Clear guidelines addressing the ethically appropriate use of anti-infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti-infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant pathogens, (...) (5) placing unreasonable costs on a capitated hospice system. Although anti-infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision-making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti-infectives. In this article we articulate important elements in ethical decision-making in the application of anti-infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases. (shrink)

ABSTRACT Clear guidelines addressing the ethically appropriate use of anti‐infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti‐infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant (...) pathogens, (5) placing unreasonable costs on a capitated hospice system. Although anti‐infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision‐making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti‐infectives. In this article we articulate important elements in ethical decision‐making in the application of anti‐infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Matter and Spirit in the Age of Animal MagnetismEric G. WilsonDuring the Romantic period, writers on both sides of the Atlantic explored the sleepwalker as a merger of holiness and horror. Emerging when scientific thinkers for the first time were connecting spirit to electricity and magnetism, the somnambulist became to certain Romantics a disclosure of the difficulty of harmonizing unseen and seen, agency and necessity. This problem prominently arose (...) in Anton Mesmer's late eighteenth-century experiments in animal magnetism, in which the sleepwalker proved a paradox: an opaque revelation of transparent currents and an unconscious vehicle of sophisticated thought. Romantics such as Coleridge embraced the somnambulist as an embodiment of these troubles involved in relating motion and meaning. Coleridge and those who responded to him saw in the hypnotized human this sobering possibility: the invisible requires the visible to make itself manifest while the visible needs the invisible to become significant. 1 This is sublime and sinister: to elevate a material form to spiritual power is transcendence; to sink the boundless into a body is grotesque.Here I explore the philosophical implications of animal magnetism, the place of the sleepwalker in the history of ideas, and the role of the hypnotized human in Romantic writers, especially Coleridge. I also meditate on relationships between matter and spirit, machine and human, word and thing. Along the way, I place the history of ideas and the works of Romantic writers in mutually illuminating dialogues. The literary texts shed fresh light on philosophical problems while the ideas reveal hidden literary elements.The somnambulistic trance had been around long before Mesmer's magnetic sleeps. For centuries, shamans had used auto-hypnosis to sound [End Page 329] their souls and other-hypnosis to cure their tribe-members' ailments. However, somnambulism could not become a scientific phenomenon until Europeans in laboratories began to study electricity and magnetism. In the early modern period, Paracelsus argued that a vital fluid courses through the cosmos. The human being draws this flow like a magnet attracts force. When the body pulls to itself evil effluvia, it falls ill. To return patients to health, Paracelsus placed magnets on painful areas. He hoped to extract the unwanted current and return it to the cosmic swirl. 2 In "magnetizing" spirit, Paracelsus opened a door for empirical inquiry into the invisible world. In 1600, William Gilbert claimed that magnets correspond to the earth: both are animated by universal attraction and repulsion. 3 By the end of the seventeenth-century, Newton proposed that things are impelled by a force that draws and repels. Newton's theory of gravity inspired natural philosophers of the next centuries to search for a principle of which the magnet and the spark are manifestations. 4During the second half of the eighteenth century and the early part of the nineteenth, natural philosophers explored electricity and magnetism with unprecedented precision. In 1752, Benjamin Franklin revealed the mystery of lightning and perhaps the spark of life. 5 Inspired by Franklin, F. C. Oetinger, J. L. Fricker, and Prokop Divisch developed a theology of electricity, based on the belief that God is the electrical current. 6 Later in the century, Luigi Galvani and Alessandro Volta debated over whether the galvanic flow might be the origin and principle of life itself. 7 A few years before Franklin harvested lightning, John Michell argued that the magnetic force is not constrained to lodestones but is possibly pervasive. Some years later, Franz Aepinus suggested that magnetism and electricity manifest a deep energy. Soon after, C. A. de Coulomb discovered the mathematical law by which electrical and magnetic forces operate (Whittaker, pp. 50–59).These findings led to the breakthroughs of the nineteenth century. 8 In 1807, Humphry Davy hypothesized that chemical elements interact through electromagnetic affinity or repulsion. 9 In 1820, H. C. Oersted demonstrated the correspondence between electricity and magnetism. The same year, A. M. Ampere formulated the laws by which electrical and magnetic currents interact (Whittaker, pp. 81–86). Michael Faraday in 1831 revealed electromagnetic induction and thus inaugurated a second Copernican revolution: he showed that matter is not solid and discrete but a field of electromagnetic energy. 10 The dreams of [End... (shrink)

At some point in the future – perhaps within the next few decades – it will be possible for foetuses to develop completely outside the womb. Ectogenesis, as this technology is called, raises substantial issues for the abortion debate. One such issue is that it will become possible for a woman to have an abortion, in the sense of having the foetus removed from her body, but for the foetus to be kept alive. We argue that while there is a (...) right to an abortion, there are reasons to doubt that there is a right to the death of the foetus. Our strategy in this essay is to consider and reject three arguments in favour of this latter right. The first claims that women have a right not to be biological mothers, the second that women have a right to genetic privacy, and the third that a foetus is one's property. Furthermore, we argue that it follows from rejecting the third claim that genetic parents also lack a right to the destruction of cryopreserved embryos used for in vitro fertilization. The conclusion that a woman possesses no right to the death of the foetus builds upon the claims that other pro-choice advocates, such as Judith Jarvis Thomson, have made. (shrink)

In this paper, we argue that promoting patient values is a legitimate goal of medicine. Our view offers a justification for certain current practices, including birth control and living organ donation, that are widely accepted but do not fit neatly within the most common extant accounts of the goals of medicine. Moreover, we argue that recognising value promotion as a goal of medicine will expand the scope of medical practice by including some procedures that are sometimes rejected as being outside (...) the scope of acceptable medical practice, such as certain forms of physician-assisted death. We then rebut some common and possible objections to this view. Our aim is not to argue that other accounts are mistaken—except when they argue for a single goal that does not include patient values—but rather to show that value promotion should play a more central role in discussions about the goals of medicine. (shrink)

Since field experiments in democratic politics influence citizens and the relationships among citizens, they are freighted with normative significance. Yet the distinctively democratic concerns that bear upon such field experiments have not yet been systematically examined. In this paper, we taxonomize such democratic concerns. Our goal is not to justify any of them, but rather to reveal their basic structure, so that they can be scrutinized at further length. We argue that field experiments could be democratically objectionable even if they (...) are not decisive – even if they do not swing the results of elections or other political decisions. Rather, if a class of campaign experiments is objectionable, one reason for this is that they undermine citizens’ equal standing. The ideal of equal standing affords nuanced judgments about the permissibility of field experiments in democratic politics. (shrink)

Pulvermüller's work in extending Hebb's theory into the realm of language is exciting. However, we feel that what he characterizes as a single cell assembly is actually a set of cooperating cell assemblies that form parts of larger cognitive structures. These larger structures account more easily for a variety of phenomena, including the psycholinguistic.

Page's target article makes a good case for the strength of localist models. This can be characterized as an issue of where new information is integrated with respect to existing knowledge structures. We extend the analysis by discussing the dimension of when this integration takes place, the implications, and how they guide us in the creation of cognitive models.

The Bible has influenced contemporary culture both positively and negatively. The present volume is a collection of papers that were discussed at an international colloquium on the use of the Bible in Ethics in the Department of Biblical Studies at the University of Sheffield in April 1995. Participants came from many parts of the world and from different backgrounds, and the papers reflect their varied interests and the contexts in which they work. The contributors, in addition to the three editors, (...) are John Barton, Bruce Birch, Mark Brett, Mark Chapman, David Clines, Philip Davies, Cheryl Exum, Stephen Fowl, Norman Gottwald, John Haldane, Walter Houston, Sharon Ringe, Chrisopher Rowland, Lisa Sowle Cahill and Gerald West. (shrink)

Presents general information about meteorology, weather, and climate and includes more than thirty activities to help study these topics, including making a ...

Although Glenberg 's theory benefits from the incorporation of a suppression concept, a more differentiated view of suppression would be even more effective. We propose such a concept, showing how it accounts for phenomena that Glenberg describes and also for phenomena that he ignores.

“What is the structure of thought?” is as central a question as any in cognitive science. A classic answer to this question has appealed to a Language of Thought (LoT). We point to emerging research from disparate branches of the field that supports the LoT hypothesis, but also uncovers diversity in LoTs across cognitive systems, stages of development, and species. Our letter formulates open research questions for cognitive science concerning the varieties of rules and representations that underwrite various LoT-based systems (...) and how these variations can help researchers taxonomize cognitive systems. (shrink)

Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

The theory and practice of history and its relevance to the modern world, by Britains greatest radical historian.

This comprehensive volume marks a new standard in scholarship in the still emerging field of the philosophy of chemistry. With selections drawn from a wide range of scholarly disciplines, philosophers, chemists, and historians of science here converge to ask some of the most fundamental questions about the relationship between philosophy and chemistry. What can chemistry teach us about longstanding disputes in the philosophy of science over such issues as reductionism, autonomy, and supervenience? And what new issues may chemistry bring to (...) the forefront now that it has joined physics and biology as a serious topic for philosophical reflection? This newest addition to the prestigious Boston Studies in the Philosophy of Science series marks the true arrival of philosophy of chemistry within the corpus of the philosophy of science. (shrink)

The underrepresentation of females in mathematics-related fields may be explained by gender differences in mathematics self-concept (rather than ability) favoring males. Mathematics self-concept typically declines with student age, differs with student ethnicity, and is sensitive to teacher influence in early schooling. We investigated whether change in mathematics self-concept occurred within the context of a longitudinal intervention to raise and sustain teacher expectations of student achievement. This experimental study was conducted with a large sample of New Zealand primary school students and (...) their teachers. Data were analyzed using longitudinal multilevel modelling with mathematics self-concept as the dependent variable and time (which represents students’ increasing age each year), gender, and ethnicity entered as predictors and achievement in mathematics included as a control variable. Interaction terms were also explored to investigate changes over time for different groups. All students demonstrated a small increase in mathematics self-concept over the three-year period of the current study but mathematics self-concept was consistently greater for boys than girls. Māori, Asian, and Other students’ initial mathematics self-concept was higher than that of New Zealand European and Pacific Islanders’ (after controlling for achievement differences). However, a statistically significant decline in mathematics self-concept occurred for Māori students alone by the end of the study. The expected age-related reduction over time in student mathematics self-concept appeared to be mitigated in association with the longitudinal study. Nevertheless, the demonstration of a comparatively lower mathematics self-concept remained for girls overall and declined for Māori. Our results reinforce implications for future research into mathematics self-concept as a possible determinant of female student career choices. (shrink)

The De Malo represents some of St. Thomas Aquinas' most mature thinking on goodness, badness, and human agency. Together with the second part of the Summa Theologiae, it is one of his most sustained contributions to moral philosophy and theology. Aquinas examines the full range of questions associated with evil: its origin, its nature, its variety, its relation to good, and its compatibility with the existence of an omnipotent, benevolent God. This edition offers the Leonine Commission's authoritative edition of the (...) Latin text with a new, clear, and readable English translation by Richard Regan with an extensive introduction and notes by Brian Davies. (shrink)

Recently, in this journal, Jeremy Gwiazda has offered a critique of our separationist view of hell. His objection relies on two key assumptions, and we show in our reply that both assumptions can be denied.

New communication technologies such as the microcomputer, videotex/teletext systems, the videocassette recorder, and satellite receiving dishes have been available to farmers since the early 1980s. This longitudinal study examines ethical issues associated with the impact that differential patterns of adoption and use of these technologies have had on inequalities among farmers from 1982 to 1989. The results demonstrate a strong adoption and use bias toward larger scale farmers who already have well-developed skills for handling information. This bias is especially strong (...) for microcomputer and videotex/teletext systems, and it isincreasing over time. Although the same farmers are not adopting all communication innovations, there is a strong tendency toward the already information-rich making the most use of the innovations they adopt. The article concludes with several recommendations that would help minimize some of these information inequalities. (shrink)

Most people who defend physician-assisted death (PAD) endorse the Joint View, which holds that two conditions—autonomy and welfare—must be satisfied for PAD to be justified. In this paper, we defend an Autonomy Only view. We argue that the welfare condition is either otiose on the most plausible account of the autonomy condition, or else is implausibly restrictive, particularly once we account for the broad range of reasons patients cite for desiring PAD, such as “tired of life” cases. Moreover, many of (...) the common objections to an Autonomy Only view fail once we understand the extent of the autonomy condition’s requirements—in particular, the importance of one’s values for autonomous choices. If our view is correct, then the scope of permissible PAD is broader than is currently accepted in both the philosophical literature and the law, and therefore poses an important challenge to this widely accepted view on justified PAD. (shrink)

Uncertainty and affect are fundamental and interrelated aspects of the human condition. Uncertainty is often associated with negative affect, but in some circumstances it is associated with positive affect. In this paper, we review different explanations for the varying relationship between uncertainty and affect. We identify “mental simulation” as a key process that links uncertainty to affective states. We suggest that people have a propensity to simulate negative outcomes, which results in a propensity towards negative affective responses to uncertainty. We (...) also propose the existence of several important moderators of this process, including context and individual differences such as uncertainty tolerance, as well as emotion regulation strategies. Finally, we highlight important knowledge gaps and promising areas for future research, both empirical and conceptual, to further elucidate the relationship between uncertainty and affect. (shrink)

Medicine and ethics alike must learn properly to attend to suffering. We can never truly experience another's distress. We can, however, learn to recognize the particular purposes, values, and aesthetic responses that shape the sense of self whose integrity is threatened by pain, disease, and the mischances of life.

Game of Thrones is a popular, award-winning television series with an eight-season run on Home Box Office, based on the Song of Fire and Ice series of books by George R.R. Martin. It depicts a morally complex political situation in a fantasy environment that has some similarities to medieval Europe. In the midst of this setting, the series advocates a cynical attitude towards politics, social structures, and religion. Most notably, the series suggests that there is no such thing as political (...) legitimacy. This chapter identifies a pattern of cynicism throughout Game of Thrones but points towards the thoughts of John Locke and Thomas Aquinas as possible alternatives to the story’s cynicism. (shrink)