Recovery of transplantable organs after cardiac or circulatory death: Transforming the paradigm for the ethics of organ donation

Organ donation after cardiac or circulatory death (DCD) has been introduced to increase the supply of transplantable organs. In this paper, we argue that the recovery of viable organs useful for transplantation in DCD is not compatible with the dead donor rule and we explain the consequential ethical and legal ramifications. We also outline serious deficiencies in the current consent process for DCD with respect to disclosure of necessary elements for voluntary informed decision making and respect for the donor's autonomy. We compare two alternative proposals for increasing organ donation consent in society: presumed consent and mandated choice. We conclude that proceeding with the recovery of transplantable organs from decedents requires a paradigm change in the ethics of organ donation. The paradigm change to ensure the legitimacy of DCD practice must include: (1) societal agreement on abandonment of the dead donor rule, (2) legislative revisions reflecting abandonment of the dead donor rule, and (3) requirement of mandated choice to facilitate individual participation in organ donation and to ensure that decisions to participate are made in compliance with the societal values of respect for autonomy and self-determination.     

Relationships between executive function,working memory,and decision-making on the Iowa Gambling Task: Evidence from ventromedial patients,dorsolateral patients,and normal subjects

The results of previous studies are inconsistent in regard to the relationship between the Iowa Gambling Task (IGT), working-memory (WM), and executive tasks, and whether these cognitive processes could be considered as mechanisms underlying a decision-making deficit. Moreover, the relationship between the IGT and executive measures is examined based on a limited number of executive tasks, within different populations showing diffuse damage. In addition, there are fewer studies carried out within control participants, with those studies also being inconclusive. It is also suggested that the association of the IGT performance with executive tasks depends on whether the IGT was running under ambiguity or under risk. In this work, all of these issues are studied. Results showed that both patients with ventromedial (VMPFC, N = 10) and dorsolateral (DLPFC, N = 10) prefrontal cortex lesions are significantly impaired on almost all executive tasks, WM tasks, and the IGT. Furthermore, when the IGT is run under risk, there are significant correlations between executive measures and the IGT for the DLPFC patients and the control participants (N = 34) but not the VMPFC patients. No correlation was found between WM tasks and the IGT for both frontal subgroups and control participants. These findings suggested that the mechanisms underlying the IGT deficit differ according to the lesion locations.     

Age and physiological, perceptual, and affective responses during walking at a self-selected pace

The aim of this study was to examine physiological, perceptual, and affective responses during self-paced walking for three age groups. 66 adult women were assigned into three groups by age: 20-25 yr. (n=22), 30-35 yr. (n=22), and 40-45 yr. (n=22). Each participant completed a maximal exercise test and a 20-min. bout of walking at a self-selected pace. The preferred walking speed was similar for all age groups, whereas physiological responses relative to maximal and ventilatory threshold values were greater in the 40-45 yr. group than the other two groups. Nevertheless, perceptual and affective responses were similar for all age groups. These findings suggest that physiological responses, but not perceptual and affective responses, of sedentary women are associated with age during walking at a self-selected pace.     

The right of women to no-fault divorce in Islam and its application by British Muslims

One of the forms of divorce mentioned in the original sources of Islam, the Qur'an and the Sunna, is no-fault divorce initiated by women, called in Arabic khul^c . This article discusses its validity in Islamic law, the degree of entitlement women have to it and its effects in dissolving the marriage. The discussion will include the attitudes towards khul^c in the modern reforms in the family laws of Muslim countries. Most of this modern legislation has been associated with furious debates and objections from both traditionalists and liberals. The article will attempt to assess the social impact of these new regulations of khul^c . It then turns to discuss the application of no-fault divorce among Muslim minorities in the West with special reference to British Muslims. It seems to be widely used unofficially to ease the problem of ‘limping marriage’ experienced by Muslim women as a result of subjection to two jurisdictions, i.e. English and Islamic laws.     

Legislative Enforcement of Nonconsensual Determination of Neurological (Brain) Death in Muslim Patients: A Violation of Religious Rights

Death is defined in the Quran with a single criterion of irreversible separation of the ruh (soul) from the body. The Quran is a revelation from God to man, and the primary source of Islamic knowledge. The secular concept of death by neurological criteria, or brain death, is at odds with the Quranic definition of death. The validity of this secular concept has been contested scientifically and philosophically. To legitimize brain death for the purpose of organ donation and transplantation in Muslim communities, Chamsi-Pasha and Albar (concurring with the US President’s Council on Bioethics) have argued that irreversible loss of capacity for consciousness and breathing (apneic coma) in brain death defines true death in accordance with Islamic sources. They have postulated that the absence of nafs (personhood) and nafas (breath) in apneic coma constitutes true death because of departure of the soul (ruh) from the body. They have also asserted that general anesthesia is routine in brain death before surgical procurement. Their argument is open to criticism because: (1) the ruh is described as the essence of life, whereas the nafs and nafas are merely human attributes; (2) unlike true death, the ruh is still present even with absent nafs and nafas in apneic coma; and (3) the routine use of general anesthesia indicates the potential harm to brain-dead donors from surgical procurement. Postmortem general anesthesia is not required for autopsy. Therefore, the conclusion must be that legislative enforcement of nonconsensual determination of neurological (brain) death and termination of life-support and medical treatment violates the religious rights of observant Muslims.     

On Measuring and Decomposing Inequality of Opportunity among Children: Evidence from Tunisia

Building on the current literature that increasingly recognizes inequality of opportunity among children, this paper analyzes to what extent access to basic education and core services is influenced by family and individual background factors in Tunisia. The analysis uses the Human Opportunity Index (HOI) methodology developed recently at the World Bank, and micro data from the National Survey on Households’ Budget, Consumption and Standard of Living (HBCLS) for 2010. The main contribution of the study is its in-depth investigation of the key factors affecting child development in Tunisia. The results reveal large and persistent interregional and intra-regional disparities among children, mainly in pre-secondary school enrollment and access to safe water and sanitation services. Such inequalities of opportunity, obviously shown between inland and littoral regions, are found to be driven mainly by geographic factors and parents” education and wealth. These findings may have important policy implications in term of developing better-targeted interventions aiming to reduce inequality in accessing basic services.     

Processing temporary syntactic ambiguity: the effect of contextual bias

This paper reports two experiments using sentences with a temporary ambiguity between a direct object and a sentence complement analysis that is resolved toward the normally preferred direct object analysis. Postverbal noun phrases in these sentences could be ambiguously attached as either a direct object or the subject of a sentence complement, whereas in unambiguous versions of the sentences the subcategorization of the verb forced the direct object interpretation. Participants read these sentences in relatively long paragraph contexts, where the context supported the direct object analysis ("preferred"), supported the sentence complement analysis ("unpreferred"), or provided conflicting evidence about both analyses ("conflicting"). Self-paced reading times for ambiguous postverbal noun phrases were almost equivalent to the reading times of their unambiguous counterparts, even in unpreferred and conflicted context conditions. However, time to read a following region, which forced the direct object interpretation, was affected by the interaction of verb subcategorization ambiguity and contextual support. The full pattern of results do not fit well with either an unelaborated single-analysis ("garden path") model or a competitive constraint-satisfaction model, but are consistent with a race model in which multiple factors affect the speed of constructing a single initial analysis.     

Behavioral performances in participants with phonological dyslexia and different patterns on the N170 component

Adults with phonological dyslexia and controls performed a lexical decision task while ERPs were recorded in the occipitotemporal pathway. Based on N170 durations, two subgroups were formed: dysl1 showing longer N170 durations and dysl2 showing normal N170 durations. While the dysl1 subgroup had poorer accuracy for infrequent words and pseudo-words, the dysl2 group responded more slowly than controls to pseudo-words. N170 amplitudes were larger in the left hemisphere for controls irrespective of items. In the dysl1 subgroup, N170 amplitudes were larger in the left hemisphere than the right for words but not for pseudo-words, a sign of hemispheric compensation, while in the dysl2 subgroup signs of bilateralization were observed. Moreover, in the dysl1 subgroup, P100 amplitudes were smaller than controls. These results indicate different behavioral profiles of dyslexics with different patterns of P100 and N170 components. The ERP changes may be due to different behavioral strategies employed by each subgroup, logographic in dysl2 and phonological in dysl1.     

Islamic Education,Eco-ethics and Community

Amid the growing coalescence between the religion and ecology movements, the voice of Muslims who care for the earth and its people is rising. While the Islamic position on the environment is not well-represented in the ecotheology discourse, it advances an environmental imaginary which shows how faith can be harnessed as a vehicle for social change. This article will draw upon doctoral research which synthesised the Islamic ecological ethic (eco-ethic) from sacred texts, traditions and contemporary thought, and illustrated how this ethic is enlivened in the educational landscape of Islam. Knowledge of the relationship between human beings and the natural world, of the creative order upon which the world was created, and of right living, is essential in this educational project and the global ecoIslamic movement employs a range of institutes, from the masjid to the maktab, to impart the environmental message of Islam. Despite the manifestation of environmental education activities across the educational establishment, much of what passes as Islamic education today is not representative of the holistic, integrated and comprehensive educational philosophy of Islam. Contemporary social concerns, such as the environmental question, can, in my view, act as an impetus to develop a pedagogy which endeavours to be true to the religious traditions, values and ethics of Islam, while also displaying the transformative force of this faith. Muslims, at more than one-fifth of the world population, own a fair share of global concern around the earth’s health and well-being. Across the world, many continue to base their life and lifestyle decisions on the teachings of Islam, and are showing the relevance of traditional resources and institutions in meeting one of the greatest challenges facing humanity—the health of our planet.