Using a real-life case involving an accidental discovery of misattributed paternity as a springboard for discussion, I reflect on several practical and theoretical issues surrounding truth-telling in the doctor-patient relationship. I present the moral dilemma and identify arguments in favour of and against disclosure. I then examine the theoretical difficulties in balancing conflicting reasons and in establishing what constitutes the 'truth'. I conclude that withholding the information from the patients would be ethically permissible and, more generally, that honesty is not (...) always the best policy. (shrink)

Medical tourists, persons that travel across international borders with the intention to access non-emergency medical care, may not be adequately informed of safety and ethical concerns related to the practice of medical tourism. Researchers indicate that the sources of information frequently used by medical tourists during their decision-making process may be biased and/or lack comprehensive information regarding individual safety and treatment outcomes, as well as potential impacts of the medical tourism industry on third parties. This paper explores the feedback from (...) former Canadian medical tourists regarding the use of an information sheet to address this knowledge gap and raise awareness of the safety and ethical concerns related to medical tourism. (shrink)

Limited edition of 101 copies of the first printing of cloth-bound edition.

edited by Tuija Takala and Matti Häyry, welcomes contributions on the conceptual and theoretical dimensions of bioethics.

In this paper, we defend a representational approach to at least some kinds of non-human psychopathology. Mentally-ill non-human minds, in particular in delusions, obsessive-compulsive disorders and similar cognitive states, are traditionally understood in purely behavioral terms. In contrast, we argue that non-human mental psychopathology should be at least sometimes not only ascribed contentful mental representation but also understood as really having these states. To defend this view, we appeal to the interactivist account of mental representation, which is a kind of (...) a constructive approach to meaning. We follow Mark Bickhard in assuming that only an organism – either human or non-human – capable of detecting its own misrepresentations is representational. However, under his autonomy-based account of biological function these minds are incapable of misrepresentations because these minds are, ex hypothesi, unable to detect error in such representations. To solve this problem, we argue that adding a historical dimension – as in Millikan’s view on mental representations – to Bickhard’s account of function makes mental misrepresentation of mentally-ill minds possible. Using Bickhard’s dynamic account of function, it is possible to explain why delusions and other mental disorders can be seen as locally functional. However, an etiological dimension can further explain why misrepresentations seem to be globally dysfunctional. Even if representational or biosemiotic hypotheses about non-human psychopathology are difficult to confirm empirically, we defend the view that they can enrich our understanding of the causes and development of such pathologies, and may constitute a new progressive research programme. (shrink)

BackgroundMedical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists (...) may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism.MethodsThe methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists.ResultsThe final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service. (shrink)

Medical tourism, the practice of persons intentionally travelling across international boundaries to access medical care, has drawn increasing attention from researchers, particularly in relation to potential ethical concerns of this practice. Researchers have expressed concern for potential negative impacts to individual safety, public health within both countries of origin for medical tourists and destination countries, and global health equity. However, these ethical concerns are not discussed within the sources of information commonly provided to medical tourists, and as such, medical tourists (...) may not be aware of these concerns when engaging in medical tourism. This paper describes the methodology utilized to develop an information sheet intended to be disseminated to Canadian medical tourists to encourage contemplation and further public discussion of the ethical concerns in medical tourism. The methodology for developing the information sheet drew on an iterative process to consider stakeholder feedback on the content and use of the information sheet as it might inform prospective medical tourists’ decision making. This methodology includes a literature review as well as formative research with Canadian public health professionals and former medical tourists. The final information sheet underwent numerous revisions throughout the formative research process according to feedback from medical tourism stakeholders. These revisions focused primarily on making the information sheet concise with points that encourage individuals considering travelling for medical tourism to do further research regarding their safety both within the destination country, while travelling, and once returning to Canada, and the potential impacts of their trip on third parties. This methodology may be replicated for the development of information sheets intending to communicate ethical concerns of other practices to providers or consumers of a certain service. (shrink)

Pro-social basic human values and civic involvement. The moderating role of survival vs self-expression cultural context The present study investigated a hypothesis that the pro-social values differentiated by S. Schwartz's model of basic human values - universalism and benevolence - would positively predict civic involvement. Most importantly, authors expected that the type of pro-social value that would play a dominant motivational role would depend on moderating role of the level of self-expression and benevolence - cultural value dimension developed by R. (...) Inglehart. Based on discriminant function analyses performed on the data gathered in 17 European countries through the European Social Survey conducted in 2002, authors found that universalism predicts civic involvement only in self-expression countries, whereas the role of benevolence is rather neglectable and independent of the cultural context. The results are discussed with reference to cross-cultural differences in Europe. (shrink)

The medical profession’s role should be limited to advice and informationThe medical establishment’s desire to interfere with the autonomous wishes of boxers seems at odds with the principle of respect for autonomy prevalent in contemporary biomedical practice. I argue that the role of the medical profession in boxing should be solely an advisory and informational one. In addition, the distinctions made between boxing and other high risk sports often rely on an insufficient knowledge of the sport. This leads to misdirected (...) criticisms and excessive emphasis on the colourful discourse of boxing, as opposed to the practice of boxing itself. Dr Herrera’s claim in his article that boxing differs from other sports in the acceptability of its acts outside the realm of sport is refuted.1 The importance of consent as a legitimising factor is highlighted, and a number of possible solutions to improve safety within the sport are tentatively suggested.In the United Kingdom, a competent adult may legally refuse medical treatment, irrespective of the severity of his condition or the validity of his reasons. With the pre-eminence of an autonomy based model of bioethics, respecting a patient’s wishes forms an integral part of acting in his best interests. It is puzzling, then, to find that the Australian Medical Association have called for a ban on boxing on the grounds that the activity is excessively hazardous to the health of boxers. The often mentioned principle of respect for autonomy is abandoned once the person drops the privileged title of “patient”. This suggests that being a patient …. (shrink)

In this paper, I analyze a type of externalist enactivism defended by Riccardo Manzotti. Such radical versions of enactivism are gaining more attention, especially in cognitive science and cognitive robotics. They are radical in that their notion of representation is purely referential, and content is conflated with reference. Manzotti follows in the footsteps of early causal theories of reference that had long been shown to be inadequate. It is commonly known that radical versions of externalism may lead to difficulties with (...) the notion of representation, especially if they cannot help themselves with the notion of syntax. I argue that a type of externalism present in Manzotti’s enactivism may well lead to anti-representationalism. (shrink)

Celem artykułu jest ukazanie, jak, mimo ustalonych dawno temu postulatów, nakazujących „oczyszczenie” powieści kryminalnej z elementów fantastycznych i nadprzyrodzonych, motywy te funkcjonują we współczesnych utworach z tego gatunku. Jako kontekst należy wskazać zjawiska dające się zauważyć w najnowszej literaturze i kulturze popularnej. Jednym nich jest zmiana postrzegania typowych monstrów z horroru, które stają się zarówno „mniej groźne”, jak i „bardziej ludzkie”. Kolejnym – zakwestionowanie związku postaci (a także zespołu motywów) z fabułą. To na przykład, co było dotąd typowe dla horroru, (...) może pojawić się w powieści kryminalnej. Przeprowadzono analizę wybranych utworów dwojga współczesnych pisarzy: Katarzyny Puzyńskiej (Czarne narcyzy, Martwiec, Rodzanice i Utopce) oraz Wojciecha Chmielarza (Wampir, Zombie i Wilkołak) pod kątem występowania w nich motywów rodem z powieści grozy. We wszystkich omawianych tekstach to ludzie, a nie potwory są zabójcami. W utworach Chmielarza nazwy rodem z horroru to metafory ludzkiego zła lub szaleństwa (autor odwołuje się do zakorzenionych w kulturze znaczeń słów użytych jako tytuły). Katarzyna Puzyńska z kolei za miejsce zdarzeń wybiera małe, często prawie wyludnione miejscowości, gdzie wciąż żywa jest wiara w duchy, wampiry, nawiedzone domy (autorka odwołuje się między innymi do wierzeń słowiańskich). Ukazuje przy tym siłę ludzkich lęków (dotyczy to, w odpowiednich okolicznościach, nawet policjantów), jak również fakt, że istoty ludzkie potrafią być gorsze od potworów z fikcji literackiej. Motywy rodem z horroru funkcjonują w omawianych tekstach na kilka sposobów: 1) jako odwołania do doświadczenia odbiorcy, który odczytuje np. zaprezentowane w powieści nazwy w oparciu o własną wiedzę; 2) jako element lokalnej lub rodzinnej tradycji (żywy najczęściej w miejscach oddalonych od „centrów”); wreszcie 3) ucieleśnienie ukrytych w ludzkiej psychice obsesji i lęków, które niespodziewanie mogą się ujawnić. (shrink)

This paper presents an argument for the realism about mechanisms, contents, and vehicles of mental representation at both the personal and subpersonal levels, and showcases its role in instrumental rationality and proper cognitive functioning. By demonstrating how misrepresentation is necessary for learning from mistakes and explaining certain failures of action, we argue that fallible rational agents must have mental representations with causally relevant vehicles of content. Our argument contributes to ongoing discussions in philosophy of mind and cognitive science by challenging (...) anti-realist views about the nature of mental representation, and by highlighting the importance of understanding how different agents can misrepresent in pursuit of their goals. While there are potential rebuttals to our claim, our opponents must explain how agents can be rational without having mental representations. This is because mental representation is grounded in rationality. (shrink)

The article presents the main types of conflict behaviour with the author’s proposal of their classification. The suggested classification is based on the way in which an individual deals with a partner’s adverse influence on his/her self-interest and welfare in a conflict situation. Four possible ways of coping i.e. attack, amicable settlement, defence, and yielding have been distinguished. On the basis of this behaviour classification, the Conflict Behaviour Questionnaire was compiled and its reliability and validity was assessed.

HERMENEUTIC INDICATORS OF PRESENTING THE HISTORY OF PHILOSOPHY The aim of the article is to discuss Hans-Georg Gadamer’s and Paul Ricoeur’s hermeneutic way of understanding the history of philosophy. I assume that hermeneutic reference to philosophical past appears as a unique dialogue with tradition, whereas their way of understanding the history of philosophy might be defined as “hermeneutic interpretation of tradition.” In order to show what its indicators are, I characterize the conception of hermeneutic experience (H.-G. Gadamer) as well as (...) the issue of the interpretation process (P. Ricoeur). Those thinkers are convinced that understanding of the history of philosophy involves the recognition of our own historicity. Keywords: HANS-GEORG GADAMER, PAUL RICOEUR, HISTORY OF PHILOSOPHY, HERMENEUTICS. (shrink)

Case 1 reminds us that patients have duties too, while case 2 presents an instance of justified withholding of informationHow refreshing to read these two cases! No conjoined twins, fantastical chimeras, or other incredible scenarios at the fringes of medical reality. Each case highlights the practical and theoretical difficulties that doctors face in their everyday practice.Case 1: In case 1, the patient, who had declined an HIV test, changed his mind and requested an HIV test on the request form without (...) informing the doctor. The pathologist performed the tests and returned the results to the unsuspecting doctor, who duly investigated the matter. The doctor’s anxiety at the situation, as well as the worries of the entire practice and pathology laboratory, must have been deeply unpleasant. Thus the patient, no doubt unintentionally, caused much distress by requesting the HIV test. He was, at the very least, guilty of a lack of foresight and consideration. As a minimum, he should have informed the doctor of his last minute alteration. This would have enabled the doctor to discuss the implications of the test, to organise appropriate counselling, and, most importantly, to receive the results in full knowledge of the situation.As Dr Fraser points out, the experience of case 1 reinforces the importance of taking good medical notes. Even if the patient’s refusal had been documented in the notes, however, this would not have prevented him from requesting the HIV test, and indeed other tests, on the blood form. Pharmacists may still occasionally be faced with situations when they are unsure whether the doctor prescribed 10 capsules of a drug, or 110 capsules, as the patient may have added a “1” in front of the doctor’s original prescription. Similarly, how …. (shrink)

The public revelation in 2003 that medical students perform intimate examinations without patient consent has engendered much debate in the press and scientific journals. Using this case as a springboard for discussion, I will argue that medical schools should encourage students to raise their ethical concerns and call for a change of policy making it easier for students to do so. I will also address the question of medical students’ moral obligations towards their patients, and conclude that medical students ought (...) to express their discontent when faced with unethical practices or attitudes.In early January 2003, a study appeared in the British Medical Journal revealing that nearly a quarter of rectal and vaginal examinations on anaesthetised patients were performed by medical students without patient consent.1 Although the study did not generate the firestorm of controversy many expected, it engendered much discussion on ethical issues surrounding informed consent and patient autonomy, as well as stressing the need for greater ethics training for medical students. As an ethical problem, however, the case of intimate examinations is, to my mind, relatively uninteresting. If we agree that it is wrong for doctors to perform a vaginal examination on a conscious person without their consent, then it follows that it will still be …. (shrink)

Although telephone consultations are widely used in the delivery of healthcare, they are vulnerable to breaches of patient confidentiality. Current guidelines on telephone consultations do not address adequately the issue of confidentiality. In this paper, we propose a solution to the problem: a password system to control access to patient information. Authorised persons will be offered the option of selecting a password which they will use to validate their request for information over the telephone. This simple yet stringent method of (...) access control should improve security while allowing the continuing evolution of telephone consultations. (shrink)

The concept of narrow content is still under discussion in the debate over mental representation. In the paper, one-factor dimensional accounts of representation are analyzed, particularly the case of Fodor's methodological solipsism. In methodological solipsism, semantic properties of content are arguably eliminated in favor of syntactic ones. If “narrow content” means content properties independent of external factors to a system (as in Segal's view), the concept of content becomes elusive. Moreover, important conceptual problems with one-factor dimensional account are pointed out (...) as a result of analysis arguments presented by J. Searle, S. Harnad and T. Burge. Furthermore, these problems are illustrated with psychological and ethological examples. Although understanding content as partially independent from contextual factors allows theorists to preserve content properties, it seems that understanding content in total abstraction from external factors of these properties is implausible. As a result, internalism is rejected in favor of externalism. (shrink)

The article discusses the composition of Lysias’ speech, devoted to the history of music, in Pseudo-Plutarch’s treatise On Music. Close attention has been paid to the unifying mechanisms employed by Lysias to create the coherence and unity of the textual construction. The analysis of the speech presented in the article leads to the conclusion that the employment of clearly marked and coordinated two-part units became the most important technique of the organisation of this speech. The first part of each of (...) eleven pairs Lysias’ speech consists of includes quotations from earlier written sources, the second displays comments and interpreting remarks on these citations. This scheme of organisation of the speech provides the internal order and continuity of thought in the historical part of Pseudo-Plutarch’s work. (shrink)

Celem artykułu jest przedstawienie wybranych wątków myśli Paula Ricreura, szczególnie jego rozważań dotyczących niewolnej woli. Po pierwsze, zaprezentowana zostaje Ricreurowska filozofia woli oraz koncepcja ludzkiej ułomności. Następnie omówionajest reinterpretacja fenomenologii Husserla, której dokonuje Ricreur, co prowadzi go do wypracowania hermeneutycznej formuły, wskazującej, że symbol daje do myślenia. Ostatecznie twierdzę, że fenomenologia hermeneu- tyczna Ricreura tworzy określoną wizję antropologiczną i rozumienie ludzkiej kondycji, które później stanie się częścią „hermeneutyki siebie”.

Case presentations, esthetics, insurance considerations, communicable diseases, referral questions, dental phobia, and legal concerns all play a role in doctor-patient relationships. These topics, and many others, are the subject of this one-of-a-kind resource, designed to show dental students and practitioners how to approach patient relationships.

Tematem artykułu są nowe założenia w nauczaniu wiedzy okrajach niemieckiego obszaru językowego, zawarte w najnowszym curriculum dotyczącym tego przedmiotu. Cele, treści, metody, mierzenie postępu w nauce opierają się na czterech podstawowych zasadach: - integralności, która oznacza łączenie przekazywanych informacji z kompetencją językową i metodyczno-dydaktyczną; - łączenia i wzajemnego powiązania wiedzy z różnych dziedzin, np. realioznawstwo, kulturoznawstwo, historia itp.; - interkulturowości, tzn. rozwijania kompetencji, umiejętności, strategii w kontakcie z innymi kulturami; - ukierunkowania na działania, tzn. przekazywanie wiedzy nie w formie prezentacji (...) faktów, lecz na drodze indukcyjnej, także w formie projektów, wyjazdów studyjnych, kontaktów w kraju i za granicą. Nadrzędnym celem jest wykształcenie człowieka, który będzie dysponował nie tylko wiedzą z zakresu przedmiotu, ale także kompetencją fachowo-dydaktyczną, interkulturową i będzie w stanie samodzielnie interpretować zjawiska społeczne, polityczne i kulturowe w krajach niemieckiego obszaru językowego, a także we własnym zakresie uzupełniać swoją wiedzę. Ponieważ zjawiska te są w ciągłym rozwoju, nie należy zakładać, iż ogarnięty zostanie ich całokształt. Należy dążyć do naświetlenia różnorakich aspektów rzeczywistości społecznej z takich zakresów, jak np. jednostka i społeczeństwo, państwo i społeczeństwo, gospodarka, życie kulturalne itp. Przy ich omawianiu punktem wyjścia są doświadczenia i zainteresowania uczących się. Znajdują oni wspólnie takie tematy, które dają się rozbudowywać w różnych kierunkach w zależności od potrzeb i zainteresowań. Efektem takiego postępowania jest stworzenie nie listy obowiązujących tematów, lecz pewnej sieci wzajemnie z siebie wynikających problemów, którą ciągle można rozszerzać. Wdrożenie takiej drogi musi iść w parze z zastosowaniem różnorakich technik i metod. Powyższe curriculum uwzględnia także powstałą w ostatnich latach koncepcję nauczania wiedzy okrajach niemieckiego obszaru językowego nie w sposób sumaryczny, czyli omawiając kolejno te kraje i występujące w nich zjawiska, lecz w sposób zintegrowany i ukierunkowany na problem, tzn. odnosząc omawiane zjawiska do wszystkich krajów jednocześnie. (shrink)