The obligation to provide information where valid consent is not needed

Accounts of consent in medical ethics typically assume that consent plays the same role irrespective of the type of treatment. In this paper I argue that this assumption is false. Because of this, obligations to provide information to patients that stem from the need for consent to be valid will not apply to all types of treatment. This does not mean that there are no reasons to provide such information. The second part of the paper maps out what these reasons are and argues that they are grounded in the obligation of beneficence and a duty to warn, not in considerations of respect for autonomy.

Informed consent and the requirement to ensure understanding

It is generally held that doctors and researchers have an obligation to obtain informed consent. Over time there has been a move in relation to this obligation from a requirement to disclose information to a requirement to ensure that that information is understood.Whilst this change has been resisted, in this article I argue that both sides on this matter are mistaken.When investigating what information is needed for consent to be informed we might be trying to determine what information a person would need in order to consent at all, or we might be trying to determine what information a person needs in order to make an informed choice about whether or not to consent. I argue that the obligation to ensure understanding only applies to information generated by the ?rst type of enquiry; but that much of the information generally thought necessary in order for consent to be informed is only required if our concern is with the second type of enquiry. For this reason it is neither the case that doctors and researchers should ensure all the information they provide is understood, nor is it the case that their only obligation is to disclose it.

Genetic professionals' reports of nondisclosure of genetic risk information within families

Patients attending genetic clinics are often the main gatekeepers of information for other family members. There has been much debate about the circumstances under which professionals may have an obligation, or may be permitted, to pass on personal genetic information about their clients but without their consent to other family members. We report findings from the first prospective study investigating the frequency with which genetics professionals become concerned about the failure of clients to pass on such information to their relatives. In all, 12 UK and two Australian regional genetic services reported such cases over 12 months, including details of actions taken by professionals in response to the clients' failure to disclose information. A total of 65 cases of nondisclosure were reported, representing

Methods to increase response to postal and electronic questionnaires

Background: Postal and electronic questionnaires are widely used for data collection in epidemiological studies but non-response reduces the effective sample size and can introduce bias. Finding ways to increase response to postal and electronic questionnaires would improve the quality of health research. Objectives: To identify effective strategies to increase response to postal and electronic questionnaires. Search strategy: We searched 14 electronic databases to February 2008 and manually searched the reference lists of relevant trials and reviews, and all issues of two journals. We contacted the authors of all trials or reviews to ask about unpublished trials. Where necessary, we also contacted authors to confirm methods of allocation used and to clarify results presented. We assessed the eligibility of each trial using pre-defined criteria. Selection criteria: Randomised controlled trials of methods to increase response to postal or electronic questionnaires. Data collection and analysis: We extracted data on the trial participants, the intervention, the number randomised to intervention and comparison groups and allocation concealment. For each strategy, we estimated pooled odds ratios (OR) and 95% confidence intervals (CI) in a random-effects model. We assessed evidence for selection bias using Egger's weighted regression method and Begg's rank correlation test and funnel plot. We assessed heterogeneity among trial odds ratios using a Chi 2 test and the degree of inconsistency between trial results was quantified using the I 2 statistic. Main results: Postal We found 481 eligible trials.The trials evaluated 110 different ways of increasing response to postal questionnaires.We found substantial heterogeneity among trial results in half of the strategies. The odds of response were at least doubled using monetary incentives (odds ratio 1.87; 95% CI 1.73 to 2.04; heterogeneity P < 0.00001, I 2 = 84%), recorded delivery (1.76; 95% CI 1.43 to 2.18; P = 0.0001, I 2 = 71%), a teaser on the envelope - e.g. a comment suggesting to participants that they may benefit if they open it (3.08; 95% CI 1.27 to 7.44) and a more interesting questionnaire topic (2.00; 95% CI 1.32 to 3.04; P = 0.06, I 2 = 80%). The odds of response were substantially higher with pre-notification (1.45; 95% CI 1.29 to 1.63; P < 0.00001, I 2 = 89%), follow-up contact (1.35; 95% CI 1.18 to 1.55; P < 0.00001, I 2 = 76%), unconditional incentives (1.61; 1.36 to 1.89; P < 0.00001, I 2 = 88%), shorter questionnaires (1.64; 95%CI 1.43 to 1.87; P < 0.00001, I 2 = 91%), providing a second copy of the questionnaire at follow up (1.46; 95% CI 1.13 to 1.90; P < 0.00001, I 2 = 82%), mentioning an obligation to respond (1.61; 95% CI 1.16 to 2.22; P = 0.98, I 2 = 0%) and university sponsorship (1.32; 95% CI 1.13 to 1.54; P < 0.00001, I 2 = 83%). The odds of response were also increased with non-monetary incentives (1.15; 95% CI 1.08 to 1.22; P < 0.00001, I 2 = 79%), personalised questionnaires (1.14; 95% CI 1.07 to 1.22; P < 0.00001, I 2 = 63%), use of hand-written addresses (1.25; 95% CI 1.08 to 1.45; P = 0.32, I 2 = 14%), use of stamped return envelopes as opposed to franked return envelopes (1.24; 95% CI 1.14 to 1.35; P < 0.00001, I 2 = 69%), an assurance of confidentiality (1.33; 95% CI 1.24 to 1.42) and first class outward mailing (1.11; 95% CI 1.02 to 1.21; P = 0.78, I 2 = 0%). The odds of response were reduced when the questionnaire included questions of a sensitive nature (0.94; 95% CI 0.88 to 1.00; P = 0.51, I 2 = 0%). Electronic: We found 32 eligible trials. The trials evaluated 27 different ways of increasing response to electronic questionnaires. We found substantial heterogeneity among trial results in half of the strategies. The odds of response were increased by more than a half using non-monetary incentives (1.72; 95% CI 1.09 to 2.72; heterogeneity P < 0.00001, I 2 = 95%), shorter e-questionnaires (1.73; 1.40 to 2.13; P = 0.08, I 2 = 68%), including a statement that others had responded (1.52; 95% CI 1.36 to 1.70), and a more interesting topic (1.85; 95% CI 1.52 to 2.26). The odds of response increased by a third using a lottery with immediate notification of results (1.37; 95% CI 1.13 to 1.65), an offer of survey results (1.36; 95% CI 1.15 to 1.61), and using a white background (1.31; 95% CI 1.10 to 1.56). The odds of response were also increased with personalised e-questionnaires (1.24; 95% CI 1.17 to 1.32; P = 0.07, I 2 = 41%), using a simple header (1.23; 95% CI 1.03 to 1.48), using textual representation of response categories (1.19; 95% CI 1.05 to 1.36), and giving a deadline (1.18; 95% CI 1.03 to 1.34). The odds of response tripled when a picture was included in an e-mail (3.05; 95% CI 1.84 to 5.06; P = 0.27, I 2 = 19%). The odds of response were reduced when "Survey" was mentioned in the e-mail subject line (0.81; 95% CI 0.67 to 0.97; P = 0.33, I 2 = 0%), and when the e-mail included a male signature (0.55; 95% CI 0.38 to 0.80; P = 0.96, I 2 = 0%). Authors' conclusions: Health researchers using postal and electronic questionnaires can increase response using the strategies shown to be effective in this systematic review. Copyright © 2009 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.


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Annotation of Case C-353/92, Hellenic Republic v Council, ECR 1994 I-3411, and Case C-358/92, Hellenic Republic v Commission, ECR I-3507

Action for annulment - Council Regulation (EEC) Nº 1765/92 of 30 June 1992 establishing a support system for producers of certain arable crops - Commission Regulation (EEC) Nº 2294/92 of 31 July 1992 on detailed rules for the application of the support system for producers of the oil seeds referred to in Council Regulation (EEC) Nº 1765/92 - Obligation to observe a final date for sowing and for lodging an application for a compensatory payment

Patterns of use of natural health products by Ontario seniors

A random dialing telephone survey of 1,071 60+ year-olds in 4 Ontario communities identified 553 (52%) users of natural health products. Mean age was 72 yrs (min-max:60-95); 76% were female. The most frequently reported natural health products were: echinacea (27%), glucosamine (26%), garlic (20%), ginkgo biloba (10%), St. John's wort (5%), ginseng (5%), flax seed oil (3%), evening primrose oil (2%), devil's claw (2%), saw palmetto (2%). Natural source vitamin use was reported by 24% of users, and 6% reporting using herbal teas. 51% of users used 2 or more herbal products and 8% used 5 or more products. 19% of herbal users also used a conventional prescription drug to manage the same health problem as the herbal product. The reported range of monthly expenditures for these products varied from a few cents (grew their own) to $288 (CAN). Thirty-five percent of users did not know the price of at least one of their natural products. Of the 75% of respondents willing to disclose their annual household income ($CAN), 20 had an income of $46,000. The widespread use and potential for significant expenditure of limited resources would suggest that more study is required into the efficacy, safety and value of these products.

Gay men and intimate partner violence: a gender analysis

Though intimate partner violence (IPV) is predominately understood as a women’s health issue most often emerging within heterosexual relationships, there is increasing recognition of the existence of male victims of IPV. In this qualitative study we explored connections between masculinities and IPV among gay men. The findings show how recognising IPV was based on an array of participant experiences, including the emotional, physical and sexual abuse inflicted by their partner, which in turn led to three processes. Normalising and concealing violence referred to the participants’ complicity in accepting violence as part of their relationship and their reluctance to disclose that they were victims of IPV. Realising a way out included the participants’ understandings that the triggers for, and patterns of, IPV would best be quelled by leaving the relationship. Nurturing recovery detailed the strategies employed by participants to mend and sustain their wellbeing in the aftermath of leaving an abusive relationship. In terms of masculinities and men’s health research, the findings reveal the limits of idealising hegemonic masculinities and gender relations as heterosexual, while highlighting a plurality of gay masculinities and the need for IPV support services that bridge the divide between male and female as well as between homosexual and heterosexual.

Evaluation of Microcollimated Pars Plana External Beam Radiation in the Porcine Eye

Purpose: To evaluate the clinical and histological side effects of a prototype stereotactic radiotherapy system delivering microcollimated external beam radiation through pars plana in porcine eyes.

Methods: Five Yucatan mini-swine (10 eyes) were randomized to five treatment groups. Eight eyes were dosed with X-ray radiation on Day 1, and two eyes served as untreated controls. Treated eyes received doses up to 60 Gy to the retina and up to 130 Gy to the sclera using single or overlapping beams. The treatment beams were highly collimated such that the diameter was approximately 2.5 mm on the sclera and 3 mm on the retinal surface. Fundus photography, fluorescein angiography (FA), and spectral domain optical coherence tomography (SD-OCT) were obtained on days 7, 30, 60, and 110. Images were examined by a masked grader and evaluated for abnormalities. Animals were sacrificed on day 111 and gross and histopathological analysis was conducted.

Results: Histological and gross changes to eye structures including conjunctiva and lens were minimal at all doses. Fundus, FA, and SD-OCT of the targeted region failed to disclose any abnormality in the control or 21 Gy treated animals. In the 42 and 60 Gy animals, hypopigmented spots were noted after treatment on clinical exam, and corresponding hyperfluorescent staining was seen in late frames. No evidence of choroidal hypoperfusion was seen. The histological specimens from the 60 Gy animals showed photoreceptor loss and displacement of cone nuclei.

Conclusion: Transcleral stereotactic radiation dosing in porcine eyes can be accomplished with no significant adverse events as doses less than 42 Gy.

Second harmonic generation in h-BN and MoS2 monolayers: Role of electron-hole interaction

We study second-harmonic generation in h-BN and MoS$_2$ monolayers using a novel \emph{ab initio} approach based on Many-body theory. We show that electron-hole interaction doubles the signal intensity at the excitonic resonances with respect to the contribution from independent electronic transitions. This implies that electron-hole interaction is essential to describe second-harmonic generation in those materials. We argue that this finding is general for nonlinear optical properties in nanostructures and that the present methodology is the key to disclose these effects.

Validation of a regional Indonesian seas model based on a comparison between model and INSTANT transports

The International Nusantara Stratification and Transport (INSTANT) program measured currents through multiple Indonesian Seas passages simultaneously over a three-year period (from January 2004 to December 2006). The Indonesian Seas region has presented numerous challenges for numerical modelers - the Indonesian Throughflow (ITF) must pass over shallow sills, into deep basins, and through narrow constrictions on its way from the Pacific to the Indian Ocean. As an important region in the global climate puzzle, a number of models have been used to try and best simulate this throughflow. In an attempt to validate our model, we present a comparison between the transports calculated from our model and those calculated from the INSTANT in situ measurements at five passages within the Indonesian Seas (Labani Channel, Lifamatola Passage, Lombok Strait, Ornbai Strait, and Timor Passage). Our Princeton Ocean Model (POM) based regional Indonesian Seas model was originally developed to analyze the influence of bottom topography on the temperature and salinity distributions in the Indonesian seas region, to disclose the path of the South Pacific Water from the continuation of the New Guinea Coastal Current entering the region of interest up to the Lifamatola Passage, and to assess the role of the pressure head in driving the ITF and in determining its total transport. Previous studies found that this model reasonably represents the general long-term flow (seasons) through this region. The INSTANT transports were compared to the results of this regional model over multiple timescales. Overall trends are somewhat represented but changes on timescales shorter than seasonal (three months) and longer than annual were not considered in our model. Normal velocities through each passage during every season are plotted. Daily volume transports and transport-weighted temperature and salinity are plotted and seasonal averages are tabulated.

A Gendered Profession

A Gendered Profession, RIBA Publications, Oct 2016

For a profession that claims to be so concerned with the needs of society, the continuing gender imbalance in architectural education and practice is a difficult subject. Difficult, because it’s been stagnant for some thirty years. This book seeks to change that.
Beyond the profession, the emergence of fourth wave feminism has broken a twenty-year drought in the discourse[1]. A new generation of feminist critique is emerging, characterised by a broader civic commitment, one fuelled by the recognition that time and again, women and minorities have been the first casualties of neo-liberalism.
Whereas after World War II the architectural profession rallied around its obligation to fulfil a social need, today architecture has all but capitulated its absolute servitude to capitalism. Recognising that feminist thinking is a meaningful response to the inequalities of capitalism, A Gendered Profession will be a forum for a discussion about the failure of our profession – one that is so explicitly concerned with the design of inclusive environments – to resolve its own inequalities. Contributions have been sought and responses elicited from all corners of the discipline to propose strategies, attitudes and solutions to this crisis in representation.
At stake is more than just the lack of female representation. Male architects suffer from the same ingrained mechanisms of gender stereotyping, obliged to place professional commitments above those to their family and children. And while three quarters of lesbian, gay, bisexual and transsexual architects report being comfortable about being open about their sexuality in the workplace, that number drops to just sixteen per cent when on the building site.
A Gendered Profession will aim to perform a diagnostic check of the architecture profession from one end of the spectrum to the other. Whereas much has been written on feminism and architecture, the majority is produced exclusively by women. A Gendered Profession has worked hard towards gender parity in both its contributions and editorial structure and therefore does not limit its understanding of gender to an either/or analogue. The chapters featured in the book are written by artists, academics, practitioners and students.
Through its diverse authorship, this book will provide the first ever attempt to move the debate beyond the tradition of gender-partitioned diagnostic or merely critical discourse on the gender and wider inclusivity debate towards something more propositional, actionable and transformative.

Commentary on Stationers' Company v. Carnan (1775)

Case in which the Court of Common Pleas decided that the Crown did not have the authority to grant exclusive prerogative rights over the printing of almanacs, a monopoly which the Stationers' Company had enjoyed, uncontested, since the formation of the ‘English Stock' in the early seventeenth century.
The commentary describes the background to the litigation, as well as the various strategies that the Stationers' Company employed in their efforts to regain control of the almanac market in the wake of the decision. It also explores how the decision provided the springboard for the emergence of a more contemporary concept of prerogative copyright. It was no longer thought that the Crown could grant printing patents over certain classes of work as of right. Rather, it was the monarch's unique constitutional position as head of both church and state that imposed an obligation to ensure the dissemination of authentic and authoritative versions of both legal and religious materials, and, from this obligation, the right to print the same arose.