Over the past several decades, medical ethics has gained a solid foothold in medical education and is now a required course in most medical schools. Although the field of medical ethics is by nature eclectic, moral philosophy has played a dominant role in defining both the content of what is taught and the methodology for reasoning about ethical dilemmas. Most educators largely rely on the case‐based method for teaching ethics, grounding the ethical reasoning in an amalgam of theories drawn from (...) moral philosophy, including consequentialism, deontology, and principlism.In this article we hope to make a case for augmenting the focus of education in medical ethics. We propose complementing the traditional approach to medical ethics with a more embedded approach, one that has been described by others as “microethics,” the ethics of everyday clinical practice. (shrink)

Brock Macdonald1, Evi Vakiani2, Rhonda K Yantiss3, Jun Lee4, Robert S Brown Jr5, Samuel H Sigal61Division of Gastroenterology, Department of Medicine, University of California-San Francisco, San Francisco, CA, 2Department of Pathology, Memorial Sloan–Kettering Cancer Center, New York, NY, 3Department of Pathology and Laboratory Medicine, New York Weill Cornell Medical College, New York, NY, 4Division of Nephrology, Department of Medicine, Weill Cornell Medical College, New York, NY, 5Division of Gastroenterology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, (...) NY, 6Division of Gastroenterology and Hepatology, Department of Medicine, New York University, New York, NY, USA: The use of sirolimus as an alternative to calcineurin inhibitors for posttransplant immunosuppression is associated with a variety of inflammatory conditions. In this report, we describe the case of a 34-year-old man who developed abnormal liver tests 6 years after live-donor kidney transplantation and 5 years after initiation of sirolimus-based immunosuppression. Elevated aminotransferase levels persisted after withdrawal of potentially hepatotoxic medications, and serologic evaluation for viral hepatitis, autoimmune disease, and genetic disorders was unrevealing. Liver biopsy revealed prominent hepatocellular injury associated with a mixed inflammatory infiltrate and liver tests normalized within 2 weeks of discontinuation of sirolimus. In this report, we review previous reports of sirolimus hepatotoxicity and propose a unifying hypothesis for the various inflammatory conditions that have been attributed to sirolimus.Keywords: sirolimus, immunosuppression, transplant, inflammatory conditions, hepatotoxicity. (shrink)

Patient and family emotional harm after medical errors may be profound. At an Agency for Healthcare Research and Quality conference to establish a research agenda on this topic, the authors used visual images as a gateway to personal reflections among diverse stakeholders. Themes identified included chaos and turmoil, profound isolation, organizational denial, moral injury and betrayal, negative effects on families and communities, importance of relational skills, and healing effects of human connection. The exercise invited storytelling, enabled psychological safety, and fostered (...) further collaborative discussion. The authors discuss implications for quality/safety, educational innovation, and qualitative research. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Journal of Aesthetic Education 37.2 (2003) 73-79 [Access article in PDF] Does Film Weaken Spectator Consciousness? R.D. Boyd and S.K. Wertz The role of spectator is crucial for an actor, for there are "no actors without spectators." 1 At times the success of the actor depends upon the role taken by the spectator. Thornton Wilder's "Our Town" depends upon an active,creative, involved audience. Other artists expect their audience (...) to be passive,almost unconscious. Whether the medium of creativity is film or the printedpage, examples of both dependencies abound. The focus of this essay is ona classic piece in the literature about film. In the Theory of Film, Siegfried Kracauer provides us with a mesmerizing printed discussion of film. 2 In this essay we wish to examine his reasoning that is in a self-contained argument by analogy. Since Kracauer does not use or mention the argument thereafter, we feel that we can isolate the argument from its context and deal with it as it stands. After an extended analysis of the argument, we will relate some of the points to the literature on film. The following analogical argument is our focus. Films...tend to weaken the spectator's consciousness. Its withdrawal from the scene may be furthered by the darkness in moviehouses. Darkness automatically reduces our contacts with actuality, depriving us of many environmental data needed for adequate judgments and other mental activities. It lulls the mind....Devotees of film and its opponents alike have compared the medium to a sort of drug and have drawn attention to its stupefying effects....Doping creates dope addicts. It would seem a sound proposition that the cinema has its habitues who frequent it out of an all but physiological urge. They are not prompted by a desire to look at a specific film or to be pleasantly entertained; what they really crave is for once to be released from the grip of consciousness, lose their identity in the dark, and let sink in, [End Page 73] with their senses ready to absorb them, the images as they happen to follow each other on the screen. 3To support his main point, "Films...tend to weaken the spectator's consciousness," Kracauer develops three intermediate arguments (IA's), which support his major argument (MA). If each sentence in the above passage were numbered one through nine, with the last full sentence being broken into two sentences at the semicolon, the following schema emerges. In English the chain of reasoning is: IA-1 Some habitues of film are not prompted by a desire to look at a specific film or to be pleasantly entertained. What they really crave is release fromthe grip of consciousness, to lose their identity in the dark, and let sink in, with their senses ready to absorb them, the images as they happen to follow each other on the screen. Therefore, the cinema has its habitues who frequent it out of an all but physiological urge.IA-2 Some habitues of film frequent it out of an all but physiological urge. Doping creates dope addicts. Therefore, devotees of film and its opponents alike have compared the medium to a sort of drug and have drawn attention to its stupefying effects.IA-3 Darkness automatically reduces our contacts with actuality, depriving us of many environmental data needed for adequate judgments and other mental activities. Darkness lulls the mind. Therefore, consciousness withdrawal from the scene may be furthered by the darkness in moviehouses.MA Devotees of film and its opponents alike have compared the medium to a sort of drug and have drawn attention to its stupefying effects. Consciousness withdrawal from the scene may be furthered by the darkness in moviehouses. Therefore, films...tend to weaken the spectator's consciousness. The above chain of arguments influences us, the spectators, to embrace his main point. However, before we are lulled into accepting his reasoning, it will be helpful to examine and evaluate each link. [End Page 74]IA-1 Some habitues of film are not prompted by a desire to... (shrink)

Adolescence is a developmental stage when adolescents are vulnerable to addictive behaviors, such as Internet addiction, which refers to pathological use of the Internet. Although there are views proposing that the links between IA and adolescent problem behavior may be bidirectional in nature, few studies have examined the reciprocal relationships between IA and other maladjustment indicators, and even fewer studies have simultaneously employed both emotional and behavioral maladjustment indicators in a single study. To address the above research gaps, the present (...) study investigated how IA is associated with both depression and delinquency among Chinese adolescents. Two waves of data were collected at two consecutive years, respectively, with 1year apart, from 3,010 students in four junior high schools in mainland China. These students completed the same questionnaire containing measures of IA, depression, and delinquency at each wave. The proposed cross-lagged panel model fitted the data very well, and there were significant positive reciprocal effects between IA and depression as well as delinquency after controlling for background socio-demographic factors. Gender differences were also observed in multi-group comparisons. Specifically, IA showed a stronger longitudinal impact on delinquency among boys than among girls. While depression significantly predicted IA in 1year among boys, such a prediction was not significant among girls. These findings delineate the bidirectionality of the associations between IA and emotional and behavioral maladjustment indexed by depression and delinquency, respectively. The findings also suggest that researchers and practitioners have to take gender differences as well as different developmental indicators in understanding the bidirectional influences between IA and adolescent behavioral and emotional development. (shrink)

This article examines the historically embedded relations of three 19th-century phenomena in which the non-consuming body is constituted as a spectacle of admiration. These three phenomena, known as Fasting Women, Living Skeletons and Hunger Artists, all emerged and disappeared in Europe in the 18th and 19th centuries. Viewing the emergence and disappearance of the three phenomena as embedded in the historical crossroads of pre-modern and modern ethics, the article argues that each of these phenomena corresponds differently to the clash between (...) modern `rationality' and the pre-modern celebration of `miracles'. The article maintains that while Fasting Women epitomized that clash by becoming (a highly contested) spectacle of `the miraculous', the Living Skeletons transcended the clash by portraying a spectacle of liminal corporeality (the `living dead') and the Hunger Artists announced the dissolution of that very clash by performing a spectacle of `the controlled self'. Through a focus on the spectacle of fasting (i.e. the appeared, performed, `gazed at' act of fasting), a phenomenological typology of the three phenomena is outlined. I suggest that while Fasting Women and Living Skeletons embodied a spectacle of a lean body, which does not require suffering, the Hunger Artists embodied a spectacle of hunger centred on suffering and pain. The phenomenological `mapping' of these phenomena is then considered in the context of `performativity theory' and proposed as a frame of reference for a sociological study of anorexia nervosa. (shrink)

When a nation declares war, it rarely takes time to define the concept. When a peace treaty is signed, governments and peoples assume that they know what to exp.

Citizenship under Fire examines the relationship among civic education, the culture of war, and the quest for peace. Drawing on examples from Israel and the United States, Sigal Ben-Porath seeks to understand how ideas about citizenship change when a country is at war, and what educators can do to prevent some of the most harmful of these changes.Perhaps the most worrisome one, Ben-Porath contends, is a growing emphasis in schools and elsewhere on social conformity, on tendentious teaching of history, (...) and on drawing stark distinctions between them and us. As she writes, "The varying characteristics of citizenship in times of war and peace add up to a distinction between belligerent citizenship, which is typical of democracies in wartime, and the liberal democratic citizenship that is characteristic of more peaceful democracies."Ben-Porath examines how various theories of education--principally peace education, feminist education, and multicultural education--speak to the distinctive challenges of wartime. She argues that none of these theories are satisfactory on their own theoretical terms or would translate easily into practice. In the final chapter, she lays out her own alternative theory--"expansive education"--which she believes holds out more promise of widening the circles of participation in schools, extending the scope of permissible debate, and diversifying the questions asked about the opinions voiced. (shrink)

Medical science at its core aims to preserve health and eliminate disease, but a common theme in scientific discovery is the application of findings in ways that were not the primary intent. The development of diagnostic modalities to predict the health of resulting children has been a fundamental aim underpinning research into prenatal and preimplantation diagnostic modalities; however, the knowledge gained has in some cases been utilized for nonmedical purposes. As an example, amniocentesis developed to determine whether the pregnancy is (...) chromosomally normal also provides information about the sex of the fetus, which normally does not affect health. The emerging gene‐editing technologies that could be used to repair mutated disease‐causing genes in an embryo will presumably also be able to be used to alter traits unrelated to disease. And yet, I will argue, the desire to preserve the mystery of reproduction remains a central value in humans’ quest to reproduce. This yearning to maintain the mysteries will likely temper the development of strategies to alter our genome and affect the genetic identities of our offspring. In my experience as an obstetrician and reproductive endocrinology and infertility subspecialist, people want to have, not the best possible baby, but rather their own baby. (shrink)

The relationship between adults and children in liberal democracies is based on two flawed assumptions that are widespread: first, that childhood is an impediment, a passing phase of impaired maturity; and second, that children benefit from the proliferation of rights ascribed to them. Social institutions, and particularly the education system, are correspondingly misconstrued. This article focuses on the combined effect of vulnerability and autonomy as they construct contemporary childhood. I conclude that adults' obligations rather than children's rights are the appropriate (...) social, political and educational basis for adult society's relations with children. (shrink)

Du film Her de Spike Jonze à 2001 L’Odyssée de l’espace de Stanley Kubrick, et des androïdes de Philip K. Dick à l’utopie intergalactique de la Culture de l’écrivain Iain M. Banks, il est impossible de comprendre aujourd’hui l’intelligence artificielle sans s’intéresser à ses puissants imaginaires. Ceux-ci, nourrissant bien des fantasmes de la Silicon Valley, sont essentiels à décrypter pour ne pas les subir, voire pour se les approprier et mieux les détourner, en faire des antidotes contre les multinationales du (...) numérique, puis cultiver grâce à eux nos propres machines rebelles de quelque futur. (shrink)

In the engaging and thought-provoking book The Gene Machine: How Genetic Technologies Are Changing the Way We Have Kids and the Kids We Have, Bonnie Rochman addresses the question of choice in human reproduction through the lens of knowledge. Asserting that the desire for knowledge is the central theme of modern-day reproduction, she asks, “Is genetic knowledge empowering or fear-inducing or both?” Yet the question at the heart of the book goes beyond knowledge. Rochman delves into whether genetic information is (...) actionable and then examines the corollary question of whether individuals should make decisions based on this data. Do parents want to choose the kinds of kids they have? Certainly, most parents would do what they could to prevent their child from having a painful, life-limiting disease. But that is the extreme. And while genetic technologies generally start by targeting the extreme, the inevitable byproduct is the ability to know about and affect the fringe. It is at the borders that the critical questions lie. Taking advantage of reproductive choices has potentially life-altering and permanent consequences not only for the chooser but also for the resulting child, the family unit, and society. (shrink)

When a nation declares war, it rarely takes time to define the concept. When a peace treaty is signed, governments and peoples assume that they know what to exp.

This paper deals about dualities for bounded prelinear Hilbert algebras. In particular, we give an Esakia-style duality between the algebraic category of bounded prelinear Hilbert algebras and a category of H-spaces whose morphisms are certain continuous p-morphisms.

This study aimed to examine how anxiety related to different styles of coping during the COVID-19 pandemic and how these relationships were moderated by the cultural orientations of individualism/collectivism and a person’s sense of meaning in life. A sample of 849 participants from Georgia completed an online survey during the final stage of lockdown. To measure the main variables, we used the State Anxiety Inventory, the Horizontal and Vertical Individualism and Collectivism Scale, the Meaning of Life Questionnaire, the COVID-19 Worry (...) Scale, and the Ways of Coping Scale tailored to COVID-19 pandemic. The latter measured rational coping via the subscales of information accessing/processing and action-planning coping, and affective coping – via the subscales of passive-submissive and avoidant coping. Results suggested that anxiety positively predicted both affective coping styles and negatively predicted the action-planning coping style, while COVID-19 worry predicted all coping styles; presence of meaning in life positively predicted both rational coping styles and negatively predicted the avoidant coping style, while search for meaning positively predicted all coping styles; individualism negatively predicted the passive-submissive style and positively predicted the action-planning style, whereas collectivism predicted all coping styles; furthermore, individualism and collectivism moderated the link between anxiety and the passive-submissive coping style, presence of meaning in life moderated the link between anxiety and avoidant coping style, while search for meaning in life moderated the link between anxiety and the action-planning coping style. Overall, the findings enrich the cultural transactional theory of stress and coping, and generate insights for the culture-sensitive approach to the meaning in life. The results were conceptualized vis-a-vis Georgia’s intermediate position between clear-cut individualism and clear-cut collectivism. (shrink)

In this paper we present an informal review of our recent work whose goal is to develop a mathematical theory of the physical phenomenon of emission and absorption of radiation by systems of nonrelativistic matter such as atoms and molecules.

How (Not) to Be Secular is what Jamie Smith calls "your hitchhiker's guide to the present" -- it is both a reading guide to Charles Taylor's monumental work A Secular Age and philosophical guidance on how we might learn to live in our times. Taylor's landmark book A Secular Age (2007) provides a monumental, incisive analysis of what it means to live in the post-Christian present -- a pluralist world of competing beliefs and growing unbelief. Jamie Smith's book is a (...) compact field guide to Taylor's insightful study of the secular, making that very significant but daunting work accessible to a wide array of readers. Even more, though, Smith's How (Not) to Be Secular is a practical philosophical guidebook, a kind of how-to manual on how to live in our secular age. It ultimately offers us an adventure in self-understanding and maps out a way to get our bearings in today's secular culture, no matter who "we" are -- whether believers or skeptics, devout or doubting, self-assured or puzzled and confused. This is a book for any thinking person to chew on. (shrink)

Cosmology is currently a broad and rapidly developing field of knowledge.