Genes, free will, and criminal responsibility

Advances in human genetics have raised the possibility that genetic mechanisms can explain various aspects of human behavior. It has been suggested that such genetic explanations would tend to diminish responsibility for one's actions. In this paper I argue that the genetic approach adds little to our understanding of free will, determinism, and responsibility. Even though human beings are material systems obeying the laws of the physical and biological sciences, their behavior may still be unpredictable and essentially undetermined. Moreover, with few exceptions, behavior influenced by genes is no more deterministic than is behavior influenced by the environment. An analysis of the genetic and environmental influences and the complex interactions between them reveals a certain symmetry between genetic and environmental explanations of behavior. Consequently, any argument concerning the relevance of a genetic excuse to a criminal defense will be equally applicable to an environmental excuse.     

'It's them faulty genes again': women, men and the gendered nature of genetic responsibility in prenatal blood screening

Prenatal blood tests are routinely offered to pregnant women in the UK. Male partners are tested only where a combined positive male and female test could detect fetal abnormality such as sickle cell anaemia. Little is known about the gendered nature of screening and the impact it has on lay feelings of genetic responsibility. For example, do women take exclusive ‘maternal responsibility’ for the fetus? How is this responsibility challenged when men are also screened? Drawing on empirical research with pregnant women and their male partners in a northern city in the UK, this paper aims to explore the gendered nature of genetic responsibility in prenatal blood screening. The paper will argue that women and men feel a sense of genetic responsibility for the fetus throughout screening. However, while women's sense of responsibility is directly ‘embodied’ and is heightened by the detection of ‘faulty genes’, men's manifests itself indirectly through shared responsibility with their pregnant partners and directly through their own genetic connections to the fetus. The paper concludes that the gendered nature of genetic responsibility is complex and contradictory, producing a set of gender roles that both challenges and reinforces a traditional gender division of labour.     

Doing the right thing: genetic risk and responsibility

This paper reports the findings of an interview study of women (n = 40) attending genetic counselling for hereditary breast/ovarian cancer (HBOC). The analysis indicates that women who attend genetics clinics perceive themselves as having a responsibility to their kin (past, present and future generations) to establish the magnitude of their risk and the risks to other family members, and to act upon this information by engaging in some form of risk management. It is observed that in acknowledging their genetic responsibility for their kin these women not only relinquished their right not to know about their risks, but also committed themselves to undertaking risk management practices which may have iatrogenic consequences. It is argued that the construction of genetic risk as a moral issue can be seen as limiting the choices which are available to women who attend genetic counselling.     

财政分权与公共卫生政府间责任分担的现实选择

按照财政分权理论,公共卫生政府间责任分担的主要原则为受益原则、规模效应原则、收入再分配原则以及基本公共卫生服务可及原则。据此,对公共卫生政府间责任进行了理论划分;随后考虑财政分权理论假设与我国现实的差距,对公共卫生政府间责任的理论划分情况进行了调整。     

Deafness, Genetics and Dysgenics

It has been argued by some authors that our reaction to deaf parents who choose deafness for their children ought to be compassion, not condemnation. Although I agree with the reasoning proposed I suggest that this practice could be regarded as unethical. In this article, I shall use the term “dysgenic” as a culturally imposed genetic selection not to achieve any improvement of the human person but to select genetic traits that are commonly accepted as a disabling condition by the majority of the social matrix; in short as a handicap. As in eugenics, dysgenics can be achieved in a positive and a negative way. Positive dysgenics intends to increase the overall number of people with a particular genetic trait. Marriage between deaf people or conceiving deaf children through reproductive technology are examples of positive dysgenics. Negative dysgenics can be obtained through careful prenatal or pre-implantation selection and abortion (or discarding) of normal embryos and foetuses. Only deaf children would be allowed to live. If dysgenics is seen as a programmed genetic intervention that undesirably shapes the human condition – like deliberately creating deaf or dwarf people – the professionals involved in reproductive technologies should answer the question if this should be an accepted ethical practice because the basic human right to an open future is violated.     

Genetics and culture: The geneticization thesis

The concept of ‘geneticization’ has been introduced in the scholarly literature to describe the various interlocking and imperceptible mechanisms of interaction between medicine, genetics, society and culture. It is argued that Western culture currently is deeply involved in a process of geneticization. This process implies a redefinition of individuals in terms of DNA codes, a new language to describe and interpret human life and behavior in a genomic vocabulary of codes, blueprints, traits, dispositions, genetic mapping, and a gentechnological approach to disease, health and the body. This article analyses the thesis of ‘geneticization’. Explaining the implications of the thesis, and discussing the critical refutations, it is argued that ‘geneticization’ primarily is a heuristic tool that can help to re-focus the moral debate on the implications of new genetic knowledge towards interpersonal relations, the power of medicine, the cultural context and social constraints, rather than emphasizing issues as personal autonomy and individual rights. This revised version was published online in July 2006 with corrections to the Cover Date.     

Trust,accountability and choice

The emphasis in recent government policy for the NHS in England on the need to increase both the accountability of health care professionals and the choice available to patients have implications for trust relations. However, the findings from empirical research have not only highlighted the continued salience of trust to health care relationships but have questioned the effectiveness of performance management as a means of accountability and the ability of performance data to act as indicators of quality. This research evidence also suggests choice and trust do seem to be related and when choice is exercised it does seem to be based on trust of the doctors' competence and the cleanliness of the hospital mainly derived from indirect or direct experience. Performance information appears to act post the GP referral decision to influence the extent to which patients feel comfortable with the referral rather than actively determining where patients choose to be referred.     

烟草控制的责任伦理

烟草控制事关公民的生命健康,从个人、群体到政府都要有伦理责任和道德担当.其中,个人责任是基础,个人要有健康责任意识、消费责任意识和权利责任意识;群体责任是关键,医生、媒介、消费、烟企等群体责无旁货;政府责任是根本,政府要通过健康教育、人才培养、科学研究、立法干预等多种方式担负起烟草控制的伦理责任.     

公立医院与社会责任

公立医院作为政府投资设立的非营利组织，应该承担一定的社会责任，但是，如何理解公立医院的社会责任是需要研究的问题。本文通过分析公立医院承担社会责任的现状，探讨公立医院承担社会责任的方式，旨在增强医院的社会责任意识，构建和谐医患关系。     

Accounting for risk and responsibility associated with smoking among mothers of children with respiratory illness

Contemporary public health discourses construct individuals as rational, responsible and knowledgeable, and thus promote a self-controlled prudent response to risk. In the context of evidence emphasising risks to children's health associated with passive smoking, mothers of children with respiratory illness may knowingly place their children at increased risk should they continue to smoke in their presence. Drawing on an analysis of depth qualitative interview accounts with mothers who smoke and whose young child was recently admitted to hospital with respiratory illness, this study describes mothers' constructions of risk and responsibility associated with their smoking. Three forms of accounting style were identified: 'stories of acceptability'; 'denial of agency'; and 'reflections of guilt'. 'Stories of acceptability' either positioned the risk of passive smoking as contained and controlled to an acceptable level, or disputed the level of risk that passive smoke posed. 'Denial of agency' drew on discourses of addiction and shared responsibility to exonerate the mother of responsibility or blame. 'Reflections of guilt' were presented when contradictions arose within accounts, particularly in relation to discussions of agency and rationality in decision-making. The study illustrates how constructions of moral responsibility, especially in relation to being a 'good mother', framed mothers' accounts of smoking in the face of risk. The study concludes that far greater consideration be given to the way in which mothers rationalise their smoking to others if paediatric doctors are to foster risk reduction practices associated with passive smoking more effectively.     

Attribute level overlap (and color coding) can reduce task complexity,improve choice consistency,and decrease the dropout rate in discrete choice experiments

A randomized controlled discrete choice experiment (DCE) with 3,320 participating respondents was used to investigate the individual and combined impact of level overlap and color coding on task complexity, choice consistency, survey satisfaction scores, and dropout rates. The systematic differences between the study arms allowed for a direct comparison of dropout rates and cognitive debriefing scores and accommodated the quantitative comparison of respondents' choice consistency using a heteroskedastic mixed logit model. Our results indicate that the introduction of level overlap made it significantly easier for respondents to identify the differences and choose between the choice options. As a stand‐alone design strategy, attribute level overlap reduced the dropout rate by 30%, increased the level of choice consistency by 30%, and avoided learning effects in the initial choice tasks of the DCE. The combination of level overlap and color coding was even more effective: It reduced the dropout rate by 40% to 50% and increased the level of choice consistency by more than 60%. Hence, we can recommend attribute level overlap, with color coding to amplify its impact, as a standard design strategy in DCEs.     

艾滋病案例的法律责任

分析了几种艾滋病案例及其法律责任,提出要负责任地对待艾滋病的检测工作,贯彻执行《献血法》,坚决打击非法卖血活动,并将传播艾滋病列入刊法打击范畴。     

Genetics of Type 2 Diabetes: Past,Present, and Future

Diabetes has reached epidemic proportions worldwide. Currently, approximately 537 million adults (20–79 years) have diabetes, and the total number of people with diabetes is continuously increasing. Diabetes includes several subtypes. About 80% of all cases of diabetes are type 2 diabetes (T2D). T2D is a polygenic disease with an inheritance ranging from 30 to 70%. Genetic and environment/lifestyle factors, especially obesity and sedentary lifestyle, increase the risk of T2D. In this review, we discuss how studies on the genetics of diabetes started, how they expanded when genome-wide association studies and exome and whole-genome sequencing became available, and the current challenges in genetic studies of diabetes. T2D is heterogeneous with respect to clinical presentation, disease course, and response to treatment, and has several subgroups which differ in pathophysiology and risk of micro- and macrovascular complications. Currently, genetic studies of T2D focus on these subgroups to find the best diagnoses and treatments for these patients according to the principles of precision medicine.     

医疗纠纷替代解决机制的分析、评价与选择

由于诉讼的周期长、成本高和刚性化特点,通过诉讼方式解决日益增多和逐步升级的医疗纠纷有一定的局限性。我国实践中正在积极探索各种行之有效的医疗纠纷替代解决机制。试图对我国现有的医疗纠纷替代解决机制进行比较、分析和评价,并给出倾向性的选择,以求为完善我国医疗纠纷解决机制提供些许建议。     

'Faced' with responsibility: Levinasian ethics and the challenges of responsibility in Norwegian public health nursing

Abstract This paper is concerned with aspects of responsibility in Norwegian public health nursing. Public health nursing is an expansive profession with diffuse boundaries. The Norwegian public health nurse does not perform ‘hands on’ nursing, but focuses on the prevention of illness, injury, or disability, and the promotion of health. What is the essence of ethical responsibility in public health nursing? The aim of this article is to explore the phenomenon based on the ethics of responsibility as reflected upon by the philosopher Emanuel Levinas (1906–1995). From an ethical point of view, responsibility is about our duty towards the Other, a duty we have not always chosen, are prepared for, or can fully explain; but it is nevertheless a demand we have to live with. Interviews with five experienced Norwegian nurses provide the empirical base for reflection and interpretation. The nurses share stories from their practice. In interpreting the nurses’ stories, the following themes emerge: personal responsibility; boundaries; temporality; worry, fear, and uncertainty; and a sense of satisfaction. As the themes are developed further, it becomes apparent that, despite their diversity, they are all interrelated aspects of ethical responsibility. Responsibility for the Other cannot be avoided, ignored, or transferred. The nurses’ responsibility is personal and infinite. Levinasian ethics can help nurses understand the importance of accepting that being a responsive carer can involve not only contentment in the predictable, but also the fear, worry, and uncertainty of the unpredictable.     

政府承担公共卫生职能的目标定位和范畴界定

针对政府公共卫生的管理职能和方式等两个问题，对政府承担公共卫生职能的目标定位和政府强化公共卫生管理职能进行了研究，提出了政府应保障民众最基本的医疗需求和公共卫生，进而提出政府应强化对公共卫生的筹资和分配，落实公共卫生体系建设和发展5项重点干预的建议。     

Religiosity and sexual responsibility: relationships of choice

OBJECTIVE: To determine the current influence of women's religiosity upon their sexual attitudes and behavior, including feelings of guilt. METHOD: An anonymous questionnaire was administered to 535 female undergraduates at a Midwestern university. RESULTS: Higher degrees of religiosity were associated with negative attitudes toward nonprocreative sexual activities, guilt towards masturbation, less likelihood of engaging in sexual intercourse, and fewer sex partners if sexually experienced. No significant differences were found regarding religiosity and physiological or psychological sexual satisfaction. CONCLUSION: Religiosity appears related to sexual attitudes and behavior of college women, but not physiological or psychological sexual satisfaction.     

医院总会计师的职责与岗位胜任力

分析了医院总会计师的角色与职责,在此基础上提出总会计师要想胜任其医院最高财务负责人的角色,需具备职业品质、专业素质及管理素质三个方面的胜任力,同时对医院总会计师胜任力模型各要素含义进行了分述。