Dissertations / Theses on the topic 'Alternative medicine Moral and ethical aspects'

Emerging markets are a great point of interest to multinational companies seeking to exploit new opportunities as they realise that catering to the rich domestic markets limits their opportunities, their potential and competitive advantage. Serving the consumers that are at the bottom of the economic pyramid (BoP) presents enormous opportunity but it also comes with its unique set of challenges. These challenges require an alternative business strategy, as companies entering these markets must develop new offerings designed to meet the specific requirements of servicing the BoP consumer. This report seeks to explore why companies operating in South Africa are entering the lower income markets, and will describe the challenges encountered both internally and externally, when operating in these markets. Ten interviews at six multinational companies based in South Africa were conducted to test the research propositions derived from the literature. The results concluded that companies enter the BoP markets in pursuit of growth. A variety of secondary factors also emerged. The data revealed that these companies have created innovative alternative execution strategies to overcome the challenges encountered in this market. The report offered a descriptive model of why companies enter the BoP market, and highlights how the challenges presented by the institutional voids and institutional distance were overcome.
Dissertation (MBA)--University of Pretoria, 2014.
lmgibs2015
Gordon Institute of Business Science (GIBS)
Unrestricted

The most ordinary man or woman has means of knowledge concerning his own feelings and circumstances that immeasurably surpass those that anyone else can have.-John Stuart Mill, On Liberty
One feature that varies within competing conceptions of medical shared decision-making is how a patient's values are to be engaged by a physician. One detail that can be overlooked under "shared" decision-making is whether or not a physician ought (or be allowed) to attempt to persuade the patient to adopt particular health-related values. Some argue that it is incumbent on a physician to share her privileged understanding of medicine so as to help her patient embrace "better" values. This thesis argues that it is dangerous to patient autonomy for a physician to exert moral suasion on her patient to attempt to influence or change those values; the danger lies in the power imbalance between patients and physicians that seems inherent in medical encounters, and is exacerbated by the sick role. Thus, while a physician ought to help her patient articulate his health-related values, she ought not try to change them.

Over the past few years, embryo research has been a widely discussed topic. New techniques such as embryo stem cell research or therapeutic cloning are considered by scientists to be very promising. Nevertheless, opponents of these experimentations warn against the commodification of human life forms and argue that the moral status of embryos should protect them from being destroyed purely for research.
Legislations on this topic have been enacted in most Western countries, though they are still much criticised. Is there an adequate way of regulating embryo research? Our argument suggests that consensus can only be procedurally obtained. That is, we believe that only legislative assemblies should have authority to take a position on this controversial topic, which is subject to moral disagreement, and as such, judges should only have a minor role.

Pharmaceutical advertising involves the advertising of medicines, medical devices, and healthcare services. A review of available international literature indicates the belief that pharmaceutical advertisements negatively affect healthcare decisions made by consumers. Very little research has been conducted to determine how consumers in South Africa (SA) are affected by pharmaceutical advertisements. This study aimed to determine how consumers in the Nelson Mandela Metropole (NMM) perceive pharmaceutical advertisements. More specific objectives included the investigation of legislation in SA employed in pharmaceutical advertisements, the interpretation and misinterpretation of the advertisements, and the identification of problematic areas in this form of advertising. South African legislation applied to pharmaceutical advertisements was investigated by means of a literature review. A qualitative research design was also used to achieve the aim and objectives. This included a focus group consisting of six randomly selected participants in the NMM. A consumer survey, consisting of a 100 consumers obtained from 10 randomly selected community pharmacies within the NMM, supported the findings of the qualitative techniques. The themes identified in the focus group were incorporated into a questionnaire used in the consumer survey. Three randomly selected pharmaceutical advertisements were also decoded to interpret the components employed in each. The results determined that pharmaceutical advertising is a marketing tool that incorporates various emotional and psychological techniques to persuade consumers. It was also evident that consumers can misinterpret pharmaceutical advertisements. Various legal and ethical problems were identified in pharmaceutical advertisements. These results showed that pharmaceutical advertisements have the possibility of negatively affecting consumers’ healthcare decisions and warrants further investigation.

The goal of this work is to explore the role of theological bioethics in influencing the formulation of existing or proposed policies dealing with treatment decisions for seriously disabled newborns in our pluralist society. Part I of the paper attempts to determine as precisely as possible what bioethics is, particularly Judeo-Christian bioethics. After comparing the latter to the Hippocratic tradition and to secular bioethics, the distinctive characteristics and potential contribution of theological bioethics are identified. The policies then examined in Part II are: medical policies formulated by physicians, bioethical policies proposed by bioethicists and legal policies enunciated by court decisions and legal writers. In each case they are evaluated in the light of a number of specific ethical tests proposed as central to Judeo-Christian bioethics. The paper concludes that Judeo-Christian bioethics has not been particularly influential in our pluralist society. A final section proposes a model treatment policy.

Numerous ethical guidelines are referred to when medical research is conducted on human participants. These guidelines include the Nuremberg Code, the Declaration of Helsinki, and the International Ethical Guidelines for Biomedical Research Involving Human Subjects. From a Western viewpoint, these guidelines may seem like well-reasoned, universally applicable codes for conducting medical research on human subjects. Some of the guidelines, however, merely impose Western values on developing countries without giving adequate consideration to their worldviews. I explore the applicability of current codes and guidelines of ethics on medical research with human subjects to the Zulu of South Africa and the Kikuyu of Kenya. Through a study of African traditional religions and philosophy and the community mindset that flows out of them, I have gained insight into the limitations of current universal codes when applied to traditional Kikuyu and Zulu communities.

This inquiry suggests a new epistemological foundation for understanding and discernment in biomedical ethics. This foundation, based on Aristotle's phronesis or practical wisdom, contains elements of the lived human experience which are seen as essential aspects of ethical, as well as medical, deliberation. The Aristotelian intellectual virtues of theoria and phronesis, used as "ideal types" of rationality, provide epistemological prejudices that structure two distinct ways of thinking. With this distinction, an alternative to certain dominant trends within biomedical ethics arises as phronesis provides more human centered prejudices for understanding. In conclusion, we shall see, using the doctrine of informed consent, that a phronetic rationality allows different, more humane meanings to come into being. Phronesis, it will be argued, provides a mode of rationality which promotes compassion and engagement in both ethics and medicine and consequently, is the more appropriate way of thinking in these important human practices.

The purpose of this project is to develop a curriculum, which will examine the ethical methods or practices used by nurses in resolving ethical dilemmas in clinical practice utilizing the Moral Decision-Making Model for staff nurses at St.Bernardine Medical Center, Five Tower North.

To illustrate the intersection of ethical language and ethical frameworks within technical communication, this dissertation analyzes the history and documentation of the human radiation experiments of the 1940s through the 1970s. Research propositions included clarifying the link between medical documentation and technical communication by reviewing the literature that links the two disciplines from the ancient period to the present; establishing an appropriate historiography for the human radiation experiments by providing a context of the military, political, medical, and rhetorical milieu of the 1940s to the 1970s; closely examining and analyzing actual human radiation experiment documentation, including proposals, letters, memos, and consent forms, looking for established rhetorical constructions that indicate a document adheres to or diverts from specific ethical frameworks; and suggesting the importance of the human radiation documents for studying ethics in technical communication. Close rhetorical analysis of the documents included with this project reveals consistent patterns of metadiscourse, passive and nominal writing styles, and other rhetorical constructions, including negative language, redundancies, hedges, and intensifiers, that could lead a reader to misunderstand the writer's original ethical purpose. Ultimately this project finds that technical communicators cannot classify language itself as ethical or unethical; the language is simply the framework with which the experimenters construct their arguments and communicate their work. Technical communicators can, however, consider the ethical nature of behavior according to specific ethical frameworks and determine whether language contributes to the behavior.

ESG (Environmental, social, and governance) investing is an investment philosophy to inform holistic and sound decision-making of investors for the purposes of both, nourishing a stable economy with acceptable rates of return while at the same time addressing stakeholders' non-financial concerns to preserve an inhabitable planet. Some scholars in finance argue that institutions subject to norms, i.e. responsible investors pay a financial cost from engaging in ESG activities. Moreover, they see ESG investing as distracting, inappropriate, risky and legally challenging. In response, several studies have emerged to show that ESG investing is a growing interest with investors, helps to mitigate financial risks, and does not need to represent a financial cost. Despite convincing evidence in a growing body of academic literature, many questions are still open to debate. Therefore, the principal objective of this thesis is to explore three dimensions of ESG investing, namely corporate environmental responsibility, renewable energy, and ESG disclosure quality. The research questions address issues relating to pension funds' investment decisions and legal obstacles resulting from utilising ESG information, financial return and risk implications of investing in renewable energy, substitutability of renewable energy for fossil fuel investments, and the effects of ESG disclosure quality on the expected cost of capital. To answer these questions, the thesis employs several standard and alternative empirical methods from the asset pricing and risk literatures. The thesis concludes the following. First, the integration of environmental responsibility into pension fund investment decision-making processes does not impede the financial and risk performance of pension funds. This means that pension funds should be allowed to consider such information in their investment decision making processes as the information does not reduce the overall financial return of the tested portfolios and does not violate trust law, i.e. the Employee Retirement Income Security Act (ERISA). Pension fund trustees have been prohibited to consider any non-financial criteria such as environmental, social, or governance criteria in their investment processes under trust law such as ERISA, when they could harm the finanical performance of the portfolio. To be more specific, a pension fund trustee breaches his fiduciary duties (the duty of loyalty and the duty of prudence), if he sacrifices the financial well-being of the pension fund for pursuing any other social goal (Langbein and Posner, 1980). In particular, the duty of loyalty is "... forbidding the trustee to invest for any object other than the highest return consistent with the preferred level of portfolio risk" (Langbein and Posner, 1980:98). Second, the thesis finds no evidence for sustained renewable energy equity premia. Furthermore, investments in renewable energy equity are considerably riskier than in fossil fuel energy equity, meaning that renewable energy firms are undergoing a period of high uncertainties related to their business model, low carbon prices, and lacking public and private infrastructure investment (Bohl et al., 2013; Kumar et al., 2012; Sadorsky, 2012b ). Finally, my thesis shows that companies with high ESG disclosure quality experience lower expected cost of equity and cost of debt financing, everything else equal.

This thesis seeks to demonstrate, by way of a multidisciplinary study, that consent is, despite its legal definition which refers to the free and enlighted expression of individual will, in fact, at times limited if not eliminated, by social considerations, arising from the medical, economic and legal context. These considerations reflect what one might call the social norm. An appropriate understanding of consent serves, therefore, to express the social norm as a constraint, which, in turn, acts as a measure of what it means to belong in society. Thus, while consent is often presented as the fundamental principle to be respected in biomedical research, it is in reality, merely one principle to respect among others. These limitations connected to consent are exacerbated in emergency situations where consent is sometimes reduced to mere signature, and in some cases it has been recognized that research can be undertaken without the subject's prior consent.

Thesis (DPhil)--University of Stellenbosch, 2004.
ENGLISH ABSTRACT: Human participant research raises a conflict between medical progress as a societal good and the protection of participants as an individual good. Prior to 1960 the discretionary authority for the protection of participants resided in the hands of individual investigators. However, a wave of research atrocities from Tuskegee in 1932 to the Beecher expose in 1966 stimulated a change to a principle based system of regulation. Research Ethics Committees (RECs) and Institutional Review Boards (IRBs) were henceforth charged with the responsibility of human participant protection. Since 1966, this system of research review was established internationally and at one institution in South Africa. In 1997, placebo-controlled HIV vertical transmission trials in a number of developing countries including South Africa raised unprecedented controversy in research ethics internationally and nationally. In 2000, the fraudulent breast cancer trials conducted by Dr Bezwoda at Baragwanath Hospital drew international attention to research ethics in South Africa. However, the events that called into question the efficiency of the system of ethical review most poignantly were the recent deaths of volunteers in research at centres of excellence in the United States. It was charged that if there were deficiencies in the research ethics review system in developed countries, these were more likely to be present in developing countries. Around the same time the Interim National Health Research Ethics Committee (INHREC) was established in South Africa to explore and regulate the ethical review system in South Africa. Cognisant of these issues, the current study was undertaken to establish the various structural, procedural and substantive ethical challenges facing justifiable and ethical review of research in South Africa. A combination of conceptualphilosophical reflection and empirical research was employed in this dissertation. The empirical work employed both quantitative and qualitative research methodology. The quantitative survey explored the composition of RECs reviewing clinical trials research in South Africa with an emphasis on committee composition and structure as well as the review process. The qualitative research was conducted using semi-structured interviews of ten REC Chairpersons in South Africa to explore complex substantive issues like informed consent, standards of care and participant remuneration, inter alia. While the review system in South Africa is functioning at a reasonable level, there is wide variation from one REC to the next. RECs are geographically distant and function in isolation without opportunity to communicate and share ideas. Amongst institutional RECs, there is a stark contrast between historically disadvantaged institutions and historically advantaged institutions. REC membership, ten years into democracy remains white male dominated. Community representation is inadequate. Most RECs are dominated by scientists and clinicians. The review process is widely variable with delays in review ranging from ten days to ten weeks. Procedural and bureaucratic demands impact on the ability of REC members to engage in debate on important substantive ethics issues like standards of care, informed consent and participant remuneration. Research ethics training and educational needs vary widely across the country. Serious attention must be paid to the way in which RECs are constituted in South Africa. Restructuring of RECs with a view to improving representation in terms of race, gender and religion must be prioritized. There is a need for community representation and non-scientific membership to be explored. RECs in South Africa need to revisit the question of whether they should be conducting both scientific and ethics review or ethics review alone. The review process requires a paradigm shift in emphasis from adverse event reporting to monitoring, from informed consent forms to a culturally relevant informed consent process. Aparadigm shift is indicated to shift the focus from informed consent to a more comprehensive review framework. Policies regarding standards of care and participant remuneration must be clarified and articulated. Although the role of RECs in human participant protection has been questioned, it is clear that in the vast majority of cases, they are fulfilling an important role. Their function could certainly be enhanced. This is being facilitated by training programs and an electronic newsletter. However, responsibility for human participant protection does not reside in the domain of the REC alone. A collective responsibility shared by researchers, institutions, research ethics committees, sponsors and participants is integral to human participant protection and the generation of new, valid and relevant scientific knowledge.
AFRIKAANSE OPSOMMING: Navorsing op menslike subjekte gee aanleiding tot ‘n konflik tussen mediese vooruitgang as ‘n voordeel vir die samelewing en die beskerming van deelnemers as iets waarby die individu direkte belang het. Voor 1960 het die diskresionêre gesag vir die beskerming van deelnemers by die individuele navorsers berus. ‘n Golf van navorsingsvergrype, van Tuskegee in 1932 tot die Beecher onthulling in 1966, het egter veranderinge in die rigting van ‘n stelsel van beginsel-gebaseerde regulasie gestimuleer. Navorsingsetiekkomitees (NEKs) en Institusionele Beoordelings- en toesigrade (IBRs) is gevolglik belas met die verantwoordelikheid om toe te sien dat mense wat deelneem, sover moontlik beskerm word. Sedert 1966 is hierdie stelsel van navorsingshersiening en -toesig internasionaal tot stand gebring – ook, aanvanklik, by een instansie in Suid-Afrika. In 1997 het plasebo-beheerde HIV-vertikale oordrag-proewe in ‘n aantal ontwikkelende lande, insluitend Suid-Afrika, tot ongekende kontroversie op die terrein van navorsingsetiek aanleiding gee, internasionaal en nasionaal. In 2000 het die bedrog met borskankerproewe, uitgevoer deur dr Bezwoda by Baragwanath Hospitaal, internasionale aandag op navorsing in Suid-Afrika gevestig. Hierdie gebeure het egter die effektiwiteit van die stelsel van etiese toesig in Suid-Afrika en elders in die wêreld bevraagteken. Die mees kommerwekkende onlangse insident was die dood van navorsingsvrywilligers by sentra van uitmuntendheid in die Verenigde State. Daar is beweer dat as daar tekortkominge in die navorsingsetiektoesigsisteem in ontwikkelende lande is, daar ‘n groter moontlikheid bestaan dat dit ook (en moontlik meer) in ontwikkelende lande voorkom. Ongeveer dieselfde tyd is die Interim Nasionale Gesondheidsnavorsings-etiekkomitee (INGNEK) [Interim National HealthResearch Ethics Committee (INHREC)] in Suid-Afrika gestig om die etiekoorsigstelsel in Suid-Afrika te ondersoek en te reguleer. Met dit in gedagte is die huidige studie onderneem om die verskillende strukturele-, prosedurele- en substantiewe etiese uitdagings wat regverdigbare en etiese oorsig van en toesig oor navorsing in Suid-Afrika in die gesig staar, vas te stel. Daar is van ‘n kombinasie van konseptuele, filosofiese refleksie en empiriese navorsing in hierdie proefskrif gebruik gemaak. Die empiriese werk maak gebruik van sowel kwantitatiewe as kwalitatiewe navorsingsmetodes. Die kwantitatiewe opname bestudeer die samestelling van NEKs wat toesig hou oor kliniese proewe in Suid-Afrika, met die klem op komiteesamestelling, -struktuur en die toesigproses. Die kwalitatiewe navorsing is gedoen met behulp van van semi-gestruktureerde onderhoude van tien NEK-voorsitters in Suid-Afrika om die komplekse substantiewe aspekte, soos onder andere ingeligte toestemming, standaard van versorging en deelnemervergoeding, te ondersoek. Terwyl die etiek-toesigstelsel in Suid-Afriks op ‘n redelike vlak funksioneer, is daar ‘n groot verskil tussen verskillende NEKs. NEKs is geografies verspreid en funksioneer dikwels in isolasie sonder ‘n geleentheid om te kommunikeer en idees te deel. Ten opsigte van die institusionele NEKs bestaan daar ‘n duidelike kontras tussen histories benadeelde instansies en histories bevoordeelde instansies. NEK-lidmaatskap word, tien jaar na demokrasie, steeds gedomineer deur blanke mans. Gemeenskapsverteenwoordiging is onvoldoende. Die meerderheid NEKs word gedomineer deur wetenskaplikes en klinici. Die toesig- en hersieningsprosesse in die verskillende komitees verskil grootliks, met vertragings wat wissel van 10 dae to 10 weke. Prosedurele- en burokratiese vereistes het ‘n impak op die vermoëns van NEK-lede om by debatte oor belangrike substantiewe etiese aangeleenthede betrokke te raak, soos byvoorbeeld die standaard van versorging, ingeligte toestemming en deelnemervergoeding. Opleiding en opvoedkundige behoeftes verskil wyd oor die land.Ernstige aandag moet geskenk word aan die wyse waarop NEKs in Suid-Afrika saamgestel is. Herstrukturering van NEKs met ‘n visie op verbeterde verteenwoordiging in terme van ras, geslag en geloof is ‘n prioriteitsvereiste. Gemeenskapsverteenwoordiging en lidmaatskap van nie-wetenskaplikes moet verder ondersoek word. NEKs in Suid-Afrika moet die vraag of hulle sowel wetenskaplike- as etiektoesig moet uitvoer, of sl slégs etiektoesig, opnuut ondersoek. Die nasiensproses vereis ‘n paradigmaskuif, vanaf ‘n klem op rapportering van gebeurtenisse, na monitering van ingeligte toestemmingsvorms sowel as na ‘n kultureel toepaslike ingeligte toestemmingsproses. ’n Paradigmaskuif is noodsaaklik ten einde die fokus te verskuif vanaf ingeligte toestemming na ‘n meer omvattende toesig- en nasiensraamwerk. Beleid rakende standaard van versorging en deelnemervergoeding moet verduidelik en geartikuleer word. Alhoewel die rol van NEKs in die beskerming van menslike deelnemers aan navorsing bevraagteken word, is dit duidelik dat NEKs in die meerderheid van gevalle wel ‘n belangrike rol vervul. Hul funksie kan natuurlik uitgebrei word. Dit sal gefasiliteer word deur opleidingsprogramme en ‘n elektroniese nuusbrief. Verantwoordelikheid vir die beskerming van mense wat deelneem aan navorsing berus egter nie uitsluitlik by NEKs nie. ‘n Kollektiewe verantwoordelikheid, gedeel deur navorsers, instellings, navorsingsetiekkomitees, borge en deelnemers is ‘n integrale vereiste vir hierdie beskerming sowel as vir die verwerwing van nuwe, geldige en relevante wetenskaplike kennis.

Thesis (MBA (Business Management))--Stellenbosch University, 2008.
ENGLISH ABSTRACT: The veterinary industry is operating in a highly regulated environment. Up till now these regulations prevented veterinarians to freely market veterinary services, especially professional services. Every business person in the biggest part of the world is subject to free-market economic pressures. However in the case of the professional, who is also a business person, these economic market-pressures could become very intense and unbalanced, and lead to what is called the “professional dilemma” (Du Preez, 2003: 8). Professional persons are governed by their respective codes of conduct. Those professionals who practice as entrepreneurs therefore need to be more business skilled and creative to successfully manage their businesses as they do not have the luxury of utilising the normal business strategies and options. The state of professionalism within the veterinary profession in South Africa in terms of entrepreneurship has been addressed in the past, but there is still a major gap in terms of providing business tools to managers in the veterinary industry. The biggest challenge in terms of the general business functions faced by veterinarians is the marketing function, thus the reason for this study. It is necessary that the highly regulated environments of professionals being understood. Therefore the research has been conducted by highlighting these environments. The researcher then continues to analyse the internal and external environment, client needs and customer profile in order to identify ways of optimising marketing opportunities.
AFRIKAANSE OPSOMMING: Die veeartseny industrie word bedryf in ‘n hoogs gereguleerde omgewing. Hierdie regulasies het veeartse tot nou toe verhoed om dienste, veral professionele dienste, vrylik te bemark. Besigheidspersone regoor die wêreld verkeer onder vryemark ekonomiese druk. In die geval van die professionele persoon, wat ook ‘n besigheidspersoon is, kan die ekonomiese druk baie intens en ongebalansseerd word. Daar word verwys na die “professionele dilemma” (Du Preez, 2003: 8). Professionele persone word gereguleer deur hul onderskeie kodes. Daardie professionele persone wat praktiseer as entrepreneurs moet dus oor meer besigheids- en kreatiewe vaardighede beskik om hul besigheid suksesvol te bestuur. Hulle het nie die luuksheid om die algemene strategiee te benut nie. Die stand van professionalisme in die veeartsenyprofessie in Suid- Afrika in terme van entrepeneurskap is al voorheen aangespreek, maar daar is nog steeds gapings ten opsigte van die beskikbaarstelling van besigheidsvaardighede aan bestuurders in die bedryf. Die grootste uitdaging in terme van besigheidsfunksies wat veeartse in die gesig staar, is die bemarkingsfunksie. Dit is dus die rede vir hierdie studieprojek. Dit is belangrik dat die hoogs gereguleerde omgewing van professionele persone verstaan word. Die studie begin dus deur hierdie verskillende omgewings te skets. Die studie skenk verder aandag aan die ontleding van die interne en eksterne omgewings, klientebehoeftes en –profiel om maniere te vind om bemarkingsgeleenthede binne regulasies ten volle te kan benut.

Il s’agit de montrer que les technosciences, rencontrant l’humanitude comme leur condition de possibilité et leur moteur propulsif, risquent d’actualiser une potentialité aporétique associée à une enclave organique perméable et à une maintenance identitaire inscrite dans le devenir - associée à une intériorité se dépliant en extériorité et à un monisme substantiel s’exprimant dans la dualité (en soi, comme soi et hors de soi). Pour ce faire, nous observons et confrontons :les techniques (des PMA aux manipulations d’embryons, des diagnostics génétiques aux thérapies géniques, du clonage à la transgenèse) à l’individu, l’individu à ses latitudes (en ce compris par la voie d’une «consultation» des personnes souffrantes, des scientifiques et de la population dite «générale») et celles-ci à l’humanitude.

Par ailleurs, nous définissons l’individu d’une indéfinition :où l’homme est point de convergence (entre divers états, plans et déterminants) et force d’émergence (hors ses donnés) - équilibre en construction incessante et incessible. Où sa spécificité tient à l’occupation corporelle et pensée d’un espace et d’un temps :équilibre en soutenance entre stase et métabolisme, non-soi et soi, subordinations et libérations, centralisations identitaires et extériorisations identifiantes. Par suite, toute intervention pesant en déséquilibre sur ces articulations devrait être évitée – en principe. En principe car, du fait de la multiplicité et de la diversité des intervenants, du fait même de leur liberté et des incertitudes plurielles, il y aura toujours pression ou déséquilibre. Néanmoins, il importe de mesurer l’acte aux conditions de la liberté et de l’humanité :conscience, autonomie, libre disposition de soi, sensibilité, émotivité, souci, malléabilité principielle (contre une assignation à demeure spécielle ou existentielle) et réappropriation essentielle (contre un déterminisme global – une appropriation par tiers). Et il convient de préserver le lien du corps et de l’esprit :où l’esprit transcende le corps qui le forme et l’informe – selon une mise à distance au sein d’une unité (et d’une unicité).

Or, nous constatons que l’humanitude, prise en charge par les techniques qu’elle produit, édifie un domaine existentiel caractérisé par une biographie de l’arrachement ou du désinvestissement. Et que l’homme, être de l’entre-deux défini par la négation de tout Etat advenu, produit un processus technique propre à l’extraire de cet «entre-deux». Déjà, l’individu libère ses tendances dispersives et ses tendances confusionnelles :mise à distance de l’entité corporelle (en sa force référentielle ou définitoire), identité décisionnelle et puissance volitive plus dispersive que centralisatrice. Où donc néoténie, imparfaite assignation, distanciation et in-essentialité ouvrent à la liberté tout en autorisant l’incorporation du non-soi, l’opérativité de la volonté et l’évanescence des états de l’organisme et de la psyché (de la personnalité comme tout identitaire). Cependant, si les techniques font exploser ces équilibres, reste la dissipation :où le «soi serait amené à se reconnaître comme pure et simple concept construit. Dans ce contexte, tout s’abandonne aux modifications. Et l’homme de jouer avec le donné et le donné en lui - donné qui est lui mais se décompose dorénavant en fonds «sacral» de puissances, en substrats géniques, mnésiques et morphologiques modelables et en constituants interchangeables. Semblable attitude recouvre une fuite hors de la condition humaine :tantôt vers «autre chose», tantôt vers un alignement démissionnaire sur un Décideur Transcendant. Et pour la première fois aussi globalement et intensément, instinct et volonté de survivre se soumettent à leur propre négation :pour qu’il subsiste «quelque chose plutôt que rien» dans le futur lointain, l’espèce conspire à sa propre fin. Pour la première fois (première fois aussi proche d’une réalisation), l’individu aspire à une dispersion de conscience, à une évanescence personnale et à une fin de l’Histoire sous couvert d’une histoire sans fin et d’un devenir incessant – gardant du devenir la seule processualité mécanique. Le danger est alors considérable car l’homme sort de l’animalité dans le champ où s’entrechoquent libre arbitre et déterminisme, références identitaires et décentrages, appartenances et abstractions. Car cet animal-là exprime sa spécificité à l’extérieur de l’enceinte biologique mais à partir d’une densité individuale :dans l’élaboration sociale et culturelle. Dès lors, quand l’existence précède l’essence et face aux possibles technoscientifiques, il importe de préserver l’homme d’une existenciation illusoire et d’une personnalisation évanescente. Et de pondérer la totalité individuale de ses dimensions temporelles :où l’individu est un être perpétuellement devenant ;où l’existence crée, investit et signifie une durée ;où l’identité est continuité d’unicité en devenir ;où l’humanité est construction d’Histoire et invention de sens. Cela oblige l’individu à se soutenir eu égard à des doubles nœuds référentiels :anthropique et autobiographique, culturel et familial, spirituel ou décisionnel et charnel ou factuel, symbolique et opératoire, autoréférentiel et relationnel. Mais aussi, en matière éthique, entre principe et casuistique, idéal et exception, collectif et individuel.

Doubles nœuds contestés par les techniques. Aussi, face à l’opérativité croissante de celles-ci, nous nous interrogeons sur ce qu’il pourrait advenir de la condition humaine et des conditions de possibilité de l’homme - considéré ici comme individu (spécimen défini en ses spécificités) au milieu du monde, conscience (sensible et émotionnelle) en situation d’interrelation, et subjectivité (volitive) face à ses semblables.

Doctorat en philosophie et lettres, Orientation bioéthique
info:eu-repo/semantics/nonPublished

In this thesis, the author studies the ethical and legal aspects of research conducted on stored tissue samples of deceased persons in North America.
The first part of this thesis presents an overview of what constitutes human tissues and how are they used in research. The author describes the process in which human tissues are acquired and stored by health facilities, their utility for scientific research, and currently used techniques.
The second part is dedicated to the analysis of the current normative framework associated with research involving human tissue samples in North America. The author underlines the presence of two different normative regimes depending on whether the human tissues were removed before or after death. Finally, the author examines international documents in order to evaluate whether or not they can provide guidance to North American national legislation.
The third part evaluates the normative limitations associated with the use of stored tissue samples of deceased persons for research. The author considers that these limitations are related to the presence of conflicting interests, the difficulties in establishing rights over human tissues, the difficulties of establishing the rights of the dead, and the limitations of the theory of informed consent with regards to stored tissue samples.
The last part of this thesis suggests that stored human tissues should be interpreted as if they were part of an individual's medical record. After presenting some of the philosophical arguments in favour of such an interpretation, the author underlines the presence of legal precedents supporting the "tissue as information" model. The author finally examines the legal implications and the potential limitations of this proposal.

M.A.
This dissertation evaluates the concept of a third alternative surrounding abortion which focuses on making abortion rare by addressing contemporary arguments. This third alternative recognises abortion as morally problematic but contends that it should be both legal and rare. Its aim is to address the overly narrow focus of the usual debate on either just the foetus or just the maternal body. In doing this it evaluates some of the current contemporary arguments surrounding abortion to show how these arguments are simply not enough. This includes questioning the social and political dimensions of the dilemma of abortion, and in particular, questions about the conditions that should be in place that will help make abortion rare. This should show how the current debate has created a clear division which has done very little to help women who are considering an abortion. Therefore the argument of making abortion rare should be supported by both Pro-Life and Pro-Choice arguments because if abortion became rare, it would mean that not only would there be fewer abortions, which is exactly what Pro-Life is arguing for, but it would also mean that women would be given more options, which is what Pro-Choice is arguing for.

This empirical study was aimed at assessing trial participants’ understanding of randomisation, double blinding and placebo use as well as investigating their attitudes towards the three procedures. The study was conducted within the HPTN035 microbicide trial that was being conducted in Blantyre and Lilongwe in Malawi among other sites. The study was descriptive in nature and used a combination of qualitative and quantitative methods which included review of study documents, in-depth interviews with study staff, structured interviews with a sample of 203 participants and two focus group discussions with 18 microbicide trial participants. Overall, more than half of participants were categorised as having lower levels of understanding on the concepts under study. The study also established that the majority of participants had negative attitudes towards the three procedures. Based on these findings, a pilot intervention was designed aimed at improving understanding. The pilot intervention consisted of an information session which was delivered with the assistance of a PowerPoint. During the session, the three terms were explained using a story based on the growing of crops, as Malawi is an agricultural society. The intervention phase was delivered using a sample of 36 low scorers who were randomly assigned to the intervention and non-intervention arms. An assessment after the intervention suggested that the intervention was useful in improving understanding of the three procedures. The findings provide some evidence that research participants can understand research procedures if the procedures are explained in user-friendly terms and if information concerning their justification and personal implications is provided. The findings further suggest that the intervention was useful in changing participants’ attitudes towards randomisation and double blinding. The intervention did not change attitudes towards placebo use in a statistically significant way. Theoretical and practical recommendations, as well as suggestions for further research were recommended.
Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2010.

In the history of public health vaccines have proven to be among the most effective disease prevention tools. It is clear that in the fight against HIV that new and powerful preventive technology such as a vaccine is badly needed. Ethically, however the processes of developing a vaccine against HIV have been distinctly different from that of any previous pharmaceutical products. HIV vaccine trials can be ethically complex for a number of reasons. In 2004 the HIV I AIDS Vaccine Ethics Group undertook a research initiative that aimed to collect data from various South African stake holders of HIV vaccine trials to ascertain what they perceived as the ethical challenges related to HIV vaccine trials. A quantitative content analysis on the data from 31 semistructured interviews revealed that the ethical issue listed spontaneously by most of the respondents was that of informed consent. Further probing and discussion on informed consent identified a number of sub issues which the respondents thought would pose important challenges to HIV vaccine trials in the South African context. This study undertook to do a more in-depth qualitative analysis of the data to ascertain whether the challenges and concerns the stakeholders have are consistent with or different to those already identified in the literature and ethical guidelines on informed consent in medical research. What variables may be impacting on the position stakeholders take was also of interest. Results indicated that many concerns relating to the substantive and procedural elements of informed consent were consistent with those debated in the literature. These issues related to first person consent, the voluntariness of participants' consent, practicing cultural sensitivity, dealing with language issues, promoting and assessing understanding of material disclosed, issues around the vulnerability of .. participants, children and adolescents' capacity to consent and the role of the media. More specific to the South African context, stakeholders were concerned about the legal framework under which the trials take place, the general lack of education and training about HIV vaccine trials, a lack of communication and coordination between stakeholder groups, and the historical influences of apartheid on black South African participants' capacity to consent. The main variables that appeared to impact on the position stakeholders took related to the role the stakeholders play within the trials, the philosophical position underpinning their ethical viewpoints, stakeholders' understanding of vulnerability and capacity to consent, and how they view the universality or relativity of ethical issues.
Thesis (M.A.)-University of KwaZulu-Natal, Pietermaritzburg, 2008.

Dissertation in compliance with the requirements for the Master's Degree in Technology: Journalism, Durban University of Technology, 2013.
Ethical behaviour by investigators is the cornerstone of scientific research. Recognizing, declaring and avoiding a conflict of interest are key responsibilities for biomedical researchers, particularly since commercial enterprises, such as pharmaceutical companies, have become major funding sources of research. Proactive disclosure of researchers' financial relationships is now a requirement for publication in most scientific journals. The question that arises is whether this same increased scrutiny of financial disclosure and potential for conflict of interest has extended to the mainstream press in Canada. A content analysis of biomedical research articles that appeared in Canadian daily newspapers from 2001 to 2008 showed that 82 per cent of the articles failed to identify the financial connection that existed between the researcher(s) and the commercial funder, and nearly half of the articles did not even identify the commercial funding source of the research. A text analysis showed that 94 per cent of the articles were positive about the drug/device cited by the research, and positive, optimistic words such as “breakthrough”, “significant”, “hope” and “promising” were often used in the news articles. Reporters frequently frame biomedical research articles using a battle-like template that describes a fight between good and evil. Another common approach was to frame the article as a message of hope for the future. A genre analysis showed that the genre of medical research news articles published in newspapers is highly dissimilar to the genre of medical research articles published in scientific journals. It is likely these two genres have been constructed to appeal to very different target audiences. The study results show overwhelmingly that readers are not provided with key information about potential financial conflicts of interest involving the researchers and the commercial sources of funding for the research. Such lack of transparency thwarts the reader’s ability to reach informed conclusions about whether or not the research has been either explicitly or implicitly influenced by the researcher’s potential conflict.

Paediatric clinical trials are crucial to ensure safety and efficacy of medicines in children. This study explored parents’ perceptions in Gaborone, Botswana, regarding children’s participation in clinical trials. One hundred participants completed a self-administered questionnaire. The results showed that 93% of the participants had a good knowledge of clinical trials; 74% thought that children would benefit from clinical trial participation; 63% would not enrol their children in clinical trials; 55% suggested that children should only be enrolled once they have reached the age of 18 years; and 71% reported that only children with an active disease should be enrolled. A large proportion (82%) reported that children’s participation should be voluntary, while joint parental consent was supported by 93% of responders. Regarding children’s assent 91% deemed respect for children’s assent essential, although 52% thought that children’s assent should not override the parental decision. There was a statistically significant correlation between finding clinical trials in general important and children’s participation in clinical trials (p=0.008, Fisher’s Exact Test), as well as the need for individual consent p<0.0001, Chi-Square). There was also a statistically significantly association between respondents, who would allow their children’s participation in clinical trials and who would encourage their family members and friends’ participation in clinical trials (p=0.0001, Chi-Square). An overwhelming 94% advocated for special regulations in Botswana to govern paediatric clinical trials. Almost all participants (99%) explicitly expressed the opinion that there should be global regulations for paediatric clinical trials.
Thesis (M.Soc.Sc.)-University of KwaZulu-Natal, Pietermaritzburg, 2012.

Bibliography: p. 379-394.
xi, 394 p. ; 30 cm.
Title page, contents and abstract only. The complete thesis in print form is available from the University Library.
Thesis (Ph.D.)--University of Adelaide, Dept. of Public Health, 1988

In received biomedical research wisdom, randomized controlled trials (RCTs) revolutionized post-World War II health research. By blending statistical analysis with the testing of new procedures and interventions, RCTs have enabled investigators to circumvent the influence of a variety of biases on research outcomes so that the effectiveness of interventions can be ascertained with high levels of confidence. While extant literature addresses the epistemological history of RCTs from the scientific community's perspective, the history of public health would be significantly enhanced by a broader, more detailed consideration of social dimensions of RCTs. Similarly, while a plethora of bioethical literature has been written on RCTs and human subject research, we currently lack a historical analysis that considers ethical shifts over time as they relate to RCTs. This dissertation describes the key political, economic, intellectual, and cultural events in the history of RCTs from their origins to 1980 and analyzes how these events influenced RCT norms. I describe the barriers to the implementation of RCTs throughout the late nineteenth and early twentieth centuries--namely the dominance of individualistic ideologies in clinical research and an absence of governmental regulatory or funding structures to require or support RCTs. I then describe how large, multi-site RCTs grew out of a Cold War political environment that supported public investment in scientific structures; how post-WWII research regulations influenced the proliferation of RCTS in the US; how politics and regulations influenced shifts in the demographics of RCT research subjects; and how ethical norms changed over time through interaction with broader ethical shifts and governmental regulations.

In Alberta, decision-making in the health system has been devolved to seventeen Regional Health Authorities (RHAs). This thesis undertakes a broad analysis of the values that underlie this regionalization. Divided into two parts, the first half of the thesis develops a liberal egalitarian theory for the distribution of resources in society that turns on the importance of providing all people with the basic resources required to plan for, develop and achieve their life goals. Four requirements for any health system that seeks to uphold the values inherent in this theory are then articulated. These requirements include the need for the health system to be sensitive to the broader determinants of health, and the need for understanding the concepts of health and disease within the context of the social and cultural communities that the system is meant to serve. Part One concludes with an argument suggesting that expressions of Canadian values cohere with the normative theory developed. In Part Two the evolution of Alberta's regionalized healthcare system is traced. The values implicit in the regionalization of the health system in this province are then examined for their congruence with the four requirements developed in Part One. Following this, the ethical difficulties faced by RHAs are considered. The thesis culminates with thoughts on the ethical challenges Alberta's regionalized healthcare system must confront, offering recommendations for how some of these challenges may be addressed. It is concluded in the thesis that while a regionalized health system is not necessary for meeting the requirements elucidated, these standards can be met with a regionalized approach. However, at least in the case of the Alberta experience, a number of important changes would have to take place for this to occur. Among these changes is a paradigm shift in the way health and disease are understood towards a more evaluative approach; the recentralization of public health initiatives to the provincial level; and an overall change in governmental health policy recognizing that many areas of society, and consequently the policies of government agencies beyond a disease-based healthcare system, impact health and well-being.

AIDS has had a negative impact on developing countries. Because most developing countries cannot afford the new antiretroviral drug therapies, it has been suggested that preventive vaccines might reduce the spread of the HIV/AIDS epidemic (Bloom, 1998). The clinical trials of AIDS vaccines do, however, present with complex ethical issues such as informed consent. Informed consent is primarily grounded on the Western principle of respect for individuals as autonomous agents. This may be at variance, however, with African societies' emphasis on the social embeddedness of the individual. The current study forms part of the HIVNET vaccine trials to be conducted in Hlabisa, in Northern Zululand, under the auspices of the South African Medical Research Council. The main aim of the study was to explore key informants' cultural conceptions of research and informed consent in order to facilitate community consultation and cultural sensitivity. Maximum variation sampling was used to select twenty-three key informants, who are in leadership positions within Hlabisa. An interview guide was used to facilitate narrative disclosure of cultural conceptions of research and informed consent. Perceptions of research, conceptions of the informed consent process, and projected motivations for why individuals agree to participate in studies were explored during interviews. Results suggest that members of the Hlabisa community have a limited understanding of the Western research process. Community education about research is therefore warranted. Informants indicated that community members would value the establishment of a relationship characterised by mutual respect for cultural differences between researchers and participants. This was perceived as likely to facilitate shared decision-making, and the reduction of the power differentials that exist between researchers and participants. While the involvement of key community leaders and family members was recommended by most informants, a few informants felt that participants could also make individual decisions about participation. The theoretical implications of the study are considered last.
Thesis (M.A.)-University of Natal, Pietermaritzburg, 1999.

This dissertation examines the legal position relating to the participation of children in research, especially in HIV preventive clinical research in South Africa. HIV/AIDS presents a real threat to humanity and particularly to the welfare of children. The participation of children in this type of trials is therefore vital. Children, as vulnerable participants, must also be protected from harm resulting from research. The study also considers the nature of HIV preventive clinical research, pointing to the inconsistencies in the legislation governing children’s participation in HIV preventive vaccine trials. The dissertation concludes that the question of the participation of children in HIV preventive clinical research poses many challenges, as the position in the South African law and relevant ethical guidelines are inconsistent and contradictory. The study recommends in the final instance that the relevant statutory provisions and ethical guidelines be harmonised in order to clear up the inconsistencies.
Jurisprudence
LL.M. (Legal Aspects of HIV/AIDS)

Text in English
The purpose of this study was to develop strategies to overcome the challenges in the management of large intensive care units (ICUs). Qualitative, research was conducted to explore and describe the challenges and needs experienced by the ICU managers and critical care nurses in the management of large ICUs. Data was collected through interviews. The study was conducted in two phases, that is, Phases I and II which involved compilation of evidence in preparation for development of the strategies and development of the strategies respectively. Two groups of critical care nurses participated in the steps of data collection in Phase I of the study. The unit managers participated in Phase I step 1 which was individual interviews and the critical care nurses not in the management role participated in Phase I, step 2 which was focus group interviews. Data was analysed using the descriptive analysis method of Tesch (1990). The study has highlighted the challenges and needs in the management of large ICUs, through seven themes that emerged from the findings. Ten strategies were developed to overcome the challenges and address the identified needs. The strategies have been presented as a contribution to literature.
Health Studies
D. Litt. et Phil. (Health Studies)

Ecofeminism perceives an interconnection between the domination of women and poor people, and the domination of nature. This domination is founded on modern, Western, patriarchal, dualised structures, which subordinate all considered as "the other" compared to the superior masculine archetype. Hence, all feminine is seen as inferior and may therefore be exploited. This is presently manifested in the neo-liberal economic development ideal. Its global penetration generates huge economic profits, which are reaped by Northern and Southern elites, while its devastating crises of poverty, violence, environmental destruction, and human rights abuses makes life increasingly unmanageable for Southern women, poor people and nature. Feminism and ecology have therefore come together aiming at liberating women, poor people and nature. They want to change the dualised, reductionist perception of reality into a holistic cosmology. Ecofeminism consequently aims to integrate the concerns of women, poor people and nature into development.
Development Studies
M.A. (Development Studies)

The study addresses from a sociocultural-historical, in particular a missiological and medical perspective the question if Catholic hospitals in Matabeleland, affected by the dramatic down-turn of Zimbabwe’s economy since 2000, did whatever they could to continue offering quality services to their patients. It starts with a portrayal of the emergence of secular modernity in the North-Atlantic World, as regards its view of the world as solely governed by natural laws, and of people as capable of taking destiny into their own hands, unperturbed by spiritual forces. The question is explored how the Christian Occident could end up there, following its development through the Middle Ages, and its expansion by missionary activity, by preaching the Word, but also by military force. Next, the achievements of pre-1900 Western medicine are examined, to identify if/how missionaries in Africa could have benefited. The study describes how professional medicine did not become part of the early Zambesi Mission, not because of its curative shortcomings, but for spiritual reasons, insofar as the Jesuits did not follow the European trend to let worldly well-being take the place of eternal salvation. Vis-à-vis their other-than-modern view of life, suffering, and (self-)sacrifice, the promises of medicine appeared just trivial. Submissiveness to authority, both ecclesiastical and worldly, is identified as the core principle that informed the Jesuits’ educational approach towards Africans in all their efforts at conversions. The missionaries thereby colluded with colonialist thinking, in not attempting to make their pupils grow into self-confident, independent thinkers in their own right. In this educational tradition, grafted onto a pre-modern local culture, the study finds the reason why Zimbabwean medical staff, as managers of their clinics or hospitals, have shown little readiness to proactively prioritise the intrinsic needs of their institutions and push for corrective measures, prepared even to challenge their superiors when encountering aberrations in the health system, locally as well as higher up. The study asks if the Church could have opted for a different educational approach, considering the prevailing socio-economic and cultural framework conditions; finally, which options present-day Zimbabweans have to choose from, regarding their country’s future development.
Christian Spirituality, Church History and Missiology
D. Th. (Missiology)