Recently, commentators close to and within the UK government have claimed that patient choice can increase equity in the context of the National Health Service. This article critically examines the basis for this claim through analysis of recent speeches and publications authored by secretaries of state for health and their policy advisers. It is concluded that this claim has not developed prospectively from an analysis of the causes of healthcare inequity, or even with a consistent normative definition of equity. The (...) limited justification that is “framed in causal explanations” of inequity has suffered from an apparent disregard of the available evidence. (shrink)

OBJECTIVES: To study and report the attitudes and practices of physicians in a former Soviet republic regarding issues pertaining to patients' rights, physician negligence and the acceptance of gratuities from patients. DESIGN: Survey questionnaire administered to physicians in 1991 at the time of the Soviet breakup. SETTING: Estonia, formerly a Soviet republic, now an independent state. SURVEY SAMPLE: A stratified, random sample of 1,000 physicians, representing approximately 20 per cent of practicing physicians under the age of 65. RESULTS: Most physicians (...) shared information with patients about treatment risks and alternatives, with the exception of cancer patients: only a third of physicians tell the patient when cancer is suspected. Current practice at the time of the survey left patients few options when physician negligence occurred; most physicians feel that under a reformed system physician negligence should be handled within the local facility rather than by the government. It was common practice for physicians to receive gifts, tips, or preferential access to scarce consumer goods from their patients. Responses varied somewhat by facility and physician nationality. CONCLUSION: The ethics of Soviet medical practice were different in a number of ways from generally accepted norms in Western countries. Physicians' attitudes about the need for ethical reform suggest that there will be movement in Estonia towards a system of medical ethics that more closely approximates those in the West. (shrink)

BackgroundHeavy media use has been linked to sleep problems in children, which may also extend to the infancy period. While international parent-advisory agencies, such as the American Academy of Pediatrics, advise no screen time before 18 months, parents often do not follow this recommendation. Research on Italian infants’ early access to media is sparse, and only very few studies have investigated links with sleeping habits.MethodTo address this gap, we examined concurrent associations between parent-reported surveys of child technology use and sleeping (...) patterns. The Italian version of the 60 item Comprehensive Assessment of Family Media Exposure Survey, developed as part of a larger international study,, the Brief Screening Questionnaire for Infant Sleep Problems Sadeh, 2004) were completed online by 264 Italian parents of 8- to 36-month-olds and a subset completed the Parenting Stress Index Abidin, 1995) between April 2017 and April 2018.ResultsMore devices located in the child’s room and the more time spent watching TV or using an iPad were associated with less hours of sleep at night. Furthermore, more time spent watching TV or using a smartphone, as well as the number of devices in the room was associated with going to sleep later at night. Instrumental media use was associated with less sleep.ConclusionLike other countries, Italian infants have high levels of exposure to media, and differences in media patterns were associated with sleep patterns. Cultural factors influence both instrumental reasons for media use and sleep practices. Further research should explore how media use may serve to regulate emotion as a function of both contextual factors and individual differences. (shrink)

A brief discussion is offered of what it means to say that a set of statements provides D-N explanation with special emphasis given to approximative D-N explanation. An idealized theory is seen to provide approximative D-N explanation. An ideal case provides explanation only if postulates are offered which connect the ideal antecedent condition with actual conditions. Such postulates will help in accounting for deviations between what the consequent of the ideal case entails and what actually occurs. Three ways are presented (...) for deciding on the acceptability of idealizations: (i) as actual conditions more closely approximate the ideal antecedent conditions specified in an ideal case, the more closely actual cases ought to approximate the consequent of the ideal case; (ii) the additional postulates connecting ideal antecedent conditions with actual conditions ought to account for deviations between what is entailed by an idealized theory and what actually occurs; and (iii) an idealized theory is explained by a more general theory when certain state variables in the more general theory are given extreme values. It is argued that (iii) is not a necessary condition for the acceptability of idealizations. (shrink)

L'aventure de Jacques et Raîssa Maritain constitue un parcours unique par son ampleur et son rayonnement. Centre de gravité de la vie spirituelle et littéraire pendant l'entre-deux-guerres, point de ralliement des générations perdues et refuge des poètes maudits, le couple tissa autour de lui le réseau d'influence le plus riche et foisonnant de l'histoire de ce siècle. Disciples de Bergson et de Léon Bloy, confidents de François Mauriac, de julien Green et de Jean Cocteau, amis de Péguy, de Mounier et (...) de Paul VI, et jetant entre les milieux littéraires, artistiques et catholiques d'invisibles passerelles, Jacques et Raïssa Maritain menèrent dans le même temps une expérience de vie spirituelle fascinante. Convertis à vingt ans, ils se firent tous deux messagers de Dieu sur les routes du monde, mendiants du Ciel au nom d'un nouvel humanisme, et ils s'engagèrent ensemble dans les combats essentiels de leur temps pour faire prévaloir en tous lieux la primauté du spirituel. On connaît l'œuvre philosophique considérable laissée par Jacques Maritain, qui garde une audience internationale. Mais cette première biographie, qui s'appuie entre autre sur une importante correspondance inédite, révèle la trame même d'une réflexion qui touche aux multiples domaine de la connaissance : une destinée d'errance et d'exil, de grandes amitiés et de combats souvent âpres contre l'injustice et les dérives du monde moderne, notamment celles de l'Eglise. C'est aussi la face invisible et secrète de la vie d'un couple qui nous est ici dévoilée. Unis par un amour fou et liés par un vœu de chasteté, les Maritainlivrèrent leur existence à Dieu sans partage, au prix pour Raïssa de "la plus dure mort à soi-même" et, pour tous les deux, d'une bouleversante solitude. (shrink)

Lexical Semantics is about the meaning of words. Although obviously a central concern of linguistics, the semantic behaviour of words has been unduly neglected in the current literature, which has tended to emphasize sentential semantics and its relation to formal systems of logic. In this textbook D. A. Cruse establishes in a principled and disciplined way the descriptive and generalizable facts about lexical relations that any formal theory of semantics will have to encompass. Among the topics covered in depth are (...) idiomaticity, lexical ambiguity, synonymy, hierarchical relations such as hyponymy and meronymy, and various types of oppositeness. Syntagmatic relations are also treated in some detail. The discussions are richly illustrated by examples drawn almost entirely from English. Although a familiarity with traditional grammar is assumed, readers with no technical linguistic background will find the exposition always accessible. All readers with an interest in semantics will find in this original text not only essential background but a stimulating new perspective on the field. (shrink)

The sport industry is an extremely diverse industry, including segments such as professional sport, intercollegiate athletics, health and fitness, recreational sport and facility management. The industry is currently experiencing rapid growth and development, and as it grows, sport managers in the different segments encounter ethical issues which are often unique to each segment. This article examines the professional sport, intercollegiate athletics, health and fitness, recreational sport and facility management segments of the sport industry and discusses the various ethical issues facing (...) managers in each of these segments. (shrink)

The ethical standard for informed consent is fostered within a shared decision-making process. SDM has become a recognized and needed approach in health care decision-making. Based on an ethical foundation, the approach fosters the active engagement of patients, where the clinician presents evidence-based treatment information and options and openly elicits the patient’s values and preferences. The SDM process is affected by the context in which the information exchange occurs. Rural settings are one context that impacts the delivery of health care (...) and SDM. Rural health care is significantly influenced by economic, geographical and social characteristics. Several specific distinctive features influence rural health care decision-making—poverty, access to health care, isolation, over-lapping relationships, and a shared culture. The rural context creates challenges as well as fosters opportunities for the application of SDM as a natural dynamic within the rural provider–patient relationship. To fulfill the ethical requirements of informed consent through SDM, it is necessary to understand its inherent challenges and opportunities. Therefore, rural clinicians and ethicists need to be cognizant of the impact of the rural setting on SDM and use the insights as an opportunity to achieve SDM. (shrink)

Revisiting African philosophy’s classic questions, D. A. Masolo advances understandings of what it means to be human—whether of African or other origin. Masolo reframes indigenous knowledge as diversity: How are we to understand the place and structure of consciousness? How does the everyday color the world we know? Where are the boundaries between self and other, universal and particular, and individual and community? From here, he takes a dramatic turn toward Africa’s current political situation and considers why individual rights and (...) freedoms have not been recognized, respected, demanded, or enforced. Masolo offers solutions for containing socially destructive conduct and antisocial tendencies by engaging community. His unique thinking about community and the role of the individual extends African philosophy in new, global directions. (shrink)

In debates about criteria for human death, several camps have emerged, the main two focusing on either loss of the "organism as a whole" (the mainstream view) or loss of consciousness or "personhood." Controversies also rage over the proper definition of "irreversible" in criteria for death. The situation is reminiscent of the proverbial blind men palpating an elephant; each describes the creature according to the part he can touch. Similarly, each camp grasps some aspect of the complex reality of death. (...) The personhood camp, in contrast to the mainstream "organism" camp, recognizes that a human organism can still be a biological living whole even without brain function. The mainstream camp, in contrast to the personhood camp, recognizes that a person can be permanently, even irreversibly unconscious, and still be a living person so long as his/her body is alive. The author proposes that hylomorphic dualism incorporates both these key insights. But to complete the picture of the entire "death elephant," a fundamental paradigm shift is needed to make sense of other seemingly conflicting insights. The author proposes a "semantic bisection" of the concept of death, analogous to the traditional distinction at the beginning of life between "conception" and "birth." To avoid the semantic baggage associated with the term "death," the two new death-related concepts are referred to as "passing away" (or "deceased") and "deanimation," corresponding, respectively, to sociolegal ceasing-to-be (mirror image of birth) and ontological/theological ceasing-to-be of the bodily organism (mirror image of conception). Regarding criteria, the distinguishing feature is whether the cessation of function is permanent (passing away) or irreversible (deanimation). If the "dead donor rule" were renamed the "deceased donor rule" (both acronyms felicitously being "DDR"), the ethics of organ transplantation from non–heart-beating donors could, in principle, be validly governed by the DDR, even though the donors are not yet ontologically "deanimated." Thus, the paradigm shift satisfies both those who insist on maintaining the DDR and those who claim that it has all along been receiving only lip service and should be explicitly loosened to include those who are "as good as dead." Even so, a number of practical caveats remain to be worked out for non–heart-beating protocols. (shrink)

" -- Africa Today "The excellence of this book lies in the wealth of perspectives that it brings to the discussion on what constitutes philosophy, rationality, ...

A three-valued propositional logic is presented, within which the three values are read as ?true?, ?false? and ?nonsense?. A three-valued extended functional calculus, unrestricted by the theory of types, is then developed. Within the latter system, Bochvar analyzes the Russell paradox and the Grelling-Weyl paradox, formally demonstrating the meaninglessness of both.

In some languages every statement must contain a specification of the type of evidence on which it is based: for example, whether the speaker saw it, or heard it, or inferred it from indirect evidence, or learnt it from someone else. This grammatical reference to information source is called 'evidentiality', and is one of the least described grammatical categories. Evidentiality systems differ in how complex they are: some distinguish just two terms (eyewitness and noneyewitness, or reported and everything else), while (...) others have six or even more terms. Evidentiality is a category in its own right, and not a subcategory of epistemic or some other modality, nor of tense-aspect. Every language has some way of referring to the source of information, but not every language has grammatical evidentiality. In English expressions such as I guess, they say, I hear that, the alleged are not obligatory and do not constitute a grammatical system. Similar expressions in other languages may provide historical sources for evidentials. True evidentials, by contrast, form a grammatical system. In the North Arawak language Tariana an expression such as "the dog bit the man" must be augmented by a grammatical suffix indicating whether the event was seen, or heard, or assumed, or reported. This book provides the first exhaustive cross-linguistic typological study of how languages deal with the marking of information source. Examples are drawn from over 500 languages from all over the world, several of them based on the author's original fieldwork. Professor Aikhenvald also considers the role evidentiality plays in human cognition, and the ways in which evidentiality influences human perception of the world.. This is an important book on an intriguing subject. It will interest anthropologists, cognitive psychologists and philosophers, as well as linguists. (shrink)

Physicians have developed a number of implicit and explicit approaches to complex medical decisions. Decision analysis is an explicit, quantitative method of clinical decision making that involves the separation of the probabilities of events from their relative values, or utilities. Its use can help physicians make difficult choices in a manner that promotes true patient participation. Decision analysis also provides a framework for the incorporation of data from multiple sources and for the assessment of the impact of uncertain data on (...) the final decision. Although this approach is imperfect, it represents a significant advance in clinical decision making. (shrink)

Signals to the brain from the flows of energy around the body, varied primarily by declining amounts of food energy in the stomach, can explain the pattern of meals in the laboratory rat, the differences between dark and light phases, and the development of obesity ion the rat wioth VMH lesions but normal sating.

Justice will once take the place which the Magians are keeping now, for it is they who lord it over the world.

The following article is a response to the position paper of the Hastings Center, “Ethical Challenges of Chronic Illness”, a product of their three year project on Ethics and Chronic Care. The authors of this paper, three prominent bioethicists, Daniel Callahan, Arthur Caplan, and Bruce Jennings, argue that there should be a different ethic for acute and chronic care. In pressing this distinction they provide philosophical grounds for limiting medical care for the elderly and chronically ill. We give a critical (...) survey of their position and reject it as well as any attempt to characterize the physician-patient relationship as a commercial contract. We emphasize, as central features of good medical practice, a commitment to be the patient's agent and a determination to acquire and be guided by knowledge. These commitments may sometimes conflict with efforts to have the physician serve as an instrument of social and economic policies limiting medical care. (shrink)