bluuebunny/crossref_metadata_2025 huggingface dataset:
The Kingdom of Plants
Authors: Waller John C.
Published: November 2008

Imperial Nature
. Joseph Hooker and the Practices of Victorian Science.
By Jim Endersby
. University of Chicago Press, Chicago, 2008. 441 pp. $35, £18. ISBN 9780226207919.

Placing the life and work of the botanist Joseph Hooker in the context of his time, Endersby considers such aspects as the transition from amateurs to professionals, empire, and the philosophical practices of 19th-century science.
The Great American Pantheist
Authors: Farmer Jared
Published: November 2008

A Passion for Nature
. The Life of John Muir.
By Donald Worster
. Oxford University Press, New York, 2008. 543 pp. $34.95, £18.99. ISBN 9780195166828.

Drawing on Muir's private correspondence, Worster offers a detailed, scholarly account of his subject's experiences, friendships, and foundational role in the American conservationist movement.
Simple Tests for Rapid Detection of Canine Parvovirus Antigen and Canine Parvovirus-Specific Antibodies
Authors: Marulappa Shashidhara Y. , Kapil Sanjay
Published: November 2008

Canine parvovirus (CPV) is the number one viral cause of enteritis, morbidity, and mortality in 8-week-old young puppies. We have developed twin assays (slide agglutination test [SAT] for CPV antigen and slide inhibition test [SIT] for CPV antibody) that are sensitive, specific, cost-effective, generic for all genotypes of CPV, and provide instant results for CPV antigen detection in feces and antibody quantification in serum. We found these assays to be useful for routine applications in kennels with large numbers of puppies at risk. The results of these assays are available in 1 min and do not require any special instrumentation. SAT-SIT technology will find applications in rapid screening of samples for other hemagglutinating emerging viruses of animals and humans (influenza virus and severe acute respiratory syndrome coronavirus).
Evaluation of the Vitros ECiQ Immunodiagnostic System for Detection of Anti-
Toxoplasma
Immunoglobulin G and Immunoglobulin M Antibodies for Confirmatory Testing for Acute
Toxoplasma gondii
Infection in Pregnant Women
Authors: Kasper David C. , Prusa Andrea R. , Hayde Michael , Gerstl Nicole , Pollak Arnold , Herkner Kurt R. , Reiter-Reisacher Rosmarie
Published: November 2008

Infection with
Toxoplasma gondii
is often asymptomatic and, when acquired during pregnancy, may lead to connatal toxoplasmosis in the offspring. The newly introduced Vitros anti-
Toxoplasma
immunoglobulin G (IgG) and IgM assays, designed for the Vitros ECiQ immunodiagnostic system, a fully automated system based on chemiluminescence, were evaluated as a screening method for the serological detection of acute and chronic
Toxoplasma
infections in the sera of 719 pregnant women. The combination of the Vitros IgG and IgM assays demonstrated a sensitivity and a specificity of 100% for the successful detection of all acute
T. gondii
infections by comparison with the Sabin-Feldman dye test as the reference test. The Vitros IgG assay parameter revealed a sensitivity of 95.0%, a specificity of 100.0%, a positive predictive value of 100.0%, a negative predictive value of 86.2%, and an overall agreement of 96.2% by comparison with the dye test. Comparison of the Vitros
Toxoplasma
IgM assay with the immunosorbent agglutination assay yielded values of 77.1%, 99.0%, 97.7%, 88.5%, and 91.1%, respectively. Subsequent receiver operating characteristic curve analysis for the accurate detection of
Toxoplasma
IgM in acute (
n
= 90) and chronic (
n
= 461) infections demonstrated high sensitivity (92.2%) and specificity (81.6%). The combination of a
Toxoplasma
-specific IgG assay with specific IgM antibody detection has improved the diagnosis of
T. gondii
infection by decreasing follow-up testing. Nonetheless, positive
Toxoplasma
IgM test results during pregnancy necessitate confirmatory testing by a reference laboratory to ensure fast and, above all, accurate test results.
Stepwise Diagnosis of
Trichomonas vaginalis
Infection in Adolescent Women
Authors: Pattullo Lucia , Griffeth Sarah , Ding Lili , Mortensen Joel , Reed Jennifer , Kahn Jessica , Huppert Jill
Published: November 2008

The objective of this study was to examine the effects of clinical factors and of the type and timing of a secondary test in improving the sensitivity of
Trichomonas vaginalis
detection in young women over that of a wet mount alone. For this purpose, sexually active adolescent women (
n
= 345) were recruited from a hospital teen clinic or emergency department. Following an interview and a pelvic exam, four primary
T. vaginalis
tests (wet mount, culture, a rapid test, and a nucleic acid amplification test [NAAT]) were performed on vaginal swabs. If the wet-mount result was negative, two secondary tests (culture and a rapid test) were performed on the used wet-mount swab and saline. A positive result by any of the four primary tests was considered a true
T. vaginalis
-positive result. The prevalence of
T. vaginalis
was 18.8% overall and 8.8% in the 307 wet-mount-negative women. There was 100% concordance between primary and secondary rapid tests. Secondary culture was 80% sensitive compared to primary culture. The likelihood of a positive rapid test increased with increasing time between specimen collection and testing. A wet mount followed by a rapid test was the most sensitive strategy using two tests (86.4%; confidence interval [CI], 75.3 to 93.4%). Limiting secondary testing to those with multiple partners resulted in a lower sensitivity (73.9%; CI, 61.5 to 84%) that was not significantly better than that of the wet mount alone (58.5%; CI, 45.6 to 70.6%). We conclude that a rapid test can be delayed or performed on a used swab with no loss of sensitivity. Until a NAAT for
T. vaginalis
is commercially available, a stepwise approach using an additional rapid test for wet-mount-negative women is recommended for adolescent women regardless of clinical factors.
Modulation of Macrophage Infiltration and Inflammatory Activity by the Phosphatase SHP-1 in Virus-Induced Demyelinating Disease
Authors: Christophi George P. , Hudson Chad A. , Panos Michael , Gruber Ross C. , Massa Paul T.
Published: November 2008

The protein tyrosine phosphatase SHP-1 is a crucial negative regulator of cytokine signaling and inflammatory gene expression, both in the immune system and in the central nervous system (CNS). Mice genetically lacking SHP-1 (me/me) display severe inflammatory demyelinating disease following inoculation with the Theiler's murine encephalomyelitis virus (TMEV) compared to infected wild-type mice. Therefore, it became essential to investigate the mechanisms of TMEV-induced inflammation in the CNS of SHP-1-deficient mice. Herein, we show that the expression of several genes relevant to inflammatory demyelination in the CNS of infectedme/memice is elevated compared to that in wild-type mice. Furthermore, SHP-1 deficiency led to an abundant and exclusive increase in the infiltration of high-level-CD45-expressing (CD45hi) CD11b+Ly-6Chimacrophages into the CNS ofme/memice, in concert with the development of paralysis. Histological analyses of spinal cords revealed the localization of these macrophages to extensive inflammatory demyelinating lesions in infected SHP-1-deficient mice. Sorted populations of CNS-infiltrating macrophages from infectedme/memice showed increased amounts of viral RNA and an enhanced inflammatory profile compared to wild-type macrophages. Importantly, the application of clodronate liposomes effectively depleted splenic and CNS-infiltrating macrophages and significantly delayed the onset of TMEV-induced paralysis. Furthermore, macrophage depletion resulted in lower viral loads and lower levels of inflammatory gene expression and demyelination in the spinal cords ofme/memice. Finally,me/memacrophages were more responsive than wild-type macrophages to chemoattractive stimuli secreted byme/meglial cells, indicating a mechanism for the increased numbers of infiltrating macrophages seen in the CNS ofme/memice. Taken together, these findings demonstrate that infiltrating macrophages in SHP-1-deficient mice play a crucial role in promoting viral replication by providing abundant viral targets and contribute to increased proinflammatory gene expression relevant to the effector mechanisms of macrophage-mediated demyelination.
Continuous Viral Escape and Selection by Autologous Neutralizing Antibodies in Drug-Naïve Human Immunodeficiency Virus Controllers
Authors: Mahalanabis Madhumita , Jayaraman Pushpa , Miura Toshiyuki , Pereyra Florencia , Chester E. Michael , Richardson Barbra , Walker Bruce , Haigwood Nancy L.
Published: November 2008

We assessed differences in the character and specificity of autologous neutralizing antibodies (ANAbs) against individual viral variants of the quasispecies in a cohort of drug-naïve subjects with long-term controlled human immunodeficiency virus type 1 (HIV-1) infection and moderate levels of broad heterologous neutralizing antibodies (HNAb). Functional plasma virus showed continuous
env
evolution despite a short time frame and low levels of viral replication. Neutralization-sensitive variants dominated in subjects with intermittent viral blips, while neutralization-resistant variants predominated in elite controllers. By sequence analysis of this panel of autologous variants with various sensitivities to neutralization, we identified more than 30 residues in envelope proteins (Env) associated with resistance or sensitivity to ANAbs. The appearance of new sensitive variants is consistent with a model of continuous selection and turnover. Strong ANAb responses directed against autologous Env variants are present in long-term chronically infected individuals, suggesting a role for these responses in contributing to the durable control of HIV replication.
Intracellular Signaling Mechanisms and Activities of Human Herpesvirus 8 Interleukin-6
Authors: Chen Daming , Sandford Gordon , Nicholas John
Published: November 2008

Human herpesvirus 8 (HHV-8)-encoded viral interleukin-6 (vIL-6) has been implicated as a key factor in virus-associated neoplasia because of its proproliferative and survival effects and also in view of its angiogenic properties. A major difference between vIL-6 and human IL-6 (hIL-6) is that vIL-6, uniquely, is largely retained and can signal intracellularly. While vIL-6 is generally considered to be a lytic gene, several reports have noted its low-level expression in latently infected primary effusion lymphoma (PEL) cultures, in the absence of other lytic gene expression. Thus, intracellular autocrine signal transduction by the viral cytokine may be of particular relevance to the growth and survival of latently infected cells and to pathogenesis. Here we report that most intracellular vIL-6 is located in the endoplasmic reticulum (ER), signals via the gp130 signal transducer in this compartment, and does so independently of the gp80 α-subunit of the IL-6 receptor, required for hIL-6 signal transduction. Signaling and biological assays incorporating ER-retained vIL-6 and hIL-6 confirmed vIL-6 activity, specifically, in this compartment. Knockdown of vIL-6 expression in PEL cells led to markedly reduced cell growth in normal culture, independently of extracellular cytokines. This could be reversed by reintroduction via virus vector of exclusively ER-retained vIL-6. These data indicate that in virus biology vIL-6 may act to support the growth and survival of cells latently infected with HHV-8 in an autocrine manner via intracrine signaling and that these activities may contribute to the maintenance of latently infected cells and to virus-induced neoplasia.
Analysis of Epstein-Barr Virus Glycoprotein B Functional Domains via Linker Insertion Mutagenesis
Authors: Reimer Jessica J. , Backovic Marija , Deshpande Charuhas G. , Jardetzky Theodore , Longnecker Richard
Published: November 2008

Epstein-Barr Virus (EBV) glycoprotein B (gB) is essential for viral fusion events with epithelial and B cells. This glycoprotein has been studied extensively in other herpesvirus family members, but functional domains outside of the cytoplasmic tail have not been characterized in EBV gB. In this study, a total of 28 linker insertion mutations were generated throughout the length of gB. In general, the linker insertions did not disrupt intracellular expression and variably altered cell surface expression. Oligomerization was disrupted by insertions located between residues 561 and 620, indicating the location of a potential site of oligomer contacts between EBV gB monomers. In addition, a novel N-glycosylated form of wild-type gB was identified under nonreducing Western blot conditions that likely represents a mature form of the protein. Fusion activity was abolished in all but three variants containing mutations in the N-terminal region (gB30), within the ectodomain (gB421), and in the intracellular C-terminal domain (gB832) of the protein. Fusion activity with variants gB421 and gB832 was comparable to that of the wild type with epithelial and B cells, and only these two mutants, but not gB30, were able to complement gB-null virus and subsequently function in virus entry. The mutant gB30 exhibited a low level of fusion activity with B cells and was unable to complement gB-null virus. The mutations generated here indicate important structural domains, as well as regions important for function in fusion, within EBV gB.
Characterization of Large Conformational Changes and Autoproteolysis in the Maturation of a T=4 Virus Capsid
Authors: Matsui Tsutomu , Lander Gabriel , Johnson John E.
Published: November 2008

Nudaurelia capensis ω virus
-like particles have been characterized as a 480-Å procapsid and a 410-Å capsid, both with T=4 quasisymmetry. Procapsids transition to capsids when pH is lowered from 7.6 to 5.0. Capsids undergo autoproteolysis at residue 570, generating the 74-residue C-terminal polypeptide that remains with the particle. Here we show that the particle size becomes smaller under conditions between pH 6.8 and 6.0 without activating cleavage and that the particle remains at an intermediate size when the pH is carefully maintained. At pH 5.8, cleavage is very slow, becoming detectable only after 9 h. The optimum pH for cleavage is 5.0 (half-life, ∼30 min), with a significant reduction in the cleavage rate at pH values below 5. We also show that lowering the pH is required only to make the virus particles compact and to presumably form the active site for autoproteolysis but not for the chemistry of cleavage. The cleavage reaction proceeds at pH 7.0 after ∼10% of the subunits cleave at pH 5.0. Employing the virion crystal structure for reference, we investigated the role of electrostatic repulsion of acidic residues in the pH-dependent large conformational changes. Three mutations of Glu to Gln that formed procapsids showed three different phenotypes on maturation. One, close to the threefold and quasithreefold symmetry axes and far from the cleavage site, did not mature at pH 5, and electron cryomicroscopy reconstruction showed that it was intermediate in size between those of the procapsid and capsid; one near the cleavage site exhibited a wild-type phenotype; and a third, far from the cleavage site, resulted in cleavage of 50% of the subunits after 4 h, suggesting quasiequivalent specificity of the mutation.
Virus-Encoded B7-2 Costimulation Molecules Enhance the Protective Capacity of a Replication-Defective Herpes Simplex Virus Type 2 Vaccine in Immunocompetent Mice
Authors: Vagvala Sri P. , Thebeau Lydia G. , Wilson Saydra R. , Morrison Lynda A.
Published: November 2008

Herpes simplex virus 2 (HSV-2) and, to a lesser extent, HSV-1 cause the majority of sexually transmitted genital ulcerative disease. No effective prophylactic vaccine is currently available. Replication-defective HSV stimulates immune responses in animals but produces no progeny virus, making it potentially useful as a safe form of live vaccine against HSV. Because it does not replicate and spread in the host, however, replication-defective virus may have relatively limited capacity to solicit professional antigen presentation. We previously demonstrated that in mice devoid of B7-1 and B7-2 costimulation molecules, replication-defective HSV-2 encoding B7-1 or B7-2 induces stronger immune responses and protection against HSV-2 challenge than immunization with replication-defective virus alone. Here, we vaccinated wild-type mice fully competent to express endogenous B7 costimulation molecules with replication-defective HSV-2 or replication-defective virus encoding B7-2 and compared their capacities to protect against vaginal HSV-2 infection and disease. Replication-defective virus encoding B7-2 induced more IFN-γ-producing CD4 T cells than did replication-defective virus alone. Immunization with B7-2-expressing virus decreased challenge virus replication in the vaginal mucosa, genital and neurological disease, and mortality more effectively than did immunization with the parental replication-defective virus. Prior immunization with B7-expressing, replication-defective virus also effectively suppressed infection of the nervous system compared to immunization with the parental virus. Thus, B7 costimulation molecules expressed at the site of HSV infection can enhance vaccine efficacy even in a fully immunocompetent host.
Factors Associated with the Development of Cross-Reactive Neutralizing Antibodies during Human Immunodeficiency Virus Type 1 Infection
Authors: Sather D. Noah , Armann Jakob , Ching Lance K. , Mavrantoni Angeliki , Sellhorn George , Caldwell Zachary , Yu Xuesong , Wood Blake , Self Steve , Kalams Spyros , Stamatatos Leonidas
Published: November 2008

The characterization of the cross-reactive, or heterologous, neutralizing antibody responses developed during human immunodeficiency virus type 1 (HIV-1) infection and the identification of factors associated with their generation are relevant to the development of an HIV vaccine. We report that in healthy HIV-positive, antiretroviral-naïve subjects, the breadth of plasma heterologous neutralizing antibody responses correlates with the time since infection, plasma viremia levels, and the binding avidity of anti-Env antibodies. Anti-CD4-binding site antibodies are responsible for the exceptionally broad cross-neutralizing antibody responses recorded only in rare plasma samples. However, in most cases examined, antibodies to the variable regions and to the CD4-binding site of Env modestly contributed in defining the overall breadth of these responses. Plasmas with broad cross-neutralizing antibody responses were identified that targeted the gp120 subunit, but their precise epitopes mapped outside the variable regions and the CD4-binding site. Finally, although several plasmas were identified with cross-neutralizing antibody responses that were not directed against gp120, only one plasma with a moderate breadth of heterologous neutralizing antibody responses contained cross-reactive neutralizing antibodies against the 4E10 epitope, which is within the gp41 transmembrane subunit. Overall, our study indicates that more than one pathway leads to the development of broad cross-reactive neutralizing antibodies during HIV infection and that the virus continuously escapes their action.
The use of narcotic analgesics in terminal illness
Authors: Twycross Robert G
Published: November 2008

To answer some of the questions surrounding the medicinal use of narcotic analgesics in advanced cancer, a group of 500 patients admitted to St Christopher's Hospice was reviewed. To achieve and maintain pain relief many of the patients received diamorphine (heroin) regularly every four hours. Almost all the patients received a phenothiazine concurrently; other drugs were prescribed when indicated. It was concluded that: 1) Although most patients receive parenteral diamorphine during the last 12 to 24 hours, the majority can be maintained on oral medication until this time. 2) There is no single optimal dose of diamorphine. 3) Psychological dependence does not occur. 4) Physical dependence may develop but does not prevent the downward adjustment of the dose of diamorphine when considered clinically feasible. 5) Tolerance is not a practical problem. 6) The prescription of diamorphine does not, by itself, lead to impairment of mental faculties.

Also discussed are: 1) the psychobiological nature of pain; 2) the rational use of analgesics; 3) the need for further research; 4) the importance of the doctor's attitude.
Communicating with the dying
Authors: Wilson J Michael
Published: November 2008

Telling a patient that the outcome of his illness is not good, or even hopeless, requires sensitivity and the ability to communicate with him in the setting of a hospital which is an unnatural environment divorced from family and friends. It is a task which must be taught and learned by doctors and nurses.
Problems of selecting donors for artificial insemination
Authors: Schoysman R
Published: November 2008

This paper is concerned with only one of the problems encountered in selecting donors for artificial insemination, that of choosing suitable donors. In Belgium medical students have generally been the donors of semen but Dr Schoysman examines the other choices of potential donors and outlines certain criteria for selecting them: these criteria are more explicit than those outlined by Professor Kerr and Miss Rogers on page 32. He also touches on the question of payment to donors.
Ethical aspects of donor insemination
Authors: Dunstan G R
Published: November 2008

Professor Dunstan has selected certain aspects of the preceding papers on artificial insemination by donor and subjected these to the scrutiny of a moral theologian.
Should the patient be allowed to die?
Authors: Nicholson Richard
Published: November 2008

In considering the patient's right to a certain quality of dying, this essay outlines how the legal and ethical justifications for passive euthanasia depend on the doctrine of acts and omissions. It is suggested that this doctrine is untenable and that alternative justifications are needed. The development of the modern mechanistic approach to death is traced, showing that a possible basis for an humane way of death lies in a reacceptance of a metaphysical concept of life.
Tissue for transplantation
Authors: Dalyell Tam
Published: November 2008

In this article Mr Tam Dalyellmpuses extracts from the speech1he made in the House of Commons on 11 December 1974 to reiterate his reasons for persisting in his attempts to have formulated in law the right of hospitals to take such organs from a dead person as might be useful unless before death potential donors (all of us) had stated that they did not consent. Details of those objecting would be registered on a central computer.
Transplantation: The relatives' view
Authors: Demetrius Priscilla M
Published: November 2008

The following short contributions add to the debate on transplantation: one describes the distress of a woman recently widowed when asked for the organs of her dead husband for transplantation, and the other the eagerness with which a boy awaits the death of a potential kidney donor - not a heartless emotion but the longing for a new lease of life.
Society's expectations of health
Authors: Leach Edmund
Published: November 2008

Sir Edmund Leach argues that doctors in the modern world, fortified by the traditional concept that the life of the sick person must at all costs be preserved, are to some extent guilty of the false antitheses current today between youth and age. Moreover youth means health, age illness and senility. Until this imbalance is corrected society will be in danger of `a kind of civil war between the generations'. Society must be taught again that mortality cannot be avoided or conquered by medical science, and at the same time that `health' is not enshrined in the young alone.
Commentary on `The medicalization of life' and `Society's expectations of health'
Authors: Horobin Gordon
Published: November 2008

The main theses of the papers by Dr Illich and Dr Leach are compared. Both writers, says Mr Horobin, a sociologist by training and profession, discuss the uses and abuses of medical expertise in the modern world. In his view, the problems so created must be solved for the good of those they treat; doctors must rediscover the old skills of treating the whole patient.
Induced abortion: epidemiological aspects.
Authors: Baird D
Published: November 2008

Sir Dugald Baird sketches the history of abortion legislation in Great Britain from the beginning of the century. In his views the 1967 Abortion Act has been one of the most important and beneficial pieces of social legislation enacted in Britain in the last 100 years. It has, however, brought problems both of administration in the hospitals and to individual doctors and nurses, particularly when the patients are young single women and even schoolgirls. One of the consequences of the Abortion Act has been a fall in maternal mortality and perinatal mortality rates. Abortion does not seem to be followed by serious emotional sequelae. Nevertheless recent changes in sexual mores have introduced new and serious social problems which are discussed in relation to the role of the doctor in his relationship with patients seeking abortion.
A new ethical approach to abortion and its implications for the euthanasia dispute.
Authors: Gardner R F
Published: November 2008

Mr Gardner, a practising gynaecologist who is necessarily involved with abortion, suggests a view of the fetus which is between the positions commonly held: the fetus is a mass of cells, the fetus is a person from the moment of conception. He considers that from the moment of conception there is established a maternal-fetal unity. In that state the previable fetus is not an individual but is on the way to that status. The writer goes on to differentiate between the moral positions of the advocates of abortion and of euthanasia. Already legal safeguards for those antipathetic to abortion have been eroded in practice and so likewise would those be if the Euthanasia Bill were to become law.
The inherent paradox of clinical trials in psychiatry.
Authors: Helmchen H , Müller-Oerlinghausen B
Published: November 2008

The authors sum up the central issue of ethics in the conduct of controlled clinical trials in these two paradoxes: 'first, it is unethical to use treatment the efficacy of which has not been examined scientifically; second, it is also unethical to examine the efficacy of treatment scientifically.' In this paper they set out to demonstrate how these antithetical statements apply in controlled trials conducted in psychiatric patients. In such trials the problem of obtaining informed consent may be acute, but in these patients giving 'informed' consent might contribute to a further exacerbation of the illness. Nevertheless the problem cannot be evaded, and scientific judgments must be applied to treatment for it to be sound and improved for the further benefit of patients. These problems in the case of psychiatric controlled trials are a part of the methodology, and in Germany a new drug law has been drafted to attempt to clarify the issue. The authors briefly discuss its application, and its consequences if such a law were enacted. British psychiatrists have exactly the same problems to face but so far no attempts have been made to establish a legal framework.
Homosexuality and the medical profession: a behaviourist's view.
Authors: Bancroft J
Published: November 2008

That a homosexual -- man or woman -- is neither a sinner nor a sick person is the thesis of this paper by an authority on sexual deviation. Therefore, such a man or woman neither needs penance and pardon nor cure in the medical sense. Nevertheless such individuals sometimes need the help of doctors and must be treated with understanding. The medical profession also has, in the view of the behaviourist school of psychiatrists, of which Dr Bancroft is a member, the duty of influencing social attitudes towards homosexuals. Obviously homosexuals who come into conflict with the law are special cases, and must be treated as such but this is not 'medical' treatment so much as social control even if drugs and other forms of therapy are used.
Doctor-patient dilemmas in multiple sclerosis.
Authors: Burnfield A
Published: November 2008

This paper is based on the second Jack Pritchard Memorial Lecture given at the Queen's University of Belfast (1). The author describes his own personal response to having multiple sclerosis (MS), and then examines the psycho-social aspects of the disease in a wider context. The distress caused by the emotional difficulties associated with MS is emphasised, and in particular the strain placed on the doctor-patient relationship at the time of diagnosis. The physician's ability to cope with the needs of MS families is explored, together with the importance of offering counselling. Also discussed is the ethical question of whether or not the patient should be told the complete truth. Patients with MS are seen as having a potential not only for helping each other, but also for being able to share in the management of their own health care.
Having a life versus being alive.
Authors: Kushner T
Published: November 2008

In an attempt to provide some clarification in the abortion issue it has recently been proposed that since 'brain death' is used to define the end of life, 'brain life' would be a logical demarcation for life's beginning. This paper argues in support of this position, not on empirical grounds, but because of what it reflects of what is valuable about the term 'life'. It is pointed out that 'life' is an ambiguous concept as it is used in English, obscuring the differences between being alive and having a life, a crucial distinction for bioethical questions. The implications of this distinction for the moral debate about abortion are discussed.
An analytic approach to resolving problems in medical ethics.
Authors: Candee D , Puka B
Published: November 2008

Education in ethics among practising professionals should provide a systematic procedure for resolving moral problems. A method for such decision-making is outlined using the two classical orientations in moral philosophy, teleology and deontology. Teleological views such as utilitarianism resolve moral dilemmas by calculating the excess of good over harm expected to be produced by each feasible alternative for action. The deontological view focuses on rights, duties, and principles of justice. Both methods are used to resolve the 1971 Johns Hopkins case of a baby born with Down's syndrome and duodenal atresia.
Ethical dilemmas in clinical genetics.
Authors: Young I D
Published: November 2008

This paper discusses the results of a survey of medical and paramedical opinion relating to various difficult ethical issues in clinical genetics. These include the confidentiality of the doctor-patient relationship, prenatal diagnosis and termination, and Huntington's chorea. It is suggested that this method provides a useful means of assessing what is ethically acceptable in contemporary society.
Killing and allowing to die in medical practice.
Authors: Slack A
Published: November 2008

This paper examines some of the issues related to the distinction between acts and omissions. It discusses the difficulties involved in deciding whether there is any moral significance in this distinction, particularly when it is applied to cases which involve killing or allowing to die. The paper shows how this problem relates to some of the current issues in medical ethics. It examines the issues raised by the widely publicised cases of selective treatment of handicapped children and argues that such decisions are taken and have to be taken in the context of wider ethical theories.
The restoration of medical ethics.
Authors: Rogers A
Published: November 2008

The ethical behaviour of doctors has been influenced by recent social and political changes. This paper discusses some of the changes which may have resulted from two far-reaching changes, a major political change, the nationalisation of medicine in the National Health Service (NHS), and a social change, the establishment of the permissive society. Some of the ethical consequences of these changes which are not considered of benefit to the profession or its patients are discussed. The recognition of these changes and their open debate is now essential so that the restitution of professional standards may take place.
In defence of situational ethics, the NHS and the permissive society.
Authors: Black D
Published: November 2008

Dr Adrian Rogers delivers a three-pronged assault on the concepts of 'situational ethics'; the eleemosynary principles underlying the National Health Service, and the permissiveness of modern society. I hold strong, and largely opposite, views on each of these matters, which are outlined in this paper.
Patients' ethical obligation for their health.
Authors: Sider R C , Clements C D
Published: November 2008

In contemporary medical ethics health is rarely acknowledged to be an ethical obligation. This oversight is due to the preoccupation of most bioethicists with a rationalist, contract model for ethics in which moral obligation is limited to truth-telling and promise-keeping. Such an ethics is poorly suited to medicine because it fails to appreciate that medicine's basis as a moral enterprise is oriented towards health values. A naturalistic model for medical ethics is proposed which builds upon biological and medical values. This perspective clarifies ethical obligations to ourselves and to others for life and health. It provides a normative framework for the doctor-patient relationship within which to formulate medical advice and by which to evaluate patient choice.
Why you don't owe it to yourself to seek health.
Authors: Gorovitz S
Published: November 2008

Sider and Clements provide a critical response to my view that there is no independent obligation to seek one's own health. They then argue that such an obligation exists. They are incorrect in their characterisation of my view; their critical discussion of the view they erroneously attribute to me is unconvincing; the positive argument they offer for their own view is unsatisfactory; they misjudge the significance of what is at issue; and they conclude by affirming a position that lacks a due regard for the rights of patients.
Arresting but misleading phrases.
Authors: Harris J
Published: November 2008

This paper discusses some common misconceptions of what a utilitarian approach to medical ethics is and of the conclusions it forces upon those disposed to accept such an approach. It suggests that broad and unargued characterisations of approaches to moral questions as 'utilitarian', 'Hippocratic' or whatever are likely to be misleading and counterproductive. What matters is not what to call the position that people feel inclined to accept but rather what arguments there are in its favour and what arguments there are against it.
Iconoclastic ethics.
Authors: Black D
Published: November 2008

Arguments are advanced, on a pragmatic basis, for preferring a 'situational' approach to medical ethical problems, rather than an approach based on any one of the dogmatic formulations on offer. The consequences of such a preference are exemplified in relation to confidentiality; and in relation to the ethical dilemmas which surround the beginning and the end of terrestrial human life.
Health promotion--caring concern.
Authors: Tannahill A
Published: November 2008

'Health promotion' has unfortunately come to mean different things to different people. Interpretations have frequently been left implicit and where spelt out have often been too diffuse or too limited to be useful. Nevertheless the term can be usefully employed to define a set of health-enhancing activities in which the focus is deflected from current disease- and cure-oriented power bases. Used in this way health promotion can come to include the best of the developing theory and practice from a wide range of 'experts' but can also place due emphasis on community involvement. To reject health promotion on the basis of selected, inadequate interpretations is to discard past successes, current developments and future possibilities in important fields of activity and to preserve an inappropriate status quo.
A workshop on medical ethics at the College of Medicine, Lagos University.
Authors: Olukoya A A
Published: November 2008

As part of an effort to improve the teaching of medical ethics in the College of Medicine, Lagos University two-day workshops were organised. Participants included people from various walks of life, for example politicians, lawyers, doctors, and patients. The workshops were quite successful, and have led to more extensive teaching of medical ethics in the college.
Medical ethics and medical practice: a social science view.
Authors: Stacey M
Published: November 2008

This paper argues that two characteristics of social life impinge importantly upon medical attempts to maintain high ethical standards. The first is the tension between the role of ethics in protecting the patient and maintaining the solidarity of the profession. The second derives from the observation that the foundations of contemporary medical ethics were laid at a time of one-to-one doctor-patient relations while nowadays most doctors work in or are associated with large-scale organisations. Records cease to be the property of individual doctors, become available not only to other doctors but also to educational and social work personnel. Making records openly available to patients is suggested as the only antidote to this irreversible loss of individual practitioner control. The importance for doctors of understanding the nature of professional and bureaucratic organisations in order to deal with the hazards involved is stressed as is the responsibility of the General Medical Council to regulate medical competence as well as personal behaviour.
Are we teaching students that patients don't matter?
Authors: Robinson J
Published: November 2008

Medical students may fear that their training leeches away the caring attitudes which attracted them to medicine. Some research suggests they are right. The medical school has a duty to support and encourage their values, but the reverse may happen. Students are taught about legal consent but not ethical consent. They may see or participate in concealment of medical mistakes and learn to practise deceit. The use of unconscious females for gynaecology teaching may encourage the wrong attitudes to patients. Trainee GPs may learn that the doctors' rights are more important than those of the patient. Measuring patients' views should be included in research protocols.
Methods of teaching medical ethics at the University of Nottingham.
Authors: Fentem P H
Published: November 2008

Medical ethics has been described as a thread woven into the fabric of the Nottingham curriculum. There exist a wide variety of relevant learning experiences, occurring at intervals throughout each of the five years of the course. The introduction of the students to clinical method from the start creates the need for early consideration of ethical aspects of professional behaviour and this in turn stimulates spontaneous discussion and inquiry amongst the students. The school has chosen to rely on having a sufficient number of medical teachers from various disciplines willing to discuss in all the necessary detail their own clinical decisions.
A model for teaching medical ethics.
Authors: Welbourn R B
Published: November 2008

The approach to teaching employed in the Dictionary of Medical Ethics (1) provides a model which might be adopted in other media. Most of the 150 authors were medical, but many represented other disciplines, and they wrote for similar professionals and for the general public. Medical ethics is derived from medical science and practice, moral philosophy, sociology, theology, the law and other disciplines, all of which make essential, distinctive and complementary contributions to knowledge and to teaching. Medical practitioners must play the primary role, because they are responsible for clinical ethical decisions, but they need the co-operation and guidance of others. All who are concerned should work towards the development of a general moral consensus among the profession and public, which keeps abreast of scientific and technical advances and to which all are committed.
Self help in medical ethics.
Authors: Shotter E
Published: November 2008

The paper traces the development of programmes of lectures and symposia in most British medical schools, which have developed into a postgraduate programme of research and publication. It is asserted that a morally neutral approach is a necessary prerequisite for wide multidisciplinary involvement, as is a high level of student participation in identifying topics for discussion. Alternative possibilities for formal teaching are discussed and pitfalls highlighted.
The moral significance of spontaneous abortion.
Authors: Murphy T F
Published: November 2008

Spontaneous abortion is rarely addressed in moral evaluations of abortion. Indeed, 'abortion' is virtually always taken to mean only induced abortion. After a brief review of medical aspects of spontaneous abortion, I attempt to articulate the moral implications of spontaneous abortion for the two poles of the abortion debate, the strong pro-abortion and the strong anti-abortion positions. I claim that spontaneous abortion has no moral relevance for strict pro-abortion positions but that the high incidence of spontaneous abortion is not (as some claim) eo ipso any sort of justification for voluntarily induced abortion. Secondly, I show that if the strict anti-abortionist position is to be taken seriously in its insistence that prenatal life has a right to be protected by virtue of its being conceived, then it seems necessary to take measures to prevent spontaneous abortion and its presumptive causes, and this as a matter of moral obligation.
Paternalism modernised.
Authors: Weiss G B
Published: November 2008

The practice of paternalism has changed along with developments in medicine, philosophy, law, sociology and psychology. Physicians have learned that a patient's values are a factor in determining what is best for that patient. Modern paternalism continues to be guided by the principle that the physician decides what is best for the patient and pursues that course of action, taking into account the values and interests of the patient. In the autonomy model of the doctor-patient relationship, patient values are decisive. In the paternalistic model, they are but one among several factors the physician must consider in making a medical decision. Although difficult to practise because of limitations in empathising with another person, modern paternalism remains a way to achieve maximum patient benefit.
Embryonic life and human life.
Authors: Shea M C
Published: November 2008

A new human life comes into being not when there is mere cellular life in a human embryo, but when the newly developing body organs and systems begin to function as a whole, the author argues. This is symmetrical with the dealth of an existing human life, which occurs when its organs and systems have permanently ceased to function as a whole. Thus a new human life cannot begin until the development of a functioning brain which has begun to co-ordinate and organise the activities of the body as a whole.
Insanity legislation.
Authors: Hamilton J R
Published: November 2008

The McNaughton Rules, which are used when someone pleads insanity at the time of a homicide, are out of date and unsatisfactory. Suggestions have been made about how the insanity defence can be reformulated. The preference of a defence of diminished responsibility means abandoning an ancient and humane principle of not convicting those who are so mentally disordered as not to be responsible for their actions. There is a need for Parliament to consider changes to the law both to prevent the mentally disordered being sent to prison inappropriately, and because the Mental Health Act 1983 has not taken account of rare cases where an offender such as an epileptic might be found legally insane but not mentally disordered.
Reducing murder to manslaughter: whose job?
Authors: Griew E
Published: November 2008

This paper compares two versions of the diminished responsibility defence, which reduces murder to manslaughter: the present statutory formulation and a proposed reformulation. The comparison confirms that evidence such as psychiatrists are commonly invited to give in murder cases takes them beyond their proper role. Paradoxically, although the two formulations mean essentially the same thing, the proposed change of wording must have the practical effect of subduing the psychiatrist's evidence. This conclusion leads to speculation about why psychiatrists are at present allowed so large a function in diminished responsibility cases and to some general observations about the role of the expert in relation to those of judge and jury.
Anomalies of Section 2 of the Homicide Act 1957.
Authors: Kenny A
Published: November 2008

Section 2 of the 1957 Homicide Act is indefensible: the concept of 'mental responsibility' is a hybrid which turns the psychiatrist witness either into a thirteenth juryman or a spare barrister. But reform does not lie along the lines suggested by the Butler Committee or the Criminal Law Revision Committee. The latter leaves the jury with insufficient guidance; the former returns to the bad eighteenth century policy of treating mental illness not as a factor in determining responsibility but as a status exempting from responsibility. The much criticised McNaughton rules provide a sounder basis for deciding where responsibility should be assigned in criminal cases.
Some comments on Dr Iglesias's paper, 'In vitro fertilisation: the major issues'.
Authors: Mill J M
Published: November 2008

In an article in an earlier edition of the Journal of Medical Ethics (1) Dr Iglesias bases her analysis upon the mediaeval interpretation of Platonic metaphysics and Aristotelian logic as given by Aquinas. Propositional forms are applied to the analysis of experience. This results in a very abstract analysis. The essential connection of events and their changing temporal relationships are ignored. The dichotomy between body and soul is a central concept. The unchanging elements in experience are assumed to be more real than the actual world of experienced process. Such a view makes the analysis of the temporal factors in experience impossible. Its abstractness is quite unsuitable for the analysis of the ontological structure and development of the neonate from fertilisation to birth. A N Whitehead made the notion of organism central to his philosophy. He refused to place human experience outside nature, or admit dualism. His philosophy of organism is an attempt to uncover the essential elements connecting human experience with the physical and biological sciences. Time, change and process are, in his view, more real than the static abstractions obtainable by the use of the fallacy of misplaced concreteness. Use of the latter negates the essential connectedness of events and the importance of temporarily and change (2). In this paper I argue that the embryo, being an organism, is not analysable in terms of thinghood. It is a process. To apply Aristotelian logical concepts to it is to distort the real nature of the datum.
Parental choice and selective non-treatment of deformed newborns: a view from mid-Atlantic.
Authors: Mason J K , Meyers D W
Published: November 2008

This paper traces the development of parental rights to accept or to refuse treatment for a defective newborn infant in the United Kingdom and in the United States of America; its main purpose is to explore the common trends from which an acceptable policy may be derived. It is probable that the British law on parental decision-making in respect of infants suffering from Down's syndrome is to be found in the civil case of In Re B rather than in the criminal case of R v Arthur. United States court decisions are strongly influenced by constitutional law and reflect the right to personal privacy. The position on each side of the Atlantic seems very similar but this similarity includes a sense of uncertainty as to legal responsibility. There is a case for agreed guidelines and a suggested format is offered for consideration.