Dissertations / Theses on the topic 'Bioethical Issues'

Medical paternalism is a common practice in Pakistan, it can be justified on the principles of beneficence and non-maleficence in certain clinical situations but in the research medicine it can pose many ethical implications.

Islam is a communitarian religion but it provides full autonomy to the competent individuals. Pakistan Medical and Dental Council (PM&DC) codes of ethics have been formulated in line with the World Medical Association and it also states in its preamble that it follows Islamic bioethical laws. The PM&DC guidelines do not provide substantial system for obtaining consent from patients and the research participants. Neither does it comply with the Islamic bioethical laws nor with the International Declarations. The language used in the codes is ambiguous that can have different interpretations and there is no legal support from the civil law of the country. These factors supplemented with the cultural values have elevated the status of the physician and gives complete authority to them for medical decisions.

Medical paternalism in research medicine can be a violation of the dignity and autonomy of the research participants. Patients are used as means and commodities rather than end in themselves. The research involves risks of harms no matter how low these risks are – the matter of concern is that research participants are involved in research accompanied with risks about which they are not aware.

This thesis examines from a socio-bioethical perspective British premenopausal cancer patients’ experiences with making oncofertility decisions. It uses original empirical research into the experiences of a small group of patients to address social, clinical and ethical concerns about how patients make decisions in the medical context. Several North American studies have noted that the ways in which cancer and fertility concerns are addressed in the medical context may affect patient decision-making. This thesis focuses specifically on how these experiences are influenced by the medical encounters in the UK, by exploring how female cancer patients make decisions about their future fertility. The thesis also examines whether social and bioethical theories of autonomy and agency adequately capture how decisions are made in practice, using empirical data to interrogate existing theory. To address these questions, semi-structured interviews were conducted with premenopausal cancer patients. Data from the interviews were analysed using sociological and bioethical theories in order to improve understandings of how this patient group makes decisions, and how they feel this experience could be improved. This research therefore contributes to the growing body of literature seeking to identify how patients make decisions within the medical context and what types of support are necessary to address the needs identified by patients. Furthermore, the thesis demonstrates how sociology as a discipline can be seen as a constitutive part of bioethics, with this project serving as an example of one way that bioethical research can be conducted through a sociological lens.

Introduction: Medical practice implies an increasing amount of bioethical issues that may negatively impact on health care professionals wellbeing. However, to date, little is known about the experience of burnout and (moral) distress related with end of life and bioethical issues in everyday working life. Objectives: to study variables (meaning in life, stress, moral distress, ethical climate, resilience, positive and negative affects) that may impact on health care professionals dealing with end-of-life and bioethics issues. Materials and methods: The study will be conducted using a multi-method design, using both quantitative and qualitative approaches. The anonymous questionnaire administered one time only to each participant was composed by socio-demographic questions, Maslach Burnout Inventory – General Survey, Schedule for Meaning in Life Evaluation, Maugeri Stress Index, Moral Distress Scale-Revised, Hospital Ethical Climate Survey, Connor-Davidson Resilience Scale, Positive Affect and Negative Affect Scale. Semi-structured interviews have been conducted, too. Main results: Managerial support and ethical vision of patient care were negatively related to emotional exhaustion, directly and through moral distress. Professionals high in resilience and positive affectivity benefited more from the protective effect of managerial support on emotional exhaustion through moral distress. Moreover, resilience improves healthcare professionals’ wellbeing and professional self-efficacy, directly and indirectly, as mediated by the ethical vision of patient care. Highly resilient professionals benefit more from the positive effect of ethical vision of patient care on wellbeing in presence of high managerial support. The qualitative part shed light on both stressors (e.g. emotion management regarding death, communication of poor diagnosis/prognosis) and protective factors (e.g. social support, positive approach and value of past experience) experienced by palliative care professionals and medical student. Moreover, palliative care professionals considered the Italian law on Advance Directives as a useful instrument for self-determination and protection despite the presence of some critical aspects. Discussion: This study may help to focus on risk and protective factors to be monitored during the health care provider’s career. It may also provide information useful for preventing and supportive interventions in medical practice with end-of-life and life-threatening patients.

Recent developments in social neuroscience have stirred up increased interest within the bioethical debate (for a review see: Specker et al. 2014). Moral enhancement is a concept that directly embodies the idea of making brain science work for the social and moral good. In recent ethical discussions about biomedical means of moral enhancement, scholars have focused on so called ‘direct means of moral enhancement,’ discussing the ethical permissibility of modifying the emotional underpinnings of moral behaviour (Douglas, 2008; 2013; Persson and Savulescu, 2008; Savulescu and Persson, 2012). However, critics have argued that such modification only seems like moral enhancement, that behavioural modification is not ‘true’ moral enhancement, for the reason that it changes behaviours without making agents better moral agents. Critics have also noted that it can undermine freedom (e.g. Harris, 2011; see also: Douglas, 2014). This thesis addresses the ethical issues relating to enhancement. In the first part of this work I consider conceptual issues surrounding the concept of moral enhancement and argue that moral enhancement is plausible if we adjust our expectations to match those we have of cognitive enhancement. I examine the difference between pro-sociality and morality, and argue that an increase in empathy and reduction in anger cannot be seen as straightforward moral enhancements. The second part examines the objections related to moral disagreement, medicalization and narrative identity. The third part of this work focuses of the issues related to freedom and agency. I argue that voluntary direct emotion modulation, if embedded in appropriate reflection, is a prima facie desirable way of moral enhancement.

With the re-emergence of values education in the school curriculum in the last decade, science is viewed as one of the key teaching domains, and in particular, socio-scientific education is increasingly perceived as instrumental in helping students explore underlying beliefs and values, develop reasoning and critical thinking skills to make informed decision on socio-scientific issues. This thesis develops a conceptual basis for a model of teaching socio-scientific issues for secondary or high school students. The teaching of controversial issues needs a stronger theoretical base and a more viable pedagogical strategy to facilitate critical thinking, argumentation and decision-making skills. Previous research has shown that science classroom discourse was largely teacher dominated and tended not to foster adequate reflective discussion of scientific issues nor forge well-informed decisions on controversial issues. The use of ethical frameworks serves as a pedagogical tool as well as provides a process to help students make ethical judgements and rationally and relationally justify them.The five ethical frameworks explored in this model are categorised as rights and duties, beneficence/non-maleficence (utilitarian), autonomy, communicative virtues and Christian moral. The features of controversy that are made explicit to the students through the use of ethical frameworks are situated in the area of human genetics and transgenic plants in Australia. Such a study is undertaken in the realm of bioethics within the context of an ethically pluralist society. The present investigation focuses on the teaching of a Year 10 biotechnology class over a period of ten weeks in an evangelical Christian college in metropolitan Perth, Western Australia. Using an interpretative case study approach, a mixed method data collection and action research as the methodology, analyses of instructional strategies, teachers and students’ beliefs/values/attitudes and achievement outcomes were conducted and evaluated accordingly.This study is unique in that it presents one of the few studies that incorporates Christian/faith values in the ethical frameworks that enables the researcher to explore the connection, if any, between cognitive learning and moral reasoning and moral development, and in the wider sense, the link between cognitive learning (scientific literacy) and ethical reasoning.Research findings indicate that through the use of the simple framework in comparing the pros and cons, students in the comparison group developed a limited measure of competency in reasoning and developing arguments to express their viewpoints. However, students have also been noted to be more motivated and engaged with learning science because of its increased relevance to their personal lives and societal concerns. On the other hand, the experimental group students utilise the five ethical frameworks to orientate the thinking process to explore possible alternatives, to prioritize conflicting and competing ethical claims, to examine from different perspectives and to integrate their information by linking from knowledge content and/ or claims to well-grounded conclusions. Essentially, the use of ethical frameworks guides students’ understanding of the socio-scientific issue and helps them to formulate the crux of decision-making.Data analysis from both qualitative and quantitative aspects suggest that the use of ethical frameworks has brought about a marked improvement in the students’ ability to reflect critically, reason analytically and make rational decisions about their own ethical values in handling socio-scientific issues. Research finding also confirms the the important role of the teacher in implementing the ethical frameworks as a reasoning and argument-developing tool in socio-scientific education. On a modest level, research from the present study has shown that using the frameworks for both comparison and experimental groups has instilled in teachers some measure of confidence; with the five ethical frameworks proven more satisfying and effective as a pedagogical tool. This study suggests that, from a teacher’s perspective, the use of ethical frameworks could be a viable tool in socio-scientific education, and this needs to be supported by the teacher taking a procedural neutral stance, role-modelling the scientific reasoning process through carefully crafted questions, creating a collaborative and caring learning environment and a variety of student-centred teaching strategies.The incorporation of faith values in the ethical frameworks confirms previous research that there is the possibility that other concepts besides that of justice and fairness could be the key in determining how one judges what is morally right. The present research also suggests that there are different problem-solving strategies in making moral judgements beside stage schemes of justice described by cognitive developmental psychologists and educators. The present study also suggests that allegiance to belief systems and ideologies can sometimes override the influence of one’s own sense of fairness in making decisions of moral rightness. This is an important factor to consider in mapping out curriculum for moral education and socio-scientific education.Overall, the analysis suggests that socio-scientific education programs focusing on dialogical and reflective processes could help to facilitate socio-scientific reasoning. The study also argues for the importance of providing a sound epistemological and dialogical environment for socio-scientific education in a science classroom through the use of carefully constructed and evaluative metacognitive tools of learning in scaffolding and structuring reasoning and argumentation process, of which the use of ethical frameworks has proven to be modestly effective.

In the wake of the 2001 anthrax attacks in the US, States Parties to the Biological and Toxin Weapons Convention started to discuss the potential malign application of biological research and technology. This thesis examines how this issue of dual-use has been developed, discussed, and how solutions have been proposed. In order to do so, the thesis follows a neopragmatist approach. As a neopragmatist methodology is largely underdeveloped, the thesis explores some of the key aspects of neopragmatism, specifically its openness to various methods and theories, by directly applying it to the topic. As a result of this approach, the thesis starts with exploratory empirical research, which follows Bruno Latour’s Actor Network Theory. This research reviews how the problem of dual-use has been discussed in three communities: politics and security, ethics, and science. One of the results is that dual-use has primarily been discussed in the security community while the other two were only marginally involved. The proposed solution to the problem by the security community is to place the burden of responsibility on the scientific community. The second part of the thesis then uses theory, Niklas Luhmann’s social systems theory and Martin Heidegger’s work on questioning technology, to critically challenge this solution developed in the security community. The thesis concludes by identifying approaches to help deal with the dual-use issue. It also examines how the adoption of a neopragmatist methodology has influenced and guided the thesis.

Partendo dai casi di cronaca - assunti nella maniera il meno ideologica possibile - il lavoro prova ad addivenire alle grandi questioni di principio che assillano il nostro tempo, in materia di diritti umani.

This study examines the science/policy interactions in global health science and technology governance. It focuses on the institutional design of organizations that sit at the interface of science and policy, conceptualizing them as Boundary Organizations (BOs). The analysis considers how the institutional design of BOs affect boundary-work. The study examines two case studies, UNESCO’s International Bioethics Committee and the WHO’s Strategic Advisory Group of Experts on Immunization. The study examines the ways in which boundary-work is carried out and finds that the concept of a BO demonstrates an institutionalization of science/policy interactions and the analysis of these two cases show that there are different ways that boundary-work is practiced as a function of the design of BOs.

Fin dalla sua nascita, la bioetica ha rappresentato un approccio interdisciplinare in cui filosofia, teologia, diritto, medicina, scienze sociali e umane si fondono per riflettere sulle complesse interazioni tra vita umana e tecno-scienza. L’obiettivo di questo lavoro è evidenziare il ruolo centrale della letteratura per la riflessione bioetica contemporanea attraverso l’analisi di alcuni romanzi di Margaret Atwood: The Handmaid’s Tale (1985), Oryx and Crake (2003) and The Year of the Flood (2009). In particolare, The Handmaid’s Tale offre numerosi spunti per la discussione di fondamentali temi bioetici quali il biopotere, il corpo femminile e l’etica della riproduzione assistita, mentre Oryx and Crake e The Year of the Flood permettono di analizzare altre questioni bioetiche come l’ecologia e l’etica dell’ingegneria genetica.
Since its birth, bioethics has been an interdisciplinary inquiry blending philosophy, theology, law, medicine, the social sciences and the humanities to reflect on the complex interactions of human life and techno-science. The present work aims to underline the central role of literature for contemporary bioethical reflection by analyzing Margaret Atwood’s cautionary novels The Handmaid’s Tale (1985), Oryx and Crake (2003) and The Year of the Flood (2009). In particular, The Handmaid’s Tale provides a framework for discussion on biopower, the female body and the ethics of ARTs (Assisted Reproduction Technologies), while Oryx and Crake and The Year of the Flood allow us to analyze other bioethical concerns, namely ecology and the ethics of genetic engineering.

碩士
南華大學
生死學研究所
95
The purpose of this study is to investigate the senior high school nursing teachers’ bioethical attitude and teaching content toward the issues of abortion, and the relationship between them. The research is expected to be a practical reference for sexual educator and researcher toward the issues of abortion. The researcher designed a questionnaire survey as the research method. All of the senior high school nursing teachers in Taiwan (N=454) defined as the research target population. This questionnaire divided into four parts. The first part involved 30 questions inquiring about participants’ bioethical attitude toward the issues of abortion. The second part focused on the recognition of the fetus as human life during different pregnancy stages, consisting of 3 items. The third part involved 27 questions inquiring the opinions about teaching content toward the issues of abortion in sexual education. The fourth part was about personal data, consisting of 18 items. The data collected were analyzed by descriptive statistics, one-way multivariate analysis of variance, cluster analysis and canonical correlation. 　 　　The research results are generalized as follows： 1. In general, all respondents were comparatively opposed to bioethical attitude toward abortion, which is subject to mother''s decision-making power. 2. Most of the nursing teachers thought the moment of truth to recognize the fetus as human life comes before first pregnancy stage. 3. Bioethical attitude toward the issues of abortion among nursing teachers with different backgrounds was significantly different. 4. Bioethical attitude toward the issues of abortion among nursing teachers who had different recognition of the fetus as human life during different pregnancy stages was significantly different. 5. All respondents thought the four dimensions of teaching content toward the issues of abortion in sexual education were all important. The four dimensions include the choice and responsibility of sexual behavior, the knowledge of contraception, pregnancy and abortion, the problems about teenager''s delivery or abortion and the proper handling with their situations, the reflection and discussion about bioethics, religion and legislation toward the issues of abortion. 6. Parts of the opinions on teaching content toward the issues of abortion among nursing teachers with different backgrounds were significantly different. 7. The opinions on teaching content toward the issues of abortion among nursing teachers who had different recognition of the fetus as human life during different pregnancy stages were not significantly different. 8. All respondents'' bioethical attitude toward the issues of abortion could be subsumed under 4 label types. 9. The opinions on teaching content toward the issues of abortion among nursing teachers with different bioethical attitude types of abortion were significantly different. 10. The respondents'' bioethical attitude and their opinions on teaching content toward the issues of abortion were significantly related. Based on the study results, the author expects to provide certain suggestions to educational authorities for teaching training courses and the future related research.

碩士
南華大學
生死學研究所
91
The purpose of this study intends to understand the attitude of senior high school students toward abortion as well as surrogate mother in the bioethical attitude. It also 　investigates the difference in each variable of backgrounds toward abortion as well as surrogate mother in bioethics. 　　 　　The study applies the approach of questionnaire, using “questionnaire ” for senior high school students' attitude toward bioethics written and revised by myself. The main group of objects of this study consists of eighteen senior high schools, private and public, in Taichung city. Under the method of classified random sampling, I picked one thousand students as the study samples. The retrieving rate is 100 percent. The material is analyzed through statistical approaches such as T test, one way ANOVA, and Scheffe’ posterior comparison. 　　 　　The conclusion of this study can be concluded as follows: First of all, the main resources of information for the abortion of senior high school students in Taichung city are: presented in order, TV, teachers, books and magazines. Whereas for substitute mother are TV, books and magazines, and teachers. Secondly, the consultants for senior high school students to talk about abortion or surrogate mother are classmates or friends, and the parents, and then the teachers in order. The perspective of senior high school students toward abortion or surrogate mother is mainly influenced by their own conscience. Thirdly, students of senior high school tend to disapprove the attitude toward the issue of abortion about bioethics. 　　 　　The most unflavored conditions to abortion are: the sex of babies is not expected, being pregnant for more than four months. Nevertheless, the most acceptable conditions to abortion are: pregnant for being raped or incest, the babies being lopsided, and life threat from being pregnant to the mother’s health. If the female subjects become pregnant during the process of schooling, there are fifty-nine percent of students who choose abortion. Thirty-three percent of the male subjects, on the contrary would hope his girl friends to practice abortion during schooling. The major consultants of discussing abortion are classmates or friends, according to the friends who have practiced abortion. Next, the attitude toward abortion in bioethics variables are on the report of different kinds of schools, believes in religion, sexual experience, the occupation of the father, the educational background of parents, the conditions of getting along with parents, the main resources of abortive information. 　　　 　　Students keep a neutral attitude toward the issue of surrogate mother in bioethics. The most tolerable reason as a surrogate mother is “being without womb inherently or after operation." The least tolerable reason as a surrogate mother is “being with a normal womb but unwilling to become pregnant.” There are fifty-six male subjects disagree with “practicing surrogate mother in order to make money because of the financial difficulties of their own sisters”. Also, there are seventy-two percent of female subjects disagree with “practicing surrogate mother in order to money for the personal financial difficulties." Finally, over half of the subjects agree that the consigning parents shouldn’t know the surrogate mother. In addition, there are sixty-seven percent for the idea that the mother of the consigning parents should be the legal mother of the baby. However, there are eighteen percent for the surrogate mother. In conclusion, the attitude toward the issue of surrogate mother in bioethics variables are according to the conditions of sex, schools, and the background of parents’ education.

博士
國立臺灣大學
哲學研究所
104
Building on the core principle of pratītya-samutpāda (dependant co-rising), Buddhist bioethics displays its qualities in both view of life and of ethics. In Buddhism, life for the sentient beings is an incessantly reincarnating ever-long process, centralizing on the continually changing course of the mind. The ethical concerns of Buddhism not only focus on the intention of one’s actions, but also examine its outcome. In Buddhism, an action that is considered good is motivated by one’s kindhearted intention, which will improve one’s quality of demeanor and bring about positive effects to its subsequent journey to ultimate enlightenment. This dissertation attempts to deliberate on issues of death and dying in modern times, approaching from the aforementioned perspectives of Buddhist bioethics, firstly drawing upon the criteria of death which is closely related to the Buddhist view of life, then moving forward to discuss the ethical issues of organ donation and the act commonly known as euthanasia. First, this dissertation will explicate the boundaries of life and death and how one’s death is determined from a Buddhist philosophical viewpoint, and remark on the criteria of death in modern neurology. From the Buddhist view of life, the living body of a sentient being is composed of many properties, which can be classified into two categories: nāma(name) and rūpa (form). One’s birth and death are not singular incidents that happened at specific timings, but are part of an incessant process caused by one’s physical and mental changes of correlated properties. In Buddhism, determination of one’s death is based on three properties: vitality, heart and consciousness; when one’s consciousness is no longer attached to the physical body—meaning the body displays no sign of breathing, temperature and mental activities, and may even be showing signs of decay—they can then be ultimately declared dead. In comparison, modern neurology classifies one’s death based on cease of activity in the whole-brain, the brainstem or the higher brain, which merely establishes the determination of one’s death on the activity, or lack of, in their physical brain, so as to allow one’s death to be declared as soon as possible. Disputes regarding how one’s death ought to be determined show that there are irresolute conflicts between the appropriate timing to declare death and the maintaining one’s organ vitality. This dissertation will utilize the Buddhist approach to deliberate how organ donation protocols in modern times can affect the donor’s dying process, while examining the ethical controversies over the existing organ donation systems. In Buddhism, the organ donation protocol after brain death or cardiac death both overly emphasize the medical advantages to the recipient and consequently overlook the donor’s rights to dying a good death. Additionally, the modern-day opt-out organ donation system is in fact an act of killing which strips an individual of their organs without consent, violating the Buddhist precepts to not killing or harm any living being and not taking what had not been given. Although the opt-in organ donation system requires consent from the individual or their executor prior to organ harvesting, medical staff should proactively assist potential donors to obtain a full understanding of organ donation and explain the effects organ harvesting surgery may have on their deaths, so as to implement the ethical principle of “informed consent.” Finally, regarding end-of-life issues, this dissertation will discuss the ethical concerns of active euthanasia, physician-assisted suicide and forgoing life-sustaining treatment from the Buddhist perspective. According to the Buddhist doctrines of karma and reincarnation, death does not mean nothingness, therefore artificial means to advance the dying process, such as active euthanasia and physician-assisted suicide, would not only fail to help the individual achieve an immediate ultimate liberation, but also take away the opportunity for one to ultimately reflect on the impermanence and suffering in life and improve the quality of their mental state before departure from this world. Additionally, the physician who carries out the act of euthanasia or assisted suicide would also be guilty of killing, and followers of Buddhism are constrained from taking part in killing or assisting others to commit suicide. In contrast, should a physician forgo life-sustaining treatment for their patient under good intentions and made appropriate decisions based on the patient’s medical condition, they would not only be relieving the patient of unnecessary medical interventions and burdens during their dying process, but also help the patient to die a good death and move on to afterlife, which would be considered an act of compassion and wisdom.

A research report submitted to the Faculty of Health Sciences, Steve Biko Centre for Bioethics, University of the Witwatersrand, in partial fulfillment of the requirements for the degree of Master of Science in Medicine In the field of Bioethics and Health Law Johannesburg, 2011
Although Human Biological Materials (HBMs) are invaluable resources in biomedical research, they have not been without controversy in collaborative research between developed and developing countries. The normative arm of the study compared the key ethical issues in the laws, regulations and guideline documents of developed and developing countries with regard to the use, collection, storage, export and benefit-sharing of HBMs in collaborative research with developed countries. The empirical arm of the study examined how investigators and a Research Ethics Committee (REC) at a South African institution addressed these ethical issues, implemented national and international frameworks with regard to the use of HBMs. The majority of sponsors (59.6%, 90/151) in the study were from the USA compared to other developed countries (p=0.0001) with the bulk (65.84%) of the funds (R517.19 million) allocated for HIV research. HBMs for storage was obtained largely from adults (80.8%, 122/151) compared to children (12.6%, 19/151) [p <0.0001]. Whilst the principle investigators (PIs) of all 151 protocols informed the REC of their intent to store HBMs, only 87.4% (132/151) of PIs informed research participants (P <0.0001). In 47.7% (72/151) and 71.5 % (57/151) of protocols research participants were informed of the location and duration of storage, respectively, compared to 86% (130/151) and 19.25% (29/151) informing the REC (p < 0.0001), respectively. In 98% (149/151) of protocols informed consent (IC) was obtained from research participants with 76.8% (116/151) of protocols soliciting broad consent compared to specific consent (21.2%, 32/151) [p < 0.0001]. In the remaining 2% (3/151) of protocols IC for storage was not obtained. In 69.5% (105/151) of protocols confidentiality was maintained by a code and in 9.35% (14/151) of protocols HBMs was anonymised [p < 0.0001]. Significantly more protocols informed the REC (90/151, 59.6%) than the research participants (67/151, 44.4%) that HBMs will be exported (p= 0.011). Separate consent forms were not available for 60.9% (92/151) of protocols as per the requirement REC’s standard operating procedures (SOP). In 74% (51/69) of protocols the rationale for export was to access specialised laboratories (74%, 51/69) that were not available locally. Export permits were not available for 73.2% (109/151) of protocols. Where export permits were available, there were more exports to the USA (31/42, 73.8%) than to Europe (26.2%, 11/42) [p < 0.0001]. In the majority of protocols research participants were not informed of benefit sharing from any discoveries (129/151, 85.4%) or commercialisation (123/151, 81.5%) of products derived from their HBMs. Material Transfer Agreements (MTAs) were not available for 94.7% (143/151) protocols. Whilst 122/151(80.8%) protocols disclosed the amount of funds available from the sponsors for the research to the REC, not a single PI made such disclosures to the research participants (p < 0.0001). The varied definitions of what constitutes HBMs, the different terminologies used to describe identifiability, confidentiality, the different models of informed consent and different standards of ownership in the various national and international frameworks are characterised by a maze of definitions, laws, regulations and guidelines that are confusing, conflicting and defy generalisation. International and national laws, regulations and guidelines are fragmented and lack harmonisation. Most developing countries are in favour of severe restrictions on the use of their HBMs in collaborative research with developed countries. The protocols in the empirical study did not adequately address the inter-related ethical issues of export, storage, IC, commercialisation and benefit sharing derived from HBMs that are currently the subject of intense debate and controversy and central to the access to HBMs in collaborative research with developed countries. Because the empirical study is limited by the use of a convenient sample, the results cannot be generalised to other RECs in South Africa. Nevertheless, the data gives some credibility to the anecdotal evidence that HBMs are leaving the country unaccounted for without export permits and MTAs in place. Given the long delays in harmonizing and publishing new regulations and changes, outdated regulations and regulatory frameworks create opportunities for the proliferation of undesirable and unethical practices. Omissions in the RSA regulatory and ethical frameworks with regard to HBMs and Tissue Biobanking are concerning and require urgent action.

碩士
國立臺灣師範大學
生命科學系在職進修碩士班
97
Biotechnology is the most important development in the 21 century, the citizen in the future should face its ethics issues. The objects of this research are as follows: what kind of the biotechnology ethics cognition and manner of the junior high school students before they are going to the high school. The social subjects were integrated into the biotechnology ethics for studying the biotechnology cognition, the biotechnology ethics cognition and the biotechnology ethics manner situation in the junior high school students. “The questionnaire of the knowledge and manner about the teaching material in the biotechnological ethics subjects : About the gene therapy ” was used for the Investigating of biotechnology ethics concept of the junior high school students. The teaching materials were developed and instructed for 100 students in three schools for understanding the change of the biotechnological ethics cognition and the manner to the students. The results showed that the differences of the biotechnology cognition between students were huge, but there were significant increasing of biotechnology knowledge of the students after instruction. About the biotechnology ethics cognition, most students had the ideas about the pro and con of biotechnology ethic after the instruction. We found that after instruction, there was media positive correlation between the judgment of biotechnology ethics and biotechnology ethic cognition. There were significant differences in biotechnology knowledge and biotechnology ethics cognition. And the judgment of biotechnology ethics was effected by biotechnology knowledge and biotechnology ethics cognition. It seemed that it is helpful for increasing the ethic judgment ability with integrating the contents of biotechnology ethics into junior high school teaching materials.

Text in English
The rise of the biotechnical and genomic revolution has motivated contemporary artists to explore the use of scientific methods as a medium for art-making. The application of these ground-breaking methods within the realm of contemporary art allows for the distortion that exists between life sciences and the imagination to become a reality. This practice is known as transgenic art. With biotechnology as the new playing-field for art comes a myriad of dangerous implications, ethical issues, questions of authorship and responsibilities. The transgenic artworks of Eduardo Kac entitled GFP Bunny (2000) and Genesis (1999) form the basis of the research. The main question posed in this research explores the purpose of transgenic art and the unavoidable impact thereof on society. Social awareness of ethical issues surrounding this type of art-making is addressed. The poignancy of the study lies in debates deliberately introduced by the artist, but also unintended controversial issues that surface from the creation of living artworks.
Art History, Visual Arts & Musicology
M.A. (Visual Arts)

L'introduction de nouvelles biotechnologies dans tout système de soins de santé est un processus complexe qui est étroitement lié aux facteurs économiques, politiques et culturels, et, par conséquent, demande de remettre en cause plusieurs questions sociales et éthiques. Dans la situation particulière de l’Argentine - c’est-à-dire: de grandes inégalités sociales entre les citoyens, la rareté des ressources sanitaires, l’accès limité aux services de base, l’absence de politiques spécifiques - l'introduction de technologies génétiques pose de sérieux défis qui doivent impérativement être abordés par les décideurs politiques. Ce projet examine le cas des tests génétiques prénataux dans le contexte du système de santé argentin pour illustrer comment leur introduction peut être complexe dans une nation où l’accès égale aux services de santé doit encore être amélioré. Il faut également examiner les restrictions légales et les préceptes religieux qui influencent l'utilisation des technologies génétiques, ce qui souligne la nécessite de développer un cadre de référence intégral pour le processus d'évaluation des technologies afin d’appuyer l’élaboration de recommandations pour des politiques cohérentes et novatrices applicables au contexte particulier de l’Argentine.
The introduction of new biotechnologies in any health care system is a complex process that is closely tied to economic, political and cultural factors and thus poses a host of challenging social and ethical issues. In the particular situation of Argentina – that is, a country characterised by significant social inequalities between citizens, a scarcity of resources in health care, limited access to needed services, and a lack of specific health policies – the introduction of new genetic technologies poses serious ethical and policy challenges that need urgent attention by policy-makers. This project examines the case of prenatal genetic tests in the context of the Argentinean health care system with the aim of illustrating how complex their introduction can be in a nation where equal access to health care still needs significant improvements. Attention must also be given to the legal restrictions and religious precepts that strongly shape the use of these technologies. This further highlights the necessity of developing an integrated framework for the process of technology assessment, in order to support coherent and innovative policy recommendations applicable to the particular Argentinean context.

Problématique : La pénurie d’organes qui sévit actuellement en transplantation rénale incite les chercheurs et les équipes de transplantation à trouver de nouveaux moyens afin d’en améliorer l’efficacité. Le Groupe de recherche transdisciplinaire sur les prédicteurs du risque immunologique du FRSQ travaille actuellement à mettre en place de nouveaux outils facilitant la quantification du risque immunologique global (RIG) de rejet de chaque receveur en attente d’une transplantation rénale. Le calcul du RIG s’effectuerait en fonction de facteurs scientifiques et quantifiables, soit le biologique, l’immunologique, le clinique et le psychosocial. La détermination précise du RIG pourrait faciliter la personnalisation du traitement immunosuppresseur, mais risquerait aussi d’entraîner des changements à l’actuelle méthode de sélection des patients en vue d’une transplantation. Cette sélection se baserait alors sur des critères quantifiables et scientifiques. L’utilisation de cette méthode de sélection possède plusieurs avantages, dont celui d’améliorer l’efficacité de la transplantation et de personnaliser la thérapie immunosuppressive. Malgré tout, cette approche soulève plusieurs questionnements éthiques à explorer chez les différents intervenants œuvrant en transplantation rénale quant à sa bonne utilisation. Buts de l’étude : Cette recherche vise à étudier les perceptions de néphrologues transplanteurs et référents de la province de Québec face à l’utilisation d’une méthode de sélection des patients basée sur des critères scientifiques et quantifiables issus de la médecine personnalisée. Les résultats pourront contribuer à déterminer la bonne utilisation de cette méthode et à étudier le lien de plus en plus fort entre science et médecine. Méthodes : Des entretiens semi-dirigés combinant l’emploi de courtes vignettes cliniques ont été effectués auprès de 22 néphrologues québécois (transplanteurs et référents) entre juin 2007 à juillet 2008. Le contenu des entretiens fut analysé qualitativement selon la méthode d’analyse de Miles et Huberman. Résultats : Les résultats démontrent une acceptation généralisée de cette approche. La connaissance du RIG pour chaque patient peut améliorer le traitement et la prise en charge post-greffe. Son efficacité serait supérieure à la méthode actuelle. Par contre, la possible exclusion de patients pose un important problème éthique. Cette nouvelle approche doit toutefois être validée scientifiquement et accorder une place au jugement clinique. Conclusions : La médecine personnalisée en transplantation devrait viser le meilleur intérêt du patient. Malgré l’utilisation de données scientifiques et quantifiables dans le calcul du RIG, le jugement clinique doit demeurer en place afin d’aider le médecin à prendre une décision fondée sur les données médicales, son expertise et sa connaissance du patient. Une réflexion éthique approfondie s’avère nécessaire quant à l’exclusion possible de patients et à la résolution de la tension entre l’équité et l’efficacité en transplantation rénale.
Background: The overwhelming scarcity of organs within renal transplantation forces researchers and transplantation teams to seek new ways to increase efficacy. The Groupe de recherche transdisciplinaire sur les prédicteurs du risque immunologique is attempting to put in place a scientifically precise method for determining the global immunological risk (GIR) of rejection for each patient waiting for a renal transplant. The quantification of the GIR is based on scientific factors, such as biological, immunological, clinical and psychosocial. The precise and global determination of the GIR could change the way patients are selected for renal transplantation. This selection will be based thus on scientific and quantifiable criteria. The advantages of the use of this method for selecting potential allograft recipients could be improvement in the efficacy of the process and the individualization of immunosuppressive therapy. In spite of these numerous advantages, this approach raises several ethical questions to explore with nephrologists working in kidney transplantation. Aims of the study: The aims of this study is to explore the views of transplant and referring nephrologists on the use of personalized medicine tools to develop a new method for selection potential recipients of a renal allograft. The results of this research could contribute to determine the acceptable use of this method in renal transplantation and to study the link between science and medicine. Methods: Twenty-two semi-directed interviews, using short clinical vignettes, were conducted with nephrologists in the province of Quebec between June 2007 and July 2008. The semi-directed interviews were analyzed qualitatively using the content and thematic analysis method described by Miles and Huberman. Results: The results demonstrate a general acceptance of this approach amongst the participants. Knowledge of each patient’s immunological risk could improve treatment and the post-graft follow-up. On the other hand, the possibility that patients might be excluded from transplantation poses a significant ethical issue. It could be more effective than the method presently used. The method must be validated scientifically, and must leave a role for clinical judgment. Conclusions: The use of personalized medicine within transplantation must be in the best interests of the patient. However, in spite of the use of such scientific data, a place must be retained for the clinical judgment that allows a physician to make decisions based on medical data, professional expertise and knowledge of the patient. An ethical reflection is necessary in order to focus on the possibility of patients being excluded, as well as on the resolution of the equity/efficacy dilemma.