Report on an audit of two decades’ activities of a clinical ethics committee: the Newcastle upon Tyne Hospitals NHS Foundation Trust Clinical Ethics Advisory Group (CEAG).Raj K. Mohindra &Stephen J. Louw -forthcoming -Journal of Medical Ethics.detailsBackground‘The Clinical Ethics Advisory Group’ (CEAG) is the clinical ethics support body for Newcastle upon Tyne Hospitals National Health Service Foundation Trust. A significant change in CEAG’s way of working occurred over the past 5 years as a result of Court decisions, increasing public expectations and an increase in CEAG’s paediatric case flow.PurposeReview historical data: (a) as a useful benchmark to look for the early impact of significant service changes and (b) to seek possible reference (‘sentinel’) cases for use with (...) a posited practical (casuistic) case-based reasoning model.MethodsAudit of the minutes of the first 22 years’ meetings was undertaken by the two chairs of CEAG over that period of time.Results223 matters discussed: 86 Trust policy issues; 117 clinical cases (84 adult (32 urgent), 33 child (8 urgent)); 12 CEAG procedural issues and 8 UK Clinical Ethics Network ‘round robin’ cases. The range of topic areas was wide. A broad range of ethical structures were deployed, principlism predominated. Quality was subjectively assessed by each reviewer, but different methods were used. This proved highly concordant between the two reviewers. 47% (105/223) of discussions were ‘excellent’ (*A4C4–A4C4) and 70% (156.5/223) ‘good’ or better (*A4C4–A3C3). By meeting the criteria of ‘excellent’ and ‘prospective’, 92/223 (41%) of matters were deemed potentially suitable as sentinel cases.ConclusionsThe audit provides a rich vein of information. There is demand for CEAG’s services, workload is becoming more complex. Formal funding for such services seems justified. (shrink)
Desmond's non-NICE choice: dilemmas from drug-eluting stents in the affordability gap.Raj K. Mohindra &Jim A. Hall -2006 -Clinical Ethics 1 (2):105-108.detailsFor medical interventions there is a gap between what clinical scientific research has established as likely to carry clinical benefit and what the National Institute for Clinical Excellence (NICE) has judged as cost-effective. This gap is the affordability gap. It is created by a value judgement made by NICE and affirmed by the Secretary of State for Health. This value judgement operates to affect other value judgements made in actual clinical situations where at least one choice of treatment falls into (...) the affordability gap. This paper considers how the creation of this affordability gap impacts upon actual clinical decisions. It explores these issues in the context of the choice between a drug-eluting stent and a bare metal stent for elective coronary angioplasty. It also argues that the option of an NHS procedure with a top-up fee to cover the cost of the affordability gap is a genuine one; that this option could improve clinical outcomes; that it is morally acceptable; and that the rules that prevent the utilization of this option should be relaxed. (shrink)
Academic Dishonesty Within Higher Education in Nepal: An Examination of Students’ Exam Cheating.Som Nath Ghimire,Upaj Bhattarai &Raj K. Baral -2024 -Journal of Academic Ethics 22 (2):303-322.detailsThe problem of academic dishonesty in general and exam cheating in particular, has been ubiquitous in schools, colleges, and universities around the world. This paper reports on the findings from teachers’ and students’ experiences and perceptions of exam cheating at Nepali schools, colleges, and universities. In so doing, the paper highlights the challenges of maintaining academic integrity in Nepali education systems. Based on qualitative research design, the study data were collected by employing semi-structured interviews with the teachers and the students. (...) Findings from the study indicated that over-emphasized value given to marks/grades and the nature of exam questions among others were the predominant factors. Our findings contribute to the practical understanding that academic institutions in Nepal have largely failed to communicate the value of academic honesty and integrity to the students of all levels of education despite the increasing prevalence of exam cheating. Therefore, exam cheating requires urgent attention from academic institutions, educators, and education leaders to educate students about the long-term educational and social values of academic honesty and integrity. (shrink)
Ethical values in health care: an Indian-Swedish co-operation.Elisabeth Hamrin,Naina S. Potdar &Raj K. Anand -2002 -Nursing Ethics 9 (4):439-444.detailsThe aim of this report is to present an example of a multidisciplinary Indian-Swedish co-operation on ethics in health care. It is based on a conference held in Asia Plateau, Panchgani, Maharasthra, India in 1998. The emphasis is on ethical values that are important for consumers of health care and professionals, and also for different cultures in developed and developing countries. The importance of human dignity is stressed. Sixteen recommendations are given in an appendix.
The whole being: a journey towards harmony and happiness.R. K.Mishra -2011 - New Delhi: Rupa Publications India in association with Brahma Vidya Kendra.detailsSection 1. Prologue -- section 2. The whole being -- section 3. Engaging with wholeness -- section 4. Wholeness in Kashmiri Shaivism -- section 5. The Buddhist perspective -- section 6. Wholeness in the modern world -- section 7. The workings of wholeness in our world -- section 8. Epilogue.
An Emotion-Based Model of Salesperson Ethical Behaviors.Raj Agnihotri,Adam Rapp,Prabakar Kothandaraman &Rakesh K. Singh -2012 -Journal of Business Ethics 109 (2):243-257.detailsAcademic research studies examining the ethical attitudes and behaviors of salespeople have produced several frameworks that explore the ethical decision-making processes to which salespeople adhere when faced with ethical dilemmas. Past literature enriches our understanding; however, a critical review of the relevant literature suggests that an emotional route to salesperson ethical decision-making has yet to be explored. Given the fact that individuals’ emotional capacities play an important role in decision-making when faced with an ethical dilemma, there is a need for (...) empirical research in this area. We address this issue by outlining and testing an emotion-based model to study the ethical attitudes and behaviors of salespeople in a relational selling context. Building on the cognitive-affective model proposed by Gaudine and Thorne (J Bus Ethics 31:175–187, 2001 ), we outline a framework that incorporates higher order prosocial emotions: capacity for concern and capacity for guilt. We include salesperson’s role clarity within the organization as a moderator to examine person–situation interaction. (shrink)
Parallel Interactions Between Linguistic and Contextual Factors in Bilinguals.Ramesh K.Mishra &Seema Prasad -forthcoming -Topics in Cognitive Science.detailsThe necessity for introducing interactionist and parallelism approaches in different branches of cognitive science emerged as a reaction to classical sequential stage-based models. Functional psychological models that emphasized and explained how different components interact, dynamically producing cognitive and perceptual states, influenced multiple disciplines. Chiefly among them were experimental psycholinguistics and the many applied areas that dealt with humans’ ability to process different types of information in different contexts. Understanding how bilinguals represent and process verbal and visual input, how their neural (...) and psychological states facilitate such interactions, and how linguistic and nonlinguistic processing overlap, has now emerged as an important area of multidisciplinary research. In this article, we will review available evidence from different language-speaking groups of bilinguals in India with a focus on situational context. In the discussion, we will address models of language processing in bilinguals within a cognitive psychological approach with a focus on existent models of inhibitory control. The paper's stated goal will be to show that the parallel architecture framework can serve as a theoretical foundation for examining bilingual language processing and its interface with external factors such as social context. (shrink)
Can curative or life-sustaining treatment be withheld or withdrawn? The opinions and views of Indian palliative-care nurses and physicians.Joris Gielen,Sushma Bhatnagar,SeemaMishra,Arvind K. Chaturvedi,Harmala Gupta,Ambika Rajvanshi,Stef Van den Branden &Bert Broeckaert -2011 -Medicine, Health Care and Philosophy 14 (1):5-18.detailsIntroduction: Decisions to withdraw or withhold curative or life-sustaining treatment can have a huge impact on the symptoms which the palliative-care team has to control. Palliative-care patients and their relatives may also turn to palliative-care physicians and nurses for advice regarding these treatments. We wanted to assess Indian palliative-care nurses and physicians’ attitudes towards withholding and withdrawal of curative or life-sustaining treatment. Method: From May to September 2008, we interviewed 14 physicians and 13 nurses working in different palliative-care programmes in (...) New Delhi, using a semi-structured questionnaire. For the interviews and analysis of the data we followed Grounded-Theory methodology. Results: Withholding a curative or life-sustaining treatment which may prolong a terminal cancer patient’s life with a few weeks but also has severe side-effects was generally considered acceptable by the interviewees. The majority of the interviewees agreed that life-sustaining treatments can be withdrawn in a patient who is in an irreversible coma. The palliative-care physicians and nurses were of the opinion that a patient has the right to refuse life-saving curative treatment. While reflecting upon the ethical acceptability of withholding or withdrawal of curative or life-sustaining treatment, the physicians and nurses were concerned about the whole patient and other people who may be affected by the decision. They were convinced they can play an important advisory role in the decision-making process. Conclusion: While deciding about the ethical issues, the physicians and nurses do not restrict their considerations to the physical aspects of the disease, but also reflect upon the complex wider consequences of the treatment decisions. (shrink)
Tumor‐Associated Macrophages Write the Script of Cancer Obesity Paradox.Anshul Sharma &Alok K.Mishra -2025 -Bioessays 47 (4):e202400264.detailsObesity paradoxically advances cancer progression while enhancing certain immunotherapies, like anti‐PD‐1/PD‐L1. Bader et al. discovered that obesity‐driven factors increase PD‐1 on tumor‐associated macrophages (TAMs), suppressing anti‐tumor responses. Remarkably, anti‐PD‐1 therapy reverses this metabolic dysfunction, boosting immune checkpoint blockade (ICB) effectiveness by reactivating PD‐1+ TAMs.
“Mir”acles in hox gene regulation.Vivek S. Chopra &Rakesh K.Mishra -2006 -Bioessays 28 (5):445-448.detailsMicro RNAs (miRNAs) have been shown to control many cellular processes including developmental timing in different organisms. The prediction that miRNAs are involved in regulating hox genes of flies and mouse is quite a recent idea and is supported by the finding that mir‐196 represses Hoxb8 gene expression. The non‐coding regions that encode these miRNAs are also conserved across species in the same way as other mechanisms that regulate expression of hox genes. On the contrary, until now no homeotic phenotype, (...) a hallmark of any hox gene mutation, had been associated with any hox miRNA. Recent work on bithorax complex miRNA (miR–iab‐4–5p) shows, for the first time, that miRNAs can lead to homeotic transformation. This miRNA regulates Ultrabithorax (Ubx) and results in the transformation of haltere to wing.1 This study unveils a new complexity and finesse to the regulation of hox gene expression pattern that is needed for determining the anteroposterior body axis in all bilaterians. BioEssays 28: 445–448, 2006. © 2006 Wiley Periodicals, Inc. (shrink)
A double‐edged sword to force posterior dominance of Hox genes.Narendra Pratap Singh &Rakesh K.Mishra -2008 -Bioessays 30 (11-12):1058-1061.detailsSpatially and temporally restricted expression of Hox genes requires multiple mechanisms at both the transcriptional and the post-transcriptional levels. New insight into this precise expression mechanism comes from recent findings of a novel sense–antisense miRNA combination from the bithorax complex of Drosophila melanogaster.1-4 These two miRNAs encoded from the same locus target 3′ untranslated regions of anterior hox genes, Antp, Ubx and abd-A to establish the dominance of posterior hox gene Abd-B in its expression domain. Such double-edge tools, sense–antisense miRNA (...) combinations, also operate at multiple loci in the genome implicating their wider impact on the post-transcriptional gene regulation in eukaryotes. BioEssays 30:1058–1061, 2008. © 2008 Wiley Periodicals, Inc. (shrink)
(1 other version)Knowledge, attitude and practice of healthcare ethics among resident doctors and ward nurses from a resource poor setting, Nepal.Kumar Paudel Samaj Adhikari,R. Aro Arja,Bipin Adhikari Tara Ballav Adhikari &Shiva RajMishra -forthcoming -Most Recent Articles: Bmc Medical Ethics.detailsHealthcare ethics is neglected in clinical practice in LMICs such as Nepal. The main objective of this study was to assess the current status of knowledge, attitude and practi...
Ethical Ideas in Descartes’ Philosophy.Desh Raj Sirswal -2008 -K.U. Research Journal of Arts and Humanities:89-97.detailsDescartes is not well known for his contributions to ethics. Some have charged that it is a weakness of his philosophy that it focuses exclusively on metaphysics and epistemology to the exclusion of moral and political philosophy. Such criticisms rest on a misunderstanding of the broader framework of Descartes’ philosophy. Evidence of Descartes’ concern for the practical import of philosophy can be traced to his earliest writings. In agreement of wisdom that is sufficient for happiness. The Third part of his (...) Discourse on the Method presents what he calls a provisional morality, a morality to govern our behaviour while we are in the process of revising our beliefs and coming to certainty. In the tree of philosophy, in the Preface to the French translation of the Principles of Philosophy, morals are listed as one of the fruits of the tree, along with medicine and mechanics. It is also a theme in the letters he exchanged with the Princess Elisabeth of Bohemia in the mid-1640s, together with another concern the passions, what they are, and more importantly, how to control them. These themes are intertwined again in Descartes last major work, The Passions of the Soul (1649). Descartes did not write extensively on ethics, and this has led some to assume that the topic lacks a place within his philosophy. It is an attempt to outline Descartes’ ethical ideas mainly in Discourse on the Method. (shrink)
A Companion to Cognitive Science.George Graham &William Bechtel (eds.) -1998 - Blackwell.detailsPart I: The Life of Cognitive Science:. William Bechtel, Adele Abrahamsen, and George Graham. Part II: Areas of Study in Cognitive Science:. 1. Analogy: Dedre Gentner. 2. Animal Cognition: Herbert L. Roitblat. 3. Attention: A.H.C. Van Der Heijden. 4. Brain Mapping: Jennifer Mundale. 5. Cognitive Anthropology: Charles W. Nuckolls. 6. Cognitive and Linguistic Development: Adele Abrahamsen. 7. Conceptual Change: Nancy J. Nersessian. 8. Conceptual Organization: Douglas Medin and Sandra R. Waxman. 9. Consciousness: Owen Flanagan. 10. Decision Making: J. Frank Yates (...) and Paul A. Estin. 11. Emotions: Paul E. Griffiths. 12. Imagery and Spatial Representation: Rita E. Anderson. 13. Language Evolution and Neuromechanisms: Terrence W. Deacon. 14. Language Processing: Kathryn Bock and Susan M. Garnsey. 15. Linguistics Theory: D. Terence Langendoen. 16. Machine Learning: Paul Thagard. 17. Memory: Henry L. Roediger III and Lyn M. Goff. 18. Perception: Cees Van Leeuwen. 19. Perception: Color: Austen Clark. 20. Problem Solving: Kevin Dunbar. 21. Reasoning: Lance J. Rips. 22. Social Cognition: Alan J. Lambert and Alison L. Chasteen. 23. Unconscious Intelligence: Rhianon Allen and Arthur S. Reber. 24. Understanding Texts: Art Graesser and Pam Tipping. 25. Word Meaning: Barbara C. Malt. Part III: Methodologies of Cognitive Science:. 26. Artificial Intelligence: Ron Sun. 27. Behavioral Experimentation: Alexander Pollatsek and Keith Rayner. 28. Cognitive Ethology: Marc Bekoff. 29. Deficits and Pathologies: Christopher D. Frith. 30. Ethnomethodology: Barry Saferstein. 31. Functional Analysis: Brian Macwhinney. 32. Neuroimaging: Randy L. Buckner and Steven E. Petersen. 33. Protocal Analysis: K. Anders Ericsson. 34. Single Neuron Electrophysiology: B. E. Stein, M.T. Wallace, and T.R. Stanford. 35. Structural Analysis: Robert Frank. Part IV: Stances in Cognitive Science:. 36. Case-based Reasoning: David B. Leake. 37. Cognitive Linguistics: Michael Tomasello. 38. Connectionism, Artificial Life, and Dynamical Systems: Jeffrey L. Elman. 39. Embodied, Situated, and Distributed Cognition: Andy Clark. 40. Mediated Action: James V. Wertsch. 41. Neurobiological Modeling: P. Read Montague and Peter Dayan. 42. Production Systems: Christian D. Schunn and David Klahr. Part V: Controversies in Cognitive Science:. 43. The Binding Problem: Valerie Gray Hardcastle. 44. Heuristics and Satisficing: Robert C. Richardson. 45. Innate Knowledge: Barbara Landau. 46. Innateness and Emergentism: Elizabeth Bates, Jeffrey L. Elman, Mark H. Johnson, Annette Karmiloff-Smith, Domenico Parisi, and Kim Plunkett. 47. Intentionality: Gilbert Harman. 48. Levels of Explanation and Cognition Architectures: Robert N. McCauley. 49. Modularity: Irene Appelbaum. 50. Representation and Computation: Robert S. Stufflebeam. 51. Representations: Dorrit Billman. 52. Rules: Terence Horgan and John Tienson. 53. Stage Theories Refuted: Donald G. Mackay. Part VI: Cognitive Science in the Real World:. 54. Education: John T. Bruer. 55. Ethics: Mark L. Johnson. 56. Everyday Life Environments: Alex Kirlik. 57. Institutions and Economics: Douglass C. North. 58. Legal Reasoning: Edwina L. Rissland. 59. Mental Retardation: Norman W. Bray, Kevin D. Reilly, Lisa F. Huffman, Lisa A. Grupe, Mark F. Villa, Kathryn L. Fletcher, and Vivek Anumolu. 60. Science: William F. Brewer and PunyashlokeMishra. Selective Biographies of Major Contributors to Cognitive Science: William Bechtel and Tadeusz Zawidzki. (shrink)