Unique characteristics of cluster randomized trials (CRTs) complicate the interpretation of standard research ethics guidelines. Variable interpretation by research ethics committees may further complicate review and conduct. An international web-based survey was administered to corresponding authors of 300 randomly sampled CRT publications. We investigated ethics review and consent practices, investigator experiences with ethics review, and the perceived need for CRT-specific ethics guidelines. The response rate was 64%. Ethics review and consent were under-reported in publications. Ethics approval was obtained in 91%, and consent from individual and cluster level participants in 79% and 82% of trials. Consent varied by level of experimental intervention, data collection, and cluster size. Respondents cited variability among ethics committees (46%), and negative impacts of ethics review on their studies (38%). The majority perceived a need for ethics guidelines (73%), and guidance for ethics committees (70%). CRT-specific ethics guidelines are required to ensure practices meet ethical standards.

Commentaries on the medieval notion of the "conjugal debt" have often emphasized its reciprocal nature, but its inequality becomes apparent when re-embedded into its theological, medical, and legal contexts. By tracing the theology that accompanied 1 Cor 7:3-4 through selected theologians, I will demonstrate that Paul's words did not function in equivalent ways for both spouses. By examining medieval medical understandings of human physiology, I will ask what it means to 'have authority over a body' when the bodies themselves are not equal. Finally, by demonstrating ways in which consent and coercion blurred together in twelfth-century legal debates, I will ask how meaningful it is to grant spouses equal rights to sex when their marriage may have been coerced. The topic will serve as a broader meditation on what it means to 'have authority over a body' and to conceive of marital sexuality as a system of debt.

Probabilities, an essential dimension of risk communication, can be presented in various formats including frequencies (e.g., 1 in 10), percentages (e.g., 10%), or verbal phrases (e.g., unlikely); the literature is mixed concerning which format best supports comprehension. Additionally, it is not well understood how people who vary in their level of numeracy understand those probabilities. The goal of the present three-phase within-participant study was to understand how the factors of format and numeracy influence comprehension and mental representations of probabilities for younger and older adults. Overall, the results of this research clearly indicated that comprehension and mental representation of health risk probabilities are influenced by format, age, and numeracy. To best support comprehension and comparison of health risk probabilities for younger adults and healthy older adults with varying numeracy, percent format should be used.

The key focus of this research project is the marginalisation of radical and alternative politics in modern democratic societies, how they have been presented in a mainstream theatrical context and what strategies a political playwright can employ to present the issues of those politics while overcoming such marginalisation. Referencing cultural theorists including Noam Chomsky, Naomi Klein and Howard Zinn, this study argues that contemporary cultures operate within the boundaries of an internalised conservative value set propagated through systems of coercion utilised by the media, governments and corporations. With a specific interest in contemporary theatre, this study proposes that this internalisation functions as an efficient and nearly invisible censor, rendering more complex the task of the political playwright in communicating with a wider and more inclusive audience and that by examining the methods used in the manufacture of consent and then returning to the strategies utilized by political playwrights in the past and at present, we can better identify how to bypass that internal censor and do something more than " preach to the converted." This project comprises two interrelated components; one is an original full length play script, Pornography: The True Confessions of Mandy Lightspeed; the other is an exegesis which compliments and augments the play. The play script represents %60 and the exegesis the remaining %40 of the examinable output of this project, although both are considered integral (and integrate) parts of the whole. Central to both these texts is the question; " How has political theatre been presented in the past and what strategies can the playwright employ to make issues of radical or alternative politics more accessible to a mainstream theatre audience?"

Drug addiction is a significant problem facing most societies. It is associated with increased violence, crime and mental illness, and is one of the leading causes of preventable mortality and disability in most developed societies, accounting for over 12% of the total burden of disease (Begg et al., 2007). Neuroscience promises to significantly reduce the incidence and severity of addictive drug use, and the harm that it causes, by providing more effective and better targeted treatment of addiction (Volkow and Li, 2005). Proponents argue that an increased understanding of the neurobiological basis of drug addiction will also lend support for more humane social policies. These policies will recognise that addiction is a neuropsychiatric condition that should be treated therapeutically, leading to increased investment in addiction research and treatment (Dackis and O'Brien, 2005; McLellan et al., 2000). Optimism about the benefits of an understanding of the neurobiological basis of addiction needs to be tempered by more critical considerations. Overly simplistic interpretations of what this kind of approach reveals about addiction could result in less welcome consequences, especially if inappropriate use is made of emerging neurotechnologies, such as coerced use of naltrexone implants, population-wide vaccination programs against addiction, or the promotion of heroic ‘cures’ for addiction, such as neurosurgery and deep brain stimulation. This thesis examines both the potentially welcome and unwelcome uses of neurobiological research of addiction with the aims of maximising the benefits, while minimizing any unanticipated harms. I refer to this as Addiction Neuroethics. The primary aims are to examine: (1) the impact that neuroscience research may have upon our understanding of autonomy and self-control in addicted individuals, (2) the implications this understanding may have for how we treat individuals with an addiction; and (3) the conditions under which it would be ethically acceptable to use various technologies emerging from this research. This thesis falls into three parts. First, a concise and accessible summary of the key findings of recent genetic and neuroscience research of addiction is provided. This includes the neuroanatomy of addiction (e.g. the mesolimbic reward pathway), the molecular and cellular biology of addiction, neurocognitive changes, and the role of genetic and environmental vulnerabilities. The second part of this thesis explores how neuroscience research may influence the way that modern societies think about drug use and addiction, and deal with those that suffer from it. This section addresses the central question: do addicted persons have the capacity to make autonomous decisions regarding their own drug use? This raises a number of additional questions. How much responsibility and blame should we attribute to addicted individual’s for their actions? How should society deal with addicted persons, or respond to the harm that they cause? Should society coerce addicted individuals into treatment, and if so, under what conditions? The third part of this thesis examines the ethical issues raised by the use of powerful new technologies that are emerging from neurobiological research on addiction, such as novel psychopharmacologies, depot implants, drug vaccines, neurosurgery and brain stimulation, neuroimaging and genetic testing. The report also considers the more speculative possibility that addiction neurobiology may improve our ability to prevent the development of addiction, for example, by using genetic screening to identify individuals at high risk of addiction and ‘drug vaccines’ to prevent these individuals from becoming addicted. This thesis demonstrates that the chronic use of addictive drugs has significant impacts upon key decision-making regions of the brain (e.g. motivation, memory, impulse inhibition) that affect addicted individuals ability to choose not to use drugs. While the autonomy of addicted individuals is impaired in certain situations, and to varying degrees, it is not extinguished. Rather than deny autonomy, we should aim to engage addicted individuals in ways that increase their autonomy. For example, coerced treatment of addiction may be a valid approach to getting addicted individuals in treatment. However we should avoid overriding the autonomy of addicted individuals by offering treatment as an alternative to punishment for some crimes (e.g. theft to fund drug habit). Such treatment should aim to treat a medical condition, and not be a form of extrajudicial punishment. Addiction is a highly stigmatised condition. This can significantly impact upon the way in which neuroscience research is understood and applied. Scientists, clinicians and policy makers must be mindful of over-enthusiastic applications of novel technologies that may be prematurely embraced and promoted to a desperate and vulnerable population without proper evaluation of the risks, or without considering how these technologies may be used once approved. The treatment of addiction should be judged by its efficacy and safety, as for any other medical treatment. Addicted individuals should be treated as any other individual suffering from a medical condition. The thesis concludes with some general suggestions about the directions in which this debate is likely to develop and identifies areas that will require further analysis and empirical investigation.

This thesis is an exploration of professional behaviour in health care settings, using a Model of Treatment Engagement that is developed as a tool for ethics critique. The Model is tested and refined using data on: a psychiatric ???treatment??? carried out on over 1,127 occasions in a 15 - 40 bed non-acute hospital during the period 1961-1979; the problematic withdrawal of all life-support from a 37 year old man who had suffered acute brain trauma some five days previously, in a tertiary hospital in March 2000; and a clinical experiment recently proposed for the emergency setting and intended to encompass five hospitals and the NSW Ambulance Service. In each case, the Model proves useful in identifying the shift from the treatment paradigm and the ethical imperative of ensuring the patient (or his/her agent) appreciates the difference between what is proposed and what would normally be done. It reveals how doctors who dealt with the patient but did not decide on treatment contributed to ethically troublesome practice. It clarifies how having multiple doctor players in the treatment situation gave rise to the need to suppress dissenting views. Doctors who were close enough to the action to comprehend its nature, by not dissenting, reinforced the problematic choice for the actor and validated it in the eyes of observers. The lack of dissent at the level of doctors working under supervision, appeared to be a function of institutional arrangements. At the consultant level, there was evidence of pressure to concur from other consultants and indirect evidence of a fear of ostracism. The public responses in the two modern cases point to there being a strong idea in Sydney???s medical community that dissent should not be publicly displayed once a decision on how to treat has been made. I conclude there are two steps to reviewing ethically problematic treatment situations. The first consists of identifying the shift from the treatment paradigm. The second consists of establishing why the problematic choice is translated into action. The Treatment Engagement Model is put forward as a useful tool for both these analyses.

Drug addiction is a significant problem facing most societies. It is associated with increased violence, crime and mental illness, and is one of the leading causes of preventable mortality and disability in most developed societies, accounting for over 12% of the total burden of disease (Begg et al., 2007). Neuroscience promises to significantly reduce the incidence and severity of addictive drug use, and the harm that it causes, by providing more effective and better targeted treatment of addiction (Volkow and Li, 2005). Proponents argue that an increased understanding of the neurobiological basis of drug addiction will also lend support for more humane social policies. These policies will recognise that addiction is a neuropsychiatric condition that should be treated therapeutically, leading to increased investment in addiction research and treatment (Dackis and O'Brien, 2005; McLellan et al., 2000). Optimism about the benefits of an understanding of the neurobiological basis of addiction needs to be tempered by more critical considerations. Overly simplistic interpretations of what this kind of approach reveals about addiction could result in less welcome consequences, especially if inappropriate use is made of emerging neurotechnologies, such as coerced use of naltrexone implants, population-wide vaccination programs against addiction, or the promotion of heroic ‘cures’ for addiction, such as neurosurgery and deep brain stimulation. This thesis examines both the potentially welcome and unwelcome uses of neurobiological research of addiction with the aims of maximising the benefits, while minimizing any unanticipated harms. I refer to this as Addiction Neuroethics. The primary aims are to examine: (1) the impact that neuroscience research may have upon our understanding of autonomy and self-control in addicted individuals, (2) the implications this understanding may have for how we treat individuals with an addiction; and (3) the conditions under which it would be ethically acceptable to use various technologies emerging from this research. This thesis falls into three parts. First, a concise and accessible summary of the key findings of recent genetic and neuroscience research of addiction is provided. This includes the neuroanatomy of addiction (e.g. the mesolimbic reward pathway), the molecular and cellular biology of addiction, neurocognitive changes, and the role of genetic and environmental vulnerabilities. The second part of this thesis explores how neuroscience research may influence the way that modern societies think about drug use and addiction, and deal with those that suffer from it. This section addresses the central question: do addicted persons have the capacity to make autonomous decisions regarding their own drug use? This raises a number of additional questions. How much responsibility and blame should we attribute to addicted individual’s for their actions? How should society deal with addicted persons, or respond to the harm that they cause? Should society coerce addicted individuals into treatment, and if so, under what conditions? The third part of this thesis examines the ethical issues raised by the use of powerful new technologies that are emerging from neurobiological research on addiction, such as novel psychopharmacologies, depot implants, drug vaccines, neurosurgery and brain stimulation, neuroimaging and genetic testing. The report also considers the more speculative possibility that addiction neurobiology may improve our ability to prevent the development of addiction, for example, by using genetic screening to identify individuals at high risk of addiction and ‘drug vaccines’ to prevent these individuals from becoming addicted. This thesis demonstrates that the chronic use of addictive drugs has significant impacts upon key decision-making regions of the brain (e.g. motivation, memory, impulse inhibition) that affect addicted individuals ability to choose not to use drugs. While the autonomy of addicted individuals is impaired in certain situations, and to varying degrees, it is not extinguished. Rather than deny autonomy, we should aim to engage addicted individuals in ways that increase their autonomy. For example, coerced treatment of addiction may be a valid approach to getting addicted individuals in treatment. However we should avoid overriding the autonomy of addicted individuals by offering treatment as an alternative to punishment for some crimes (e.g. theft to fund drug habit). Such treatment should aim to treat a medical condition, and not be a form of extrajudicial punishment. Addiction is a highly stigmatised condition. This can significantly impact upon the way in which neuroscience research is understood and applied. Scientists, clinicians and policy makers must be mindful of over-enthusiastic applications of novel technologies that may be prematurely embraced and promoted to a desperate and vulnerable population without proper evaluation of the risks, or without considering how these technologies may be used once approved. The treatment of addiction should be judged by its efficacy and safety, as for any other medical treatment. Addicted individuals should be treated as any other individual suffering from a medical condition. The thesis concludes with some general suggestions about the directions in which this debate is likely to develop and identifies areas that will require further analysis and empirical investigation.

Drug addiction is a significant problem facing most societies. It is associated with increased violence, crime and mental illness, and is one of the leading causes of preventable mortality and disability in most developed societies, accounting for over 12% of the total burden of disease (Begg et al., 2007). Neuroscience promises to significantly reduce the incidence and severity of addictive drug use, and the harm that it causes, by providing more effective and better targeted treatment of addiction (Volkow and Li, 2005). Proponents argue that an increased understanding of the neurobiological basis of drug addiction will also lend support for more humane social policies. These policies will recognise that addiction is a neuropsychiatric condition that should be treated therapeutically, leading to increased investment in addiction research and treatment (Dackis and O'Brien, 2005; McLellan et al., 2000). Optimism about the benefits of an understanding of the neurobiological basis of addiction needs to be tempered by more critical considerations. Overly simplistic interpretations of what this kind of approach reveals about addiction could result in less welcome consequences, especially if inappropriate use is made of emerging neurotechnologies, such as coerced use of naltrexone implants, population-wide vaccination programs against addiction, or the promotion of heroic ‘cures’ for addiction, such as neurosurgery and deep brain stimulation. This thesis examines both the potentially welcome and unwelcome uses of neurobiological research of addiction with the aims of maximising the benefits, while minimizing any unanticipated harms. I refer to this as Addiction Neuroethics. The primary aims are to examine: (1) the impact that neuroscience research may have upon our understanding of autonomy and self-control in addicted individuals, (2) the implications this understanding may have for how we treat individuals with an addiction; and (3) the conditions under which it would be ethically acceptable to use various technologies emerging from this research. This thesis falls into three parts. First, a concise and accessible summary of the key findings of recent genetic and neuroscience research of addiction is provided. This includes the neuroanatomy of addiction (e.g. the mesolimbic reward pathway), the molecular and cellular biology of addiction, neurocognitive changes, and the role of genetic and environmental vulnerabilities. The second part of this thesis explores how neuroscience research may influence the way that modern societies think about drug use and addiction, and deal with those that suffer from it. This section addresses the central question: do addicted persons have the capacity to make autonomous decisions regarding their own drug use? This raises a number of additional questions. How much responsibility and blame should we attribute to addicted individual’s for their actions? How should society deal with addicted persons, or respond to the harm that they cause? Should society coerce addicted individuals into treatment, and if so, under what conditions? The third part of this thesis examines the ethical issues raised by the use of powerful new technologies that are emerging from neurobiological research on addiction, such as novel psychopharmacologies, depot implants, drug vaccines, neurosurgery and brain stimulation, neuroimaging and genetic testing. The report also considers the more speculative possibility that addiction neurobiology may improve our ability to prevent the development of addiction, for example, by using genetic screening to identify individuals at high risk of addiction and ‘drug vaccines’ to prevent these individuals from becoming addicted. This thesis demonstrates that the chronic use of addictive drugs has significant impacts upon key decision-making regions of the brain (e.g. motivation, memory, impulse inhibition) that affect addicted individuals ability to choose not to use drugs. While the autonomy of addicted individuals is impaired in certain situations, and to varying degrees, it is not extinguished. Rather than deny autonomy, we should aim to engage addicted individuals in ways that increase their autonomy. For example, coerced treatment of addiction may be a valid approach to getting addicted individuals in treatment. However we should avoid overriding the autonomy of addicted individuals by offering treatment as an alternative to punishment for some crimes (e.g. theft to fund drug habit). Such treatment should aim to treat a medical condition, and not be a form of extrajudicial punishment. Addiction is a highly stigmatised condition. This can significantly impact upon the way in which neuroscience research is understood and applied. Scientists, clinicians and policy makers must be mindful of over-enthusiastic applications of novel technologies that may be prematurely embraced and promoted to a desperate and vulnerable population without proper evaluation of the risks, or without considering how these technologies may be used once approved. The treatment of addiction should be judged by its efficacy and safety, as for any other medical treatment. Addicted individuals should be treated as any other individual suffering from a medical condition. The thesis concludes with some general suggestions about the directions in which this debate is likely to develop and identifies areas that will require further analysis and empirical investigation.

Drug addiction is a significant problem facing most societies. It is associated with increased violence, crime and mental illness, and is one of the leading causes of preventable mortality and disability in most developed societies, accounting for over 12% of the total burden of disease (Begg et al., 2007). Neuroscience promises to significantly reduce the incidence and severity of addictive drug use, and the harm that it causes, by providing more effective and better targeted treatment of addiction (Volkow and Li, 2005). Proponents argue that an increased understanding of the neurobiological basis of drug addiction will also lend support for more humane social policies. These policies will recognise that addiction is a neuropsychiatric condition that should be treated therapeutically, leading to increased investment in addiction research and treatment (Dackis and O'Brien, 2005; McLellan et al., 2000). Optimism about the benefits of an understanding of the neurobiological basis of addiction needs to be tempered by more critical considerations. Overly simplistic interpretations of what this kind of approach reveals about addiction could result in less welcome consequences, especially if inappropriate use is made of emerging neurotechnologies, such as coerced use of naltrexone implants, population-wide vaccination programs against addiction, or the promotion of heroic ‘cures’ for addiction, such as neurosurgery and deep brain stimulation. This thesis examines both the potentially welcome and unwelcome uses of neurobiological research of addiction with the aims of maximising the benefits, while minimizing any unanticipated harms. I refer to this as Addiction Neuroethics. The primary aims are to examine: (1) the impact that neuroscience research may have upon our understanding of autonomy and self-control in addicted individuals, (2) the implications this understanding may have for how we treat individuals with an addiction; and (3) the conditions under which it would be ethically acceptable to use various technologies emerging from this research. This thesis falls into three parts. First, a concise and accessible summary of the key findings of recent genetic and neuroscience research of addiction is provided. This includes the neuroanatomy of addiction (e.g. the mesolimbic reward pathway), the molecular and cellular biology of addiction, neurocognitive changes, and the role of genetic and environmental vulnerabilities. The second part of this thesis explores how neuroscience research may influence the way that modern societies think about drug use and addiction, and deal with those that suffer from it. This section addresses the central question: do addicted persons have the capacity to make autonomous decisions regarding their own drug use? This raises a number of additional questions. How much responsibility and blame should we attribute to addicted individual’s for their actions? How should society deal with addicted persons, or respond to the harm that they cause? Should society coerce addicted individuals into treatment, and if so, under what conditions? The third part of this thesis examines the ethical issues raised by the use of powerful new technologies that are emerging from neurobiological research on addiction, such as novel psychopharmacologies, depot implants, drug vaccines, neurosurgery and brain stimulation, neuroimaging and genetic testing. The report also considers the more speculative possibility that addiction neurobiology may improve our ability to prevent the development of addiction, for example, by using genetic screening to identify individuals at high risk of addiction and ‘drug vaccines’ to prevent these individuals from becoming addicted. This thesis demonstrates that the chronic use of addictive drugs has significant impacts upon key decision-making regions of the brain (e.g. motivation, memory, impulse inhibition) that affect addicted individuals ability to choose not to use drugs. While the autonomy of addicted individuals is impaired in certain situations, and to varying degrees, it is not extinguished. Rather than deny autonomy, we should aim to engage addicted individuals in ways that increase their autonomy. For example, coerced treatment of addiction may be a valid approach to getting addicted individuals in treatment. However we should avoid overriding the autonomy of addicted individuals by offering treatment as an alternative to punishment for some crimes (e.g. theft to fund drug habit). Such treatment should aim to treat a medical condition, and not be a form of extrajudicial punishment. Addiction is a highly stigmatised condition. This can significantly impact upon the way in which neuroscience research is understood and applied. Scientists, clinicians and policy makers must be mindful of over-enthusiastic applications of novel technologies that may be prematurely embraced and promoted to a desperate and vulnerable population without proper evaluation of the risks, or without considering how these technologies may be used once approved. The treatment of addiction should be judged by its efficacy and safety, as for any other medical treatment. Addicted individuals should be treated as any other individual suffering from a medical condition. The thesis concludes with some general suggestions about the directions in which this debate is likely to develop and identifies areas that will require further analysis and empirical investigation.

Thesis (J.C.L.)--Catholic University of America, 1989. / Includes bibliographical references (leaves 99-103).