (TLR4), and CpG oligodeoxynucleotide (TLR9) for 24 h. Upon stimulation, levels of tumor necrosis factor alpha and the neutrophil chemoattractant CXCL1 were increased, indicating microglial activation. Phagocytic activity was studied after adding eitherE. coliDH5α orE. coliK1 strains. After 60 and 90 min of bacterial exposure, the number of ingested bacteria was significantly higher in cells prestimulated with TLR agonists than in unstimulated controls (P< 0.01). Addition of cytochalasin D, an inhibitor of actin polymerization, blocked >90% of phagocytosis. We also analyzed the ability of microglia to kill the ingestedE. colistrains. Intracellularly surviving bacteria were quantified at different time points (90, 150, 240, and 360 min) after 90 min of phagocytosis. The number of bacteria killed intracellularly after 6 h was higher in cells primed with the different TLR agonists than in unstimulated microglia. Our data suggest that microglial stimulation by the TLR system can increase bacterial phagocytosis and killing. This approach could improve central nervous system resistance to infections in immunocompromised patients.
A Hemidominant
Naip5
Allele in Mouse Strain MOLF/Ei-Derived Macrophages Restricts
Legionella pneumophila
Intracellular Growth
Authors: Losick Vicki P. , Stephan Kristin , Smirnova Irina I. , Isberg Ralph R. , Poltorak Alexander
Published: November 2008

Mouse-derived macrophages have the unique ability to restrict or permit
Legionella pneumophila
intracellular growth. The common inbred mouse strain C57BL/6J (B6) restricts
L. pneumophila
growth, whereas macrophages derived from A/J mice allow >10
3
-fold bacterial growth within three days. This phenotypic difference was mapped to the mouse
Naip5
allele. The B6 restrictive
Naip5
allele is dominant, and six amino acid changes in its product were predicted to control permissiveness. By using the wild-derived mouse strain MOLF/Ei, we found that MOLF/Ei-derived macrophages also restrict
L. pneumophila
growth, yet the Naip5 protein is identical to the A/J Naip5 at the six-amino-acid signature. The MOLF/Ei restrictive trait, unlike that of B6-derived macrophages, was not dominant over the A/J trait. In spite of this phenotypic difference, the
L. pneumophila
growth restriction in MOLF/Ei macrophages was mapped to the
Naip5
region as well, indicating that the originally predicted change in the A/J
Naip5
allele may not be critical for restriction. In the product of the A/J
Naip5
permissive allele, there are four unique amino acid changes that map to a NACHT-like domain. Similar misregulating mutations have been identified in the NACHT domains of Nod-like receptor (NLR) proteins. Therefore, one of these mutations may be critical for restriction of
L. pneumophila
intracellular growth, and this parallels results found with human NLR variants with defects in the innate immune response.
Development of an Immunochromatographic Test To Detect Antibodies against Recombinant Em18 for Diagnosis of Alveolar Echinococcosis
Authors: Sako Yasuhito , Fukuda Kenta , Kobayashi Yukuharu , Ito Akira
Published: November 2008

An immunochromatographic test (ICT) for the rapid detection of antibodies to
Echinococcus multilocularis
was developed. The ICT showed a sensitivity of 94% and a specificity of 95.4%. High degrees of agreement were observed between the ICT and an enzyme-linked immunosorbent assay (κ = 0.93) and between the ICT and immunoblot analysis (κ = 0.97). It is expected that the ICT developed in this study will be useful for the serodiagnosis of alveolar echinococcosis.
Epstein-Barr Virus LF2: an Antagonist to Type I Interferon
Authors: Wu Liguo , Fossum Even , Joo Chul Hyun , Inn Kyung-Soo , Shin Young Chul , Johannsen Eric , Hutt-Fletcher Lindsey M. , Hass Juergen , Jung Jae U.
Published: November 2008

Upon viral infection, the major defense mounted by the host immune system is activation of the interferon (IFN)-mediated antiviral pathway, which is mediated by IFN regulatory factors (IRFs). In order to complete their life cycle, viruses must modulate host IFN-mediated immune responses. Despite its association with significant human health problems, activities of Epstein-Barr virus (EBV), a human tumor-inducing herpesvirus, to evade host IFN-mediated innate immunity have not been well characterized. To search for EBV genes that block IFN signal transduction, we carried out a screening of EBV open reading frames for their abilities to block IFN-α/β-mediated luciferase expression upon Sendai virus infection. This screening demonstrates that EBV LF2 tegument protein specifically interacts with the central inhibitory association domain of IRF7, and this interaction leads to inhibition of the dimerization of IRF7, which suppresses IFN-α production and IFN-mediated immunity. This demonstrates a novel immune evasion mechanism of EBV LF2 in blocking cellular IRF7-mediated innate immunity.
Identification of the LWYIK Motif Located in the Human Immunodeficiency Virus Type 1 Transmembrane gp41 Protein as a Distinct Determinant for Viral Infection
Authors: Chen Steve S.-L. , Yang Polung , Ke Po-Yuan , Li Hsiao-Fen , Chan Woan-Eng , Chang Ding-Kwo , Chuang Chin-Kai , Tsai Yu , Huang Shu-Chen
Published: November 2008

The highly conserved LWYIK motif located immediately proximal to the membrane-spanning domain of the gp41 transmembrane protein of human immunodeficiency virus type 1 has been proposed as being important for the surface envelope (Env) glycoprotein's association with lipid rafts and gp41-mediated membrane fusion. Here we employed substitution and deletion mutagenesis to understand the role of this motif in the virus life cycle. None of the mutants examined affected the synthesis, precursor processing, CD4 binding, oligomerization, or cell surface expression of the Env, nor did they alter Env incorporation into the virus. All of the mutants, particularly the ΔYI, ΔIK, and ΔLWYIK mutants, in which the indicated residues were deleted, exhibited greatly reduced one-cycle viral replication and the Env
trans
-complementation ability. All of these deletion mutant proteins were still localized in the lipid rafts. With the exception of the Trp-to-Ala (WA) mutant, which exhibited reduced viral infectivity albeit with normal membrane fusion, all mutants displayed loss of some or almost all of the membrane fusion ability. Although these deletion mutants partially inhibited in
trans
wild-type (WT) Env-mediated fusion, they were more effective in dominantly interfering with WT Env-mediated viral entry when coexpressed with the WT Env, implying a role of this motif in postfusion events as well. Both T20 and L43L peptides derived from the two gp41 extracellular C- and N-terminal α-helical heptad repeats, respectively, inhibited WT and ΔLWYIK Env-mediated viral entry with comparable efficacies. Biotin-tagged T20 effectively captured both the fusion-active, prehairpin intermediates of WT and mutant gp41 upon CD4 activation. Env without the deletion of the LWYIK motif still effectively mediated lipid mixing but inhibited content mixing. Our study demonstrates that the immediate membrane-proximal LWYIK motif acts as a unique and distinct determinant located in the gp41 C-terminal ectodomain by promoting enlargement of fusion pores and postfusion activities.
Studies of an Influenza A Virus Temperature-Sensitive Mutant Identify a Late Role for NP in the Formation of Infectious Virions
Authors: Noton Sarah L. , Simpson-Holley Martha , Medcalf Elizabeth , Wise Helen M. , Hutchinson Edward C. , McCauley John W. , Digard Paul
Published: November 2008

The influenza A virus nucleoprotein (NP) is a single-stranded RNA-binding protein that encapsidates the virus genome and has essential functions in viral-RNA synthesis. Here, we report the characterization of a temperature-sensitive (
ts
) NP mutant (US3) originally generated in fowl plague virus (A/chicken/Rostock/34). Sequence analysis revealed a single mutation, M239L, in NP, consistent with earlier mapping studies assigning the
ts
lesion to segment 5. Introduction of this mutation into A/PR/8/34 virus by reverse genetics produced a
ts
phenotype, confirming the identity of the lesion. Despite an approximately 100-fold drop in the viral titer at the nonpermissive temperature, the mutant US3 polypeptide supported wild-type (WT) levels of genome transcription, replication, and protein synthesis, indicating a late-stage defect in function of the NP polypeptide. Nucleocytoplasmic trafficking of the US3 NP was also normal, and the virus actually assembled and released around sixfold more virus particles than the WT virus, with normal viral-RNA content. However, the particle/PFU ratio of these virions was 50-fold higher than that of WT virus, and many particles exhibited an abnormal morphology. Reverse-genetics studies in which A/PR/8/34 segment 7 was swapped with sequences from other strains of virus revealed a profound incompatibility between the M239L mutation and the A/Udorn/72 M1 gene, suggesting that the
ts
mutation affects M1-NP interactions. Thus, we have identified a late-acting defect in NP that, separate from its function in RNA synthesis, indicates a role for the polypeptide in virion assembly, most likely involving M1 as a partner.
Human Immunodeficiency Virus Type 1 Nef Incorporation into Virions Does Not Increase Infectivity
Authors: Laguette Nadine , Benichou Serge , Basmaciogullari Stéphane
Published: November 2008

The viral protein Nef contributes to the optimal infectivity of human and simian immunodeficiency viruses. The requirement for Nef during viral biogenesis particles suggests that Nef might play a role in this process. Alternatively, because Nef is incorporated into viruses, it might play a role when progeny virions reach target cells. We challenged these hypotheses by manipulating the amounts of Nef incorporated in viruses while keeping its expression level constant in producer cells. This was achieved by forcing the incorporation of Nef into viral particles by fusing a Vpr sequence to the C-terminal end of Nef. A cleavage site for the viral protease was introduced between Nef and Vpr to allow the release of Nef fragments from the fusion protein during virus maturation. We show that the resulting Nef-CS-Vpr fusion partially retains the ability of Nef to downregulate cell surface CD4 and that high amounts of Nef-CS-Vpr are incorporated into viral particles compared with what is seen for wild-type Nef. The fusion protein is processed during virion maturation and releases Nef fragments similar to those found in viruses produced in the presence of wild-type Nef. Unlike viruses produced in the presence of wild-type Nef, viruses produced in the presence of Nef-CS-Vpr do not have an increase in infectivity and are as poorly infectious as viruses produced in the absence of Nef. These findings demonstrate that the presence of Nef in viral particles is not sufficient to increase human immunodeficiency virus type 1 infectivity and suggest that Nef plays a role during the biogenesis of viral particles.
Sensitivity and specificity of clinical signs for assessment of dehydration in endurance athletes
Authors: McGarvey J , Thompson J , Hanna C , Noakes T D , Stewart J , Speedy D
Published: November 2008

Objective

To investigate the diagnostic accuracy of commonly used signs of dehydration in marathon runners.

Design

The diagnostic accuracy of 5 clinical signs/symptoms thought to indicate dehydration (altered skin turgor, dry oral mucous membranes, sunken eyes, an inability to spit and the sensation of thirst) was assessed by comparing the presence of these markers with the criterion standard of body weight change over a marathon footrace.

Setting

2006 Auckland Marathon

Participants

606 competitors in the full marathon Assessment: Body weight was measured before and immediately after the marathon. The 5 clinical signs/symptoms were assessed immediately after the marathon.

Main outcome measures

Diagnostic accuracy of clinical signs/symptoms to detect dehydration greater than 3% of body weight.

Results

606 complete data sets were obtained. 3 clinical signs were associated with greater percentage weight loss: sunken eyes (mean percentage weight loss with symptom 2.6% (standard deviation 1.5), without 2.3% (1.5)); decreased skin turgor (with 3.0% (1.4), without 2.3% (1.5)) and the sensation of thirst (with 2.5% (1.5), without 2.3% (1.5)). The ability to spit and dry oral mucous membranes were unrelated to percentage weight loss. No signs/symptoms showed acceptably high validity for detecting a weight loss equal to or greater than 3% of body weight.

Conclusions

The 5 parameters (decreased skin turgor, sensation of thirst, sunken eyes, inability to spit and dry mucous membranes) tested in this study did not precisely identify runners with total weight loss.3% at the end of a marathon.
Composition and function of ethical committees
Authors: May William W
Published: November 2008

In this paper the need for review (ethical) committees is elaborated to include a discussion of their composition and function. In some institutions more than one such committee may be set up, a departmental ethical committee and one which studies the projects of all the departments concerned. By considering proposed research before it is started patients or volunteers are protected from injury, discomfort, and inconvenience, and the scientific validity of a clinical experiment can be scrutinized. A list of possible criteria for the work of ethical committees is given.
AID and the law
Authors: Cusine D J
Published: November 2008

The present state of the law is unsatisfactory. The exact effect on the marriage of the parties has not been decided although in English law if artificial insemination by donor (AID) takes place without consent that would appear to be a ground for divorce since 1969. The law regards a child born as a result of AID as illegitimate and draws no distinction between the case where the husband consents and where he does not. Theoretically, an offence is committed if the birth entry is falsified, presumably in cases where the husband consents. The AID child, like any other illegitimate child, has rights against the natural parents, but he is in a worse position than most illegitimate children, in that he may not have any information about his father.

It is now possible to freeze sperm and so preserve it over longer periods. All the problems associated with AID are present also when sperm is preserved in banks, but if the law is in an unsatisfactory state in relation to AID this is even more true in relation to sperm banks. The main criticism of the Feversham Report (1960) could be that it recommended, broadly speaking, the `status quo' but scientific progress has now overtaken and left the Feversham findings well behind. What, therefore, is required is a full consideration of the subject of AID and, on the basis of that, some statutory code regulating all its aspects.
Transplantation
Authors: Calne R Y
Published: November 2008

In this paper Professor Calne pleads for a more informed approach to the problem of donor transplants, particularly in cases of kidney disease. He is concerned to inform both the medical profession and lay people. Establishing a computerized register of names and addresses of those who do not wish to have their organs used for transplantation after death would allow enquiries to be made immediately after death.

The second point of emphasis is that death of the brain is the death of the individual. A code of practice is suggested which should be followed in all transplantation centres and would allay the fears of the public and encourage the cooperation of doctors.
The donor doctor's dilemma
Authors: Jennett Bryan
Published: November 2008

Professor Jennett first defines the term `brain death' and the problems arising from a diagnosis of death, some the result of recent technological advances. The diagnosis is not necessarily connected with donor transplants, although in the popular mind this is still so. The criteria for establishing brain death and the sources of potential error in this diagnosis are outlined. The diagnosis of brain death can be made confidently, as is already common practice, and this should become standard good medical practice.
Ethical aspects of donor consent in transplantation
Authors: Mahoney John
Published: November 2008

Two recent events have caused renewed anxiety concerning the ethics of donor transplantation. The first is the report of the British Transplantation Society and the second is the Bill introduced by Mr Tam Dalyell MP (see page 61 of this issue) in which he seeks to establish by law that unless an individual in his life time has expressly contracted out his organs may after death be used for transplantation. Dr Mahoney in this paper therefore examines from the point of view of ethics some of the personal and social aspects of both proposals.
The medicalization of life
Authors: Illich Ivan
Published: November 2008

Two contributions from Dr Ivan Illich follow. The first, in which he sets out his primary thesis of the medicalization of life, is a section from Dr Illich's book `Medical Nemesis'. (It is reprinted with the permission of the author and his publishers, Messrs Calder and Boyars.) The second is a transcript of the paper which Dr Illich read at the conference organized by the London Medical Group on iatrogenic disease. Both are ultimately addressed to the recipients of medical care, the general public, although the second paper is specifically addressed to young doctors and medical students. For Dr Illich the world is suffering from too much medical interference, and a medical edifice has been built which is one of the threats to the real life of human beings - a threat which so far has been disguised as care.
Why make people patients?
Authors: Marinker Marshall
Published: November 2008

People confront their doctors with three modes of unhealth - disease, illness and sickness. Each is discussed, and the question is asked and answered as to why in this situation people wish to become patients.
Not quite what the patient ordered
Authors: Whitehorn Katharine
Published: November 2008

In the last of the group of papers from the conference on inatrogenic disease which we are publishing is this issue Katharine Whitehorn told the audience mainly of doctors and doctors in training - and tells many more through this Journal - what the patient expects from them. She envisages a generation of doctors who are coming to see their role rather differently from that of their fathers, and perhaps in the future a new medical scene.
Injuries to unborn children: Extracts from the report of the Law Commission
Authors: Cooke Samuel , Bicknell Claud , Diamond Aubrey L. , Hodgson Derek , Marsh Norman S. , Sharp J M Cartwright
Published: November 2008

We are printing, by kind permission of the Law Commission, two sections of the report of the Law Commission on injuries to unborn children. This report was the result of a request to the Law Commission by the Lord Chancellor at the time (Lord Hailsham of Saint Marylebone) to advise on `what the nature and extent of civil liability for antenatal injury should be'. The Law Commission followed its usual practice in such circumstances of consulting various bodies and obtaining expert advice on the subject and then embodying the results in a working paper (Working Paper No. 47 - injuries to unborn children) published on 19 January 1973, which preceded their report (Cmnd 5709). Meanwhile a Royal Commission is considering much wider issues of civil liability for injury (including antenatal injury) but the terms of reference for the Law Commission were much narrower and confined to the position of children injured before birth. In the section relating to the present law the report makes it clear that it is probable that liability under the common law already exists.

The Scottish Law Commission has also issued a report (Cmnd 5371). They were given different terms of reference and came to somewhat different conclusions.

We are printing from this long report the paragraphs discussing the medical background and the summary of recommendations. As will be evident on reading the paragraphs on the medical background to injuries to the unborn child, events are moving very rapidly, particularly in the study of congenital defects and the effects of drugs but the problems of proof present great difficulty. Other causes of injury to the unborn child are better known to the general public: for example, those following the illness, infection and disease of the mother during pregnancy, injury caused in attempted termination of pregnancy and the risks resulting from the mother's condition. The summary of the recommendations sets out very clearly the legal position of the unborn child, as the Law Commission sees it, arising from injury before birth, the final conclusion being that `legislation is desirable'.

These extracts from the report, apart from their intrinsic interest, lead on to the paper by Mr Kennedy and Dr Edwards in which they set out their criticisms of it, and provide quick references to the original document.
The ethics of clinical trials.
Authors: Wing J K
Published: November 2008

In summary, the discussion by Professors Helmchen and Müller-Oerlinghausen of the morality of clinical trials has emphasized a point that is frequently overlooked. It is an essential to consider those situations in which it might be unethical not to conduct a trial as it is to be concerned about the ways in which trials might restrict the rights of the individuals taking part in them. They and I have dealt mainly with the first of these two issues because it has been relatively neglected. The second is, of course, equally important and has rightly received much attention. Both matters deserve further public discussion.
The teaching of medical ethics.
Authors: Sporken P
Published: November 2008

The following description of the situation in Maastricht in the Netherlands is unique as this is a new faculty of medicine and the opportunity has been taken to build the teaching of medical ethics into the curriculum from the start.
A note on nursing ethics in the USA.
Authors: Bunzl M
Published: November 2008

In this note on nursing ethics, Mr Martin Bunzl, a philosopher who is involved in seminars on medical ethics at his university, describes the ethical dilemmas of the nurse in the USA. He sets out the arguments to support the view that a nurse ought always to follow the orders of the physician and critically evaluates them both from an ethical and a legal standpoint. The practical implications of the view that a nurse's responsibility is to do what is in the best interests of patients are also discussed.
Intended goals and appropriate treatment: an alternative to the ordinary/extraordinary distinction.
Authors: Meyers C
Published: November 2008

This article argues that the ordinary/extraordinary distinction has little or no moral value when preservation of life is not given a near absolute status. What is appealed to instead is a determination of both medical and moral duties, upon which appropriate treatment decisions should be based. Included is a partial delineation of those duties.
Paternalism and partial autonomy.
Authors: O'Neill O
Published: November 2008

A contrast is often drawn between standard adult capacities for autonomy, which allow informed consent to be given or withheld, and patients' reduced capacities, which demand paternalistic treatment. But patients may not be radically different from the rest of us, in that all human capacities for autonomous action are limited. An adequate account of paternalism and the role that consent and respect for persons can play in medical and other practice has to be developed within an ethical theory that does not impose an idealised picture of unlimited autonomy but allows for the variable and partial character of actual human autonomy.
Medical ethics--a Christian view.
Authors: Habgood J S
Published: November 2008

All ethics has a religious dimension. This paper considers how specific Christian insights concerning death, suffering, human nature and human creatureliness can help to expose more fully the moral issues at stake in some of the dilemmas faced by doctors. It ends by acknowledging the crushing burden of decision-making which rests on many in the medical profession, and indicates the importance of religious resources in dealing with this.
Current arrangements for teaching medical ethics to undergraduate medical students.
Authors: Bicknell D J
Published: November 2008

Those teachers in contact with medical students from pre-clinical days onwards will impart their ethical views by example and by precept, but such learning by 'osmosis' is insufficient. There is a knowledge base to be imparted which will enrich the understanding of ethical judgements on clinical problems seen during the undergraduate years. However, the learning process continues after qualification and in particular the doctor's capacity to make ethical clinical judgements will evolve with maturity and experience. It is essential therefore that students see their teachers willing and able to debate ethical issues at the postgraduate level.
Objections to hospital philosophers.
Authors: Ruddick W , Finn W
Published: November 2008

Like morally sensitive hospital staff, philosophers resist routine simplification of morally complex cases. Like hospital clergy, they favour reflective and principled decision-making. Like hospital lawyers, they refine and extend the language we use to formulate and defend our complex decisions. But hospital philosophers are not redundant: they have a wider range of principles and categories and a sharper eye for self-serving presuppositions and implicit contradictions within our practices. As semi-outsiders, they are often best able to take an 'external point of view,' unburdened by routine, details, and departmental loyalties. Their clarifications can temporarily disrupt routine, but can eventually improve staff morale, hence team practice and patient welfare.
Medical confidence.
Authors: Havard J
Published: November 2008

If medical confidentiality is not observed patients may well be reluctant to disclose information to their doctors or even to seek medical advice. Therefore, argues the author, it is of the utmost importance that doctors strive to protect medical confidentiality, particularly now when it is under threat not only in this country but also overseas. The profession must cease to regard ethical issues to do with confidentiality, and indeed to do with all areas of medical practice, as abstract phenomena requiring no justification. If it does not then it will come under increasing and justified criticism from the community it serves.
Contracts to bear children.
Authors: Davies I
Published: November 2008

In the surrogate mother procreation can be divorced both from sex as well as any anticipation of child rearing. Often the risks of surrogate motherhood are presented in terms of alternative family structures and economic exploitation of women. Such possibilities must invite critical reflection in order for there to be legal reform. Of paramount importance is the child's best interest and until the full psychological is the child's best interest and until the full psychological ramifications for the child, adoptive parents and natural mother are determined then the law's role must be ambivalent. In this impasse the minority view of the Warnock Report has much to commend itself.
Striking responsibilities.
Authors: Brecher R
Published: November 2008

It is commonly held that National Health Service (NHS) workers are under a moral obligation not to go on strike, because doing so might well result in people's dying. Unless sainthood is demanded, however, this position is untenable: indeed, those most vociferously pursuing it are often those who bear the greatest responsibility, on their own grounds, for needless death and suffering.
Dignity and death: a reply.
Authors: Brooks S A
Published: November 2008

Some form of utilitarian approach can be discerned as underlying much current medical ethical decision-making. Criticisms of the practical effects of such an approach are not parried by asserting the fundamental strengths of utilitarianism as theory.
Sperm and ova as property.
Authors: Jansen R P
Published: November 2008

To whom do sperm and ova belong? Few tissues are produced by the human body with more waste than the germ cells. Yet dominion over the germ cells, and over the early embryo that results from their union in vitro, is behind much of the emotion that modern reproductive intervention can engender. The germ cells differ from other human tissues that can be donated or transplanted because they carry readily utilizable genetic information. Eventual expression of the germ cells' genetic potential is the legitimate concern and responsibility of their donors, although in the right circumstances the responsibility can by agreement be entrusted to institutions administering gamete or embryo donor programmes; these institutions, in turn, may need to assume responsibility for decisions if, in the case of embryo storage, the wishes of the two donors conflict. The fact of sperm and ovum ownership (and the genetic potential that goes with it) before individuals part with these tissues is beyond dispute. Some contentious issues may be clarified if this area of human dominion, namely control over genetic expression among offspring, is acknowledged to be the legitimate persisting concern of those who have produced sperm and ova after storage commences.
Child abuse and neglect: ethical issues.
Authors: Harris J
Published: November 2008

Children may be abused physically, sexually, emotionally and by omission or commission in any permutation under these headings. This is discussed in terms of the separate and overlapping responsibilities of parents, guardians, the community in which they live and the network of professional services developed to care for, protect and educate children. An attempt is made to place these issues within an ethical framework, with regard to the legislature of England and Wales. It is argued that professionals working within this field have an obligation either to keep up to date in respect of a large and growing body of research and practice knowledge or to consult 'experts' within the field when making complex and far-reaching decisions on behalf of abused children and their families. A representative, inevitably incomplete, bibliography is discussed and appended and there is brief reference to the role of expert witnesses concerning children involved in civil legal proceedings.
Heroin addiction, ethics and philosophy of medicine.
Authors: ten Have H , Sporken P
Published: November 2008

This article discusses various ethical and philosophical aspects of heroin addiction. It arose as a result of the plan by the Amsterdam city council to supply free heroin to drug addicts. The objective of treatment of heroin addicts is ambivalent because what is in fact a socio-cultural problem is transformed into a medical problem. The characteristics of this treatment are made explicit through a philosophical analysis which sees the medical intervention as part of a strategy aimed at achieving social normalisation. The reason why such a social control function is practised by physicians is discussed, as well as the reason why heroin users in particular are the object of such a process. In this paper, heroin addiction is considered primarily as a cultural problem. The consequences of this for treatment and ethics form the conclusion.
The products of conception: the social context of reproductive choices.
Authors: Rothman B K
Published: November 2008

This paper addresses the changing ideology regarding reproduction, an evolving American, and potentially worldwide, value system regarding children and parenthood. Children are increasingly being seen as products, and the new technology of reproduction, including the sale of reproductive material and services and especially prenatal diagnosis and selective abortion, encourage this commodification of the fetus. While the new technology does indeed offer new choices, it also creates new structures and new limitations on choice. In the contemporary American social structure, these choices are inevitably couched in terms of production and commodification, and thus do not offer individuals genuine choice or control.
The brain-life theory: towards a consistent biological definition of humanness.
Authors: Goldenring J M
Published: November 2008

This paper suggests that medically the term a 'human being' should be defined by the presence of an active human brain. The brain is the only unique and irreplaceable organ in the human body, as the orchestrator of all organ systems and the seat of personality. Thus, the presence or absence of brain life truly defines the presence or absence of human life in the medical sense. When viewed in this way, human life may be seen as a continuous spectrum between the onset of brain life in utero (eight weeks gestation), until the occurrence of brain death. At any point human tissue or organ systems may be present, but without the presence of a functional human brain, these do not constitute a 'human being', at least in a medical sense. The implications of this theory for various ethical concerns such as in vitro fertilisation and abortion are discussed. This theory is the most consistent possible for the definition of a human being with no contradictions inherent. However, having a good theory of definition of a 'human being' does not necessarily solve the ethical problems discussed herein.
Case method.
Authors: Carson R A
Published: November 2008

Teaching medical ethics by the case method may be enriched by adding to the principles-and-rules approach to practical reasoning modes of inquiry and interpretation that engage the moral imagination.
Informed dissent: the view of a disabled woman
Authors: Davis Alison
Published: November 2008

Madeleine Simms begins her article by saying that it will attempt to `redress the balance' of views on the conflicting rights of handicapped children and their parents. I, on the other hand, will argue that no semblance of a balance has yet been achieved, and that her questions and conclusions merely serve to tip the scales further away from a genuine rights-based theory to a pragmatic utilitarian assessment of individual `worth'.
Psychoanalysis and analytic psychotherapy in the NHS--a problem for medical ethics.
Authors: Wilkinson G
Published: November 2008

I question the place of psychoanalysis and psychoanalytically oriented psychotherapy in the National Health Service (NHS), with reference to published material; and, particularly, in relation to primary care, health economics and medical ethics. I argue that there are pressing clinical, research, economic, and ethical reasons in support of the contention that an urgent review of the extent and impact of psychoanalytic practices in the health service is called for.
Research in psychotherapy and psychoanalysis
Authors: Shapiro David A
Published: November 2008

Wilkinson's (1) critique of psychoanalysis and psychoanalytically oriented psychotherapy is weakened by inconsistent use of crucial terms, a systematically biased selectivity in reviewing empirical evidence and prior debates, and a failure to address issues crucial for a scientific understanding of psychotherapy.
Medical confidentiality: an intransigent and absolute obligation.
Authors: Kottow M H
Published: November 2008

Clinicians' work depends on sincere and complete disclosures from their patients; they honour this candidness by confidentially safeguarding the information received. Breaching confidentiality causes harms that are not commensurable with the possible benefits gained. Limitations or exceptions put on confidentiality would destroy it, for the confider would become suspicious and un-co-operative, the confidant would become untrustworthy and the whole climate of the clinical encounter would suffer irreversible erosion. Excusing breaches of confidence on grounds of superior moral values introduces arbitrariness and ethical unreliability into the medical context. Physicians who breach the agreement of confidentiality are being unfair, thus opening the way for, and becoming vulnerable to, the morally obtuse conduct of others. Confidentiality should not be seen as the cosy but dispensable atmosphere of clinical settings; rather, it constitutes a guarantee of fairness in medical actions. Possible perils that might accrue to society are no greater than those accepted when granting inviolable custody of information to priests, lawyers and bankers. To jeopardize the integrity of confidential medical relationships is too high a price to pay for the hypothetical benefits this might bring to the prevailing social order.
Patients' wants versus patients' interests.
Authors: Wilson J
Published: November 2008

Should we treat other people according to what they want (their own values), or according to what we take their best interests to be? If they have given us no mandate to decide for them, their values should prevail. This applies not only to allowing but also to assisting them to get what they want. Taking this seriously in medical practice involves a lot of communication between doctor and patient, and a lot of research to establish a typology of patients in respect of their wants. The results would seriously affect doctor-patient relationships and the organisation of general practice and hospital care. It is with this, rather than dramatic 'moral problems', that medical ethics should be chiefly concerned.
Informed consent and the psychiatric patient.
Authors: Dyer A R , Bloch S
Published: November 2008

Informed consent is reviewed as it applies to psychiatric patients. Although new legislation, such as the Mental Health Act 1983, provides a useful safeguard for the protection of the civil rights of patients, it could actually reduce their humane care unless applied with sensitivity for the nature of their unique difficulties. In order to guard against this possibility, we suggest that legal requirements should be considered in light of the ethical principles which underlie them. Three principles are considered: those of autonomy (freedom); beneficence (paternalism); and the fiduciary principle (partnership). Psychotherapy is offered as a model for informed consent, which might be generalised to other clinical situations.
Proper care for the dying: a critical public issue.
Authors: Crispell K R , Gomez C F
Published: November 2008

The ability of the medical profession to sustain life, or more appropriately, to prolong dying, in patients with terminal illness, creates a most complex and controversial situation for all involved: the patient, if mentally alert; the patient's family; and the medical care team including physicians, nurses and attendants. This situation is especially complex in large acute care hospitals where medical and nursing students, residents and house officers receive advanced medical training. A major problem, prolonging the dying of the terminally ill, with its medical, legal, ethical and economic complexities now confronts American society. The problem is particularly acute in teaching hospitals, in which one finds a disproportionate number of terminally ill patients. The ability to work at these questions as a community rather than as adversaries will determine much about the ability of the health care system to respect the dignity and autonomy of those who seek aid and comfort when faced with serious illness and impending death. Better communication between the physicians, health care providers, the lawyers and ethicists must be developed in order to solve these problems. Over the next ten years society and our elected representatives will be making very demanding decisions about the use of the health dollar. One possible way to prevent increasing costs is to reach significant agreement on the proper care of the dying. Proper care for the dying is being considered, discussed, and evaluated by very thoughtful people. It is not governments which should decide who is to live or who is to die. There is the serious problem of the 'slippery slope' to euthanasia by omission if cost containment becomes the major force in formulating policy on the proper care of the dying.
Mutilation, deception, and sex changes.
Authors: Lavin M
Published: November 2008

The paper considers and rejects two arguments against the performance of sexual reassignment surgery. First, it is argued that the operation is not mutilating, but functionally enabling. Second, it is argued that the operation is not objectionably deceptive, since, if there is such a thing as our 'real sex', we do not know (ordinarily) what it is. The paper is also intended to shed light on what our sexual identity is and on what matters in sexual relations.
The ethics of human cadaver organ transplantation: a biologist's viewpoint.
Authors: Emson H E
Published: November 2008

The rights of the various individuals involved in decision-making in cadaver organ donation are considered, and there is discussion of the relation of human cadavers to the planetary biomass. I conclude that the rights of the potential recipient should outweigh those of the other parties concerned and that education and legislation should recognise and promote this.
Practical problems in the teaching of ethics to medical students.
Authors: Calman K C , Downie R S
Published: November 2008

Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may be as important as that of the students.
Fertilisation and moral status: a scientific perspective.
Authors: Dawson K
Published: November 2008

The debate about the moral status of the embryo has gained new impetus because of the advances in reproductive technology that have made early human embryo experimentation a possibility, and because of the public concern that this arouses. Several philosophical arguments claiming that fertilisation is the event that accords moral status to the embryo were initially formulated in the context of the abortion debate. Were they formulated with sufficient precision to account for the scientific facts as we now understand them? Or do these arguments need modification? Aspects of three arguments for moral status being acquired at fertilisation are examined in relation to current scientific knowledge, highlighting the reasons why such arguments, at present, seem to provide an inadequate basis for the determination of moral status.
Computer-aided medical ethics.
Authors: Sieghart P , Dawson J
Published: November 2008

This paper describes COMET, the first 'expert' computer system to incorporate a comprehensive set of the rules of law and medical ethics relating to consent to medical treatment.
Exoneration of the mentally ill.
Authors: Fields L
Published: November 2008

Mental illness may be manifested in the impairment of understanding or of volitional control. Impairment of understanding may be manifested in delusions. Impairment of volitional control is shown when a person is unable to act in accordance with good reasons that he himself accepts. In order for an impairment of understanding or of self-control to exculpate, the offence must be causally connected with the impairment in question. The rationale of exculpation in general, which applies also to the case of mental illness, is that the offence does not indicate a morally bad attitude in the offender. A consequence of this rationale is that Kenny is wrong to hold that no injustice would result from the elimination of the legal defence of diminished responsibility.
Treatment of defective newborns--a survey of paediatricians in Poland.
Authors: Szawarski Z , Tulczyński A
Published: November 2008

We report the results of a survey of the attitudes and practices of paediatricians in Warsaw, Poland, with respect to the treatment of infants born with severe handicaps. The results are compared with a similar survey conducted by Australian researchers (1). In the Polish medical community surveyed, unconditional respect for life is a dominant attitude. Our study has revealed a deeply-entrenched paternalistic attitude among Polish doctors and a strong unwillingness to distinguish between 'ordinary and extraordinary means' of prolonging life, as well as an ambivalent attitude towards legal regulations binding in Poland.