The Patient's Charter has been in effect for nearly five years. This article considers the purpose and value of the document through a comparison with the New Jersey Patient Bill of Rights. Patient rights statements have been posted in American hospitals for more than twenty years. However, the New Jersey document and the patient rights programme it established seven years ago, have proven to be economically effective, successful in their representation of patients and enforceable, due to the adoption of state (...) legislation and regulation to oversee the process. Several examples of how the programme works are included in the comparison, with a similar review of The Patient's Charter. In the comparison the author argues that for the programme to succeed as it has done in New Jersey, the government will need to develop legislative backing to ensure enforcement, and an efficient system for monitoring compliance. The programme will need to become credible in the eyes of the health service user. The author suggests this may be best achieved by developing an efficient, accessible and user-friendly means of redress, should the patient consider his or her rights have been violated. A "mish-mash" of quality assurance standards and levels of care which patients can "expect" from the health service providers only serves to distract the health service user from the government's failure to commit the resources that would empower the patients rights portion of The Patient's Charter. (shrink)

Introduction, by D. J. Silver.--The issues: Some current trends in ethical theory, by A. Edel. Contemporary problems in ethics from a Jewish perspective, by H. Jonas. What is the contemporary problematic of ethics in Christianity? By J. M. Gustafson. Modern images of man, by J. N. Hartt. Is there a common Judaeo-Christian ethical tradition? By I. M. Blank. Problematics of Jewish ethics, by M. A. Meyer. Revealed morality and modern thought, by N. Samuelson.--The Jewish background: Does Torah mean law? (...) By J. Neusner. Confrontation of Greek and Jewish ethics: Philo: De Decalogo, by S. Sandmel. Reprobation, prohibition, invalidity: an examination of the Halakhic development concerning intermarriage, by L. Silberman. Death and burial in the Jewish tradition, by S. B. Freehof. God and the ethical impulse, by W. G. Plaut.--Social action: Civil disobedience and the Jewish tradition, by S. G. Broude. Religious responsibility for the social order: A Jewish view, by E. L. Fackenheim. Toward a theology for social action, by R. G. Hirsch. The mission of Israel and social action, by E. Lipman. Some cautionary remarks, by J. Kravetz.--The mission of Israel: On the theology of Jewish survival, by S. S. Schwarzchild. Meaning and purpose of Jewish survival, by A. Gilbert. Beyond the apologetics of mission, by D. J. Silver. (shrink)

That brings me to the crux of my disagreement with Hillis Miller. The central contention is not simply that I am sometimes, or always, wrong in my interpretation, but instead that I—like other traditional historians—can never be right in my interpretation. For Miller assents to Nietzsche's challenge of "the concept of 'rightness' in interpretation," and to Nietzsche's assertion that "the same text authorizes innumerable interpretations : there is no 'correct' interpretation."1 Nietzsche's views of interpretation, as Miller says, are relevant to (...) the recent deconstructive theorists, including Jacques Derrida and himself, who have "reinterpreted Nietzsche" or have written "directly or indirectly under his aegis." He goes on to quote a number of statements from Nietzsche's The Will to Power to the effect, as Miller puts it, "that reading is never the objective identifying of a sense but the importation of meaning into a text which had no meaning 'in itself.'" For example: "Ultimately, man finds in things nothing but what he himself has imported into them." "In fact interpretation is itself a means of becoming master of something."2 On the face of it, such sweeping deconstructive claims might suggest those of Lewis Carroll's linguistic philosopher, who asserted that meaning is imported into a text by the interpreter's will to power: "The question is," said Alice, "whether you can make words mean so many different things.""The question is," said Humpty Dumpty, "which is to be master—that's all." But of course I don't believe that such deconstructive claims are, in Humpty Dumpty fashion, simply dogmatic assertions. Instead, they are conclusions which are derived from particular linguistic premises. I want, in the time remaining, to present what I make out to be the elected linguistic premises, first of Jacques Derrida, then of Hillis Miller, in the confidence that if I misinterpret these theories, my errors will soon be challenged and corrected. Let me eliminate suspense by saying at the beginning that I don't think that their radically skeptical conclusions from these premises are wrong. On the contrary, I believe that their conclusions are right—in fact, they are infallibly right, and that's where the trouble lies. · 1. "Tradition and Difference," Diacritics 2 : 8, 12.· 2. Ibid. M. H. Abrams’s contributions to Critical Inquiry include "Rationality and Imagination in Cultural History: A Reply to Wayne Booth" and "Behaviorism and Deconstruction: A Comment on Morse Peckham's 'The Infinitude of Pluralism'". (shrink)

Let us call an integer part of an ordered field any subring such that every element of the field lies at distance less than 1 from a unique element of the ring. We show that every real closed field has an integer part.

The hopes and fears expressed in the debate on human enhancement are not always based on a realistic assessment of the expected possibilities. Discussions about extreme scenarios may at times obscure the ethical and policy issues that are relevant today. This paper aims to contribute to an adequate and ethically sound societal response to actual current developments. After a brief outline of the ethical debate concerning neuro-enhancement, it describes the current state of the art in psychopharmacological science and current uses (...) of psychopharmacological enhancement, as well as the prospects for the near future. It then identifies ethical issues regarding psychopharmacological enhancements that require attention from policymakers, both on the professional and on the governmental level. These concern enhancement research, the gradual expansion of medical categories, off-label prescription and responsibility of doctors, and accessibility of enhancers on the Internet. It is concluded that further discussion on the advantages and drawbacks of enhancers on a collective social level is still needed. (shrink)

Aldous Huxley’s Brave New World is a famous dystopia, frequently called upon in public discussions about new biotechnology. It is less well known that 30 years later Huxley also wrote a utopian novel, called Island. This paper will discuss both novels focussing especially on the role of psychopharmacological substances. If we see fiction as a way of imagining what the world could look like, then what can we learn from Huxley’s novels about psychopharmacology and how does that relate to the (...) discussion in the ethical and philosophical literature on this subject? The paper argues that in the current ethical discussion the dystopian vision on psychopharmacology is dominant, but that a comparison between Brave New World and Island shows that a more utopian view is possible as well. This is illustrated by a discussion of the issue of psychopharmacology and authenticity. The second part of the paper draws some further conclusions for the ethical debate on psychopharmacology and human enhancement, by comparing the novels not only with each other, but also with our present reality. It is claimed that the debate should not get stuck in an opposition of dystopian and utopian views, but should address important issues that demand attention in our real world: those of evaluation and governance of enhancing psychopharmacological substances in democratic, pluralistic societies. (shrink)

Peckham claims that my "behavior" in dealing with the quotations in Natural Supernaturalism is the same, in methodology and validity, as the interpretative behavior of Booth's waiter. But the great bulk of the utterances in my quotations—and no less, of the utterances constituting Peckham's own essay—do not consist of orders, requests, or commands. Instead, they consist of assertions, descriptions, judgments, exclamations, approbations, condemnations, and many other kinds of speech-acts, the meanings of which are not related to my interpretative behavior, even (...) in the indirect way in which the meaning of Booth's order is related to the future behavior of his waiter. M. H. Abrams, author of Natural Supernaturalism and The Mirror and the Lamp and Class of 1916 Professor of English at Cornell University, responds in this essay to Morse Peckham's "The Infinitude of Pluralism" . Morse Peckham, in his Critical Response, was commenting on issues raised by the forum on "The Limits of Pluralism" , to which M. H. Abrams contributed. Previous contributions to Critical Inquiry are "Rationality and Imagination in Cultural History: A Reply to Wayne Booth" and "The Deconstructive Angel". (shrink)

In retrospect, I think I was right to compose Natural Supernaturalism by relying on taste, tact, and intuition rather than on a controlling method. A book of this kind, which deals with the history of human intellection, feeling, and imagination, employs special vocabularies, procedures, and modes of demonstration which, over many centuries of development, have shown their profitability when applied to matters of this sort. I agree with Booth that these procedures, when valid, are in a broad sense rational, and (...) subject to analysis and some degree of definition. But the rules underlying such a discourse are complex, elusive, unsystematic, and subject to innovative modification; they manifest themselves in the intuitive expertise of the historian; and the specification of these rules should not precede, but follow practice. . . . After the fact, nevertheless, a book like Natural Supernaturalism is subject to close critical inquiry about its methods and rationale. I am grateful to Booth for opening up such an inquiry, and for doing so in a way that is not only disarming, but seems to me to be the most promising of useful results. That is, instead of adopting a prosecutorial stance, demanding: "Justify the rationality and probative force of what you have done; it looks dammed suspicious to me," he has adopted the friendly tactic of saying: "Your book, in my experience of it, has yielded discoveries that I want to call knowledge, by methods, however deviant from standard rubrics of valid reasoning, that it seems irrational to call non-rational. Let's set out to clarify what these methods are, and to see what grounds we can find for the claim that they provide warranted knowledge." M.H. Abrams' contributions to Critical Inquiry are "The Deconstructive Angel" and "Behaviorism and Deconstruction: A Comment on Morse Peckham's 'The Infinitude of Pluralism'". (shrink)

Clinicians' work depends on sincere and complete disclosures from their patients; they honour this candidness by confidentially safeguarding the information received. Breaching confidentiality causes harms that are not commensurable with the possible benefits gained. Limitations or exceptions put on confidentiality would destroy it, for the confider would become suspicious and un-co-operative, the confidant would become untrustworthy and the whole climate of the clinical encounter would suffer irreversible erosion. Excusing breaches of confidence on grounds of superior moral values introduces arbitrariness and (...) ethical unreliability into the medical context. Physicians who breach the agreement of confidentiality are being unfair, thus opening the way for, and becoming vulnerable to, the morally obtuse conduct of others. Confidentiality should not be seen as the cosy but dispensable atmosphere of clinical settings; rather, it constitutes a guarantee of fairness in medical actions. Possible perils that might accrue to society are no greater than those accepted when granting inviolable custody of information to priests, lawyers and bankers. To jeopardize the integrity of confidential medical relationships is too high a price to pay for the hypothetical benefits this might bring to the prevailing social order. (shrink)

The United Nations Educational, Scientific and Cultural Organization recently declared transhumance pastoralism as an Intangible Cultural Heritage of Humanity. The notion of heritage seeks to recognize the culture behind the seasonal grazing movements along herding routes, between distant and dissimilar ecosystems. The pastoral families move with their herds from pasturelands used during the winter (winter-lands) to areas pastured during the summer (summer-lands). Whereas this is a key step towards the recognition of the cultural dimension associated to this ancient practice, a (...) relevant feature of transhumance pastoralism is its strong linkage with environmental dynamics. This activity developed in a spatiotemporal and co-evolutionary trajectory, which gave rise to a pastoral territory. A territory is the union or linkage of a meaning with a specific place, that is, the space that is appropriated and valued, both symbolically and instrumentally, by human groups. Hence, the pastoral territory represents the socio-ecological system that integrates a pastoral-based community with the natural environment that it inhabits. We propose a co-evolutionary approach to analyzing some key attributes of transhumant pastoralism, which modulate the socio-ecological interdependence. Based on a study case from Northwest Patagonia, Argentina, we identified and characterized seven attributes: (I) mobility, (II) connectivity, (III) temporal synchrony, (IV) local interdependence, (V) local ecological knowledge, (VI) adaptive capacity legacy, and (VII) mixture of land tenure. We discuss these features as examples that represent keystone socio-ecological attributes for the recognition of transhumant pastoral territories as a biocultural heritage. (shrink)