Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)

First published in 1989. Routledge is an imprint of Taylor & Francis, an informa company.

Recent scandals in the business world have intensified the demand for an explanation of the causes of corporate wrongdoing. This study empirically tests the effects of mutual fund management fees and control structures on the likelihood of illegal activity within mutual fund organizations. Specific attention is given to the presence of agency duality issues in the mutual fund industry and how this influences the motivations and decisions of fund managers. Findings provide support for the hypothesized relationship that higher levels of (...) management fees decrease the likelihood of illegal behavior. Additionally, control of the mutual fund by external management is found to have a negative impact on the likelihood of illegal activity while also acting as a moderator of the management fee-illegal behavior relationship. (shrink)

The legal requirements and justifications for collecting patient-identifiable data without patient consent were examined. The impetus for this arose from legal and ethical issues raised during the development of a population-based disease register. Numerous commentaries and case studies have been discussing the impact of the Data Protection Act 1998 and Caldicott principles of good practice on the uses of personal data. But uncertainty still remains about the legal requirements for processing patient-identifiable data without patient consent for research purposes. This is (...) largely owing to ignorance, or misunderstandings of the implications of the common law duty of confidentiality and section 60 of the Health and Social Care Act 2001. The common law duty of confidentiality states that patient-identifiable data should not be provided to third parties, regardless of compliance with the DPA1998. It is an obligation derived from case law, and is open to interpretation. Compliance with section 60 ensures that collection of patient-identifiable data without patient consent is lawful despite the duty of confidentiality. Fears regarding the duty of confidentiality have resulted in a common misconception that section 60 must be complied with. Although this is not the case, section 60 support does provide the most secure basis in law for collecting such data. Using our own experience in developing a disease register as a backdrop, this article will clarify the procedures, risks and potential costs of applying for section 60 support. (shrink)

A "problem" book which reads, throughout too many of its pages, like an almanac of distinctions. Yet Bunge's discussions of partial truth, causality and chance, and especially of metanomological statements restore the balance and lend support to his thesis: science as a body of knowledge must be regarded as a set of systems of propositions and proposals of many kinds with the aim of "the maximization of the degree of truth."--G. L. C.

Previous studies have identified the critical role of the left fusiform cortex in visual word form processing, learning, and memory. However, this so-called visual word form area's other functions are not clear. In this study, we used fMRI and the subsequent memory paradigm to examine whether the putative VWFA was involved in the processing and successful memory encoding of faces as well as words. Twenty-two native Chinese speakers were recruited to memorize the visual forms of faces and Chinese words. Episodic (...) memory for the studied material was tested 3. h after the scan with a recognition test. The fusiform face area and the VWFA were functionally defined using separate localizer tasks. We found that, both within and across subjects, stronger activity in the VWFA was associated with better recognition memory of both words and faces. Furthermore, activation in the VWFA did not differ significantly during the encoding of faces and words. Our results revealed the important role of the so-called VWFA in face processing and memory and supported the view that the left mid-fusiform cortex plays a general role in the successful processing and memory of different types of visual objects. © 2010 Elsevier Inc. (shrink)

An engineer views mind as a graduated development of, and complement to the physical world, aided by the principle of microphysical coding of information.--G. L. C.

The chronic worldwide lack of organs for transplantation and the continuing improvement of strategies for in situ organ preservation have led to renewed interest in elective non-therapeutic ventilation of potential organ donors. Two types of situation may be eligible for elective intensive care: patients definitely evolving towards brain death and patients suitable as controlled non-heart beating organ donors after life-supporting therapies have been assessed as futile and withdrawn. Assessment of the ethical acceptability and the risks of these strategies is essential. (...) We here offer such an ethical assessment using the four principles of medical ethics of Beauchamp and Childress applying them in their broadest sense so as to include patients and their families, their caregivers, other potential recipients of intensive care, and indeed society as a whole. The main ethical problems emerging are the definition of beneficence for the potential organ donor, the dilemma between the duty to respect a dying patient's autonomy and the duty not to harm him/her, and the possible psychological and social harm for families, caregivers other potential recipients of therapeutic intensive care, and society more generally. Caution is expressed about the ethical acceptability of elective non-therapeutic ventilation, along with some proposals for precautionary measures to be taken if it is to be implemented. (shrink)

Science, which is guided by reason and not pure intuition, is to be regarded as justifiable opinion. Bunge's sketch of philosophical intuition from Aristotle to Heidegger will probably be of interest primarily to the general reader.--G. L. C.

These letters reveal Cohen the friend and teacher of philosophers and jurists, the conscientious liberal, the philosopher. Since few of Cohen's germinal ideas appear in his letters, his tenets find their chief expression through his daughter's uneven commentary. Of the major series of letter exchanged between Cohen and noted figures of his time, O. W. Holmes's letters--with their wit and irony-prove the most exciting.--G. L. C.

In lieu of an abstract, here is a brief excerpt of the content:Criminal Law, Pain Relief, and Physician Aid in DyingFaye Girsh, Ed.D., Executive DirectorMadam:The article by Cantor and Thomas on “Pain Relief, Acceleration of Death, and Criminal Law” (KIEJ, June 1996) was a tortured attempt to develop criteria for the humane and compassionate physician who tries to serve the needs of a patient in unremitting pain. There are three areas that merit comment.The authors dealt with pain medications that might (...) have the undesirable side effect of causing death. They did not mention tolerance, which usually occurs in a patient with chronic pain and which would require exceedingly high doses to be effective. They did not mention barbiturates, which are preferable to opiates in causing death and which are used increasingly by compassionate physicians to answer the pleas of their suffering patients, but for which there is no excuse about alleviating pain. Would the criminal law just call the prescription of a lethal dose of barbiturates a reckless act and require conviction? Fortunately, juries, as the authors point out, do not balance these formulas on the head of a pin. When they see the circumstances under which these doctors do help their patients, they choose to nullify the law and would ignore the suggestions made in this article.The authors refer to the “consent” of the patient. They do not mention that these doctors are operating with more than consent; they are administering these medications because suffering patients are begging them to put them out of their pain and the indignities of the dying process. The article discusses the process as though it were the same as consent to elective surgery. These patients—with AIDS, cancer, and hopeless neurological degeneration—are not simply agreeing to a procedure; they are desperately seeking a way out. If the criminal law were to develop criteria for physician aid in dying, certainly one of them should be the active, witnessed, repeated request of such a patient for a certain, quick, painless, gentle death.The third point is that physicians do not face prosecution when administering no treatment to a patient whose life could be saved with treatment but who chooses not to receive it. This has been upheld by the U.S. Supreme Court; no criteria for suffering, alternatives, terminality, justifiability, or unbearability are required. The doctor can stand by while the patient dies what may be a protracted, difficult death, but it is within the law. What matters in this situation is the decision of the patient to refuse treatment, and that is absolute. How ironic that the patient who cannot refuse treatment must, with his or her doctor, jump through all these hoops to achieve a peaceful death.One worries that the physician who must balance the risk of “risky pain relief” against the accusation of recklessness will err in the direction of allowing [End Page 103] the patient to bear the pain rather than help with a dose of analgesics that might be considered beyond the stipulated “risk.”Why don’t we just be honest about it? Allow dying or hopelessly ill patients to make the decision about what they want by passing a carefully defined law allowing euthanasia rather than balancing the risk and trying to determine the “purpose” of the physician’s ministrations. We protect some patients from themselves while allowing others almost complete autonomy to make the choice of ending their lives. The authors were right in saying that proponents of rational laws consider this sheer hypocrisy.Faye Girsh, Executive DirectorHemlock Society U.S.A. Denver, COFaye Girsh misconceives our article’s objective as an “attempt to develop criteria” for the humane physician. Our goal in writing the paper was to analyze the current criminal law framework in the hope of sharpening debate and engendering normative critiques. We readily acknowledge tensions in the current legal framework and would support changes in that framework.Copyright © 1997 The Johns Hopkins University Press... (shrink)

This collection of essays brings together three philosophers, a lawyer, and an economist, who discuss both similar and unrelated points. Of special importance is the treatment of the problem of adjudicating equality and merit. Questions of political, legal, and moral obligation, and of the relationship between justice and the good life are also explored.--G. L. C.

A "problem" book which reads, throughout too many of its pages, like an almanac of distinctions. Yet Bunge's discussions of partial truth, causality and chance, and especially of metanomological statements restore the balance and lend support to his thesis: science as a body of knowledge must be regarded as a set of systems of propositions and proposals of many kinds with the aim of "the maximization of the degree of truth."--G. L. C.

A distinguished group of linguists examine the present state of theoretic linguistics by looking to the past to see what has been accomplished, and to the future for requirements needed to frame a workable theory of language. The universals of language are taken from phonology, grammar, semantics and psycho-linguists. Uriel Weinreich's paper, "On the Semantic Structure of Language," should be of special interest to philosophers.--G. L. C.

Wigner time reversal implemented by antiunitary transformations on the wavefunctions is to be refined if we are to deal with systems with internal symmetry. The necessary refinements are formulated. Application to a number of physical problems is made with some unexpected revelations about some popular models.

Our goal was to explore self‐care practices among men who have sex with men in the context of Mpox in Brazil. This study used qualitative research methods, including interviews and thematic analysis, to collect and analyze data from male participants across the Brazilian territory. The narratives unveil men's perspectives on self‐care, risk reduction, and health beliefs during the Mpox pandemic. Our findings highlight a multifaceted approach to self‐care among men, encompassing hygiene, physical contact management, mask usage, skin lesion vigilance, and (...) adherence to official guidelines. Men's attitudes toward sexual behaviors emphasize the importance of reducing sexual partners, practicing safe sex, and combating misinformation through accurate information dissemination. The development of these behaviors and self‐care practices can be facilitated by nurses guided by Dorothea Orem's Self‐Care Theory, supported by patient‐centered care, with strategies to address and confront the stigma associated with the disease and provide emotional support. Thus, the study underscores the pivotal role of self‐care in mitigating infection risks, especially in the context of emerging infectious diseases. It acknowledges the impact of socio‐cultural factors and healthcare policies on men's preventive measures. However, it also recognizes limitations, such as potential bias due to stigma concerns and a nonrepresentative sample. Ultimately, the research advocates for tailored education, promotion of gender equity, and healthcare empowerment to effectively manage health risks in such contexts. (shrink)

In the 1950s and 60s, H. L. A. Hart's writings were responsible for the revitalizing of legal philosophy in the UK and worldwide. This new collection of essays by distinguished philosophers and legal theorists addresses the enduring significance of Hart's work, focusing upon some of its more neglected aspects, including his work on causation and the philosophy of action. Two essays discuss Hart and Honore;'s Causation in the Law, a book that has been undeservedly overlooked in many philosophical discussions of (...) causation. The majority of the essays consider Hart's views on the justification of punishment. They discuss Hart's dislike of retribution, his claim that harmless immorality should not be punished, and his search for a non-retributivist theory of mens rea and excuses. Other topics examined include Hart's definitions of key legal and philosophical concepts, including 'punishment', 'responsibility' and 'voluntariness', and his views on punishing negligent acts. (shrink)