The paper is written in response to those who fail to recognize the relation between a patient's mental competency and her state of pain. Some clinicians claim that a proper diagnosis can only be made in the absent of analgesia. Rather, the patient's state of pain directly affects her mental competency and thus her ability to give valid consent. Clinicians should rethink their approach to diagnosis when the patient is in pain.

At least four different frameworks — psychiatric, cognitive, functional and decision-making — are used in the evaluation of competence, all of which remain more or less unrelated in the literature. In the first section of this paper we consider various meanings of competence, in order to arrive at a definition of the term relevant to the medical and legal setting. Patient or client competence, we conclude, refers to the practical abilities that individuals employ in pursuing their own autonomous goals in (...) life. We then show how a systematic categorization of these practical abilities — which we call a taxonomy of practical judgment — allows us to show when the traditional frameworks for the evaluation of competence may or may not be useful in the evaluation of a particular competence.In the final section we explore some of the normative considerations underlying the taxonomy. For instance, competence is not only related to intrinsic abilities but to resources available in the community. Here we touch on questions related to the fair distribution of community resources. (shrink)

This book is a collection of secondary essays on America's most important philosophic thinkers—statesmen, judges, writers, educators, and activists—from the colonial period to the present. Each essay is a comprehensive introduction to the thought of a noted American on the fundamental meaning of the American regime.

In many research studies, tumor biopsies are an unavoidable requirement for achieving key scientific aims. Yet some commentators view mandatory research biopsies as coercive and suggest they should be optional, or at least optional until further data are obtained regarding their scientific usefulness. Further complicating the ethical picture is the fact that some research biopsies offer a potential for clinical benefit to trial participants. We interviewed and surveyed a convenience sample of participants in phase I clinical trials at a single (...) institution. Our primary aim was to describe phase I participants’ understanding of whether a research biopsy offered them the prospect of medical benefit. We also endeavored to describe participants’ views about biopsies—specifically, the benefits of biopsies, if any, and whether biopsies were acceptable, risky, or discouraged trial participation. Finally, we collected data on demographics and attitudes to see if any strong correlations with misunderstanding, acceptability, or riskiness existed. Overall, the respondents tended to view research biopsies as acceptable, though they did not succeed in identifying the lack of benefit of a research biopsy. These findings call for renewed efforts in consent conversations and documents to carefully describe the benefits, or lack thereof, of research biopsies. (shrink)

The essays explore virtually all of Johnson's writings: each of his novels, his numerous short stories, the range of his nonfiction essays, his many book ...

The collection as a whole will extend the mutual creative interaction among the sciences, philosophy, and theology.

(1941). A survey of the growth of knowledge about certain parts of the foetal cardio-vascular apparatus, and about the foetal circulation, in Man and some other mammals. Part I: Galen to Harvey. Annals of Science: Vol. 5, No. 1, pp. 57-89.

The development and utility of genetically modified crops for smallholders around the world is controversial. Critical questions include what traits and crops are to be developed; how they can be adapted to smallholders’ ecological, social and economic contexts; which dissemination channels should be used to reach smallholders; and which policy environments will enable the greatest benefits for smallholders and the rural poor. A key question is how the voices of smallholders who have experience with or desire to use GM technologies (...) enter the larger debate. Africa has the greatest number of smallholders and poor with the least exposure to GM crops. Because of the well-established use of GM crops in South Africa by commercial farmers, we formed a community of practice involving smallholders, extension, researchers, non-profits and agribusiness in KwaZulu-Natal to examine the conditions under which GM crops are used by smallholders, how smallholders interact with GM technologies and what insights smallholders and other stakeholders can provide regarding these questions. One of the advantages of the CoP approach is that it brings stakeholders together in a non-hierarchical way that encourages new ways of thinking and new partnerships. Such interaction around a specific project can enhance the voice of smallholders in a variety of ways. In our project, smallholder participants have increased their knowledge and can make better decisions about GM technologies, which had been barriers for them. Notably, they have also improved their knowledge of maize production practices, accessed new practice networks, and met new researchers and resource providers. They are now being integrated into these networks in a way that should improve their livelihoods and make the wants and needs of smallholders better known. Such knowledge and experience has improved their voice in agriculture and rural development discussions. (shrink)

High-spin states in the odd-odd N = Z nucleus Co-54 have been investigated by the fusion-evaporation reaction Si-28(S-32,1 alpha 1p1n)Co-54. Gamma-ray information gathered with the Ge detector array Gammasphere was correlated with evaporated particles detected in the charged particle detector system Microball and a 1 pi neutron detector array. A significantly extended excitation scheme of Co-54 is presented, which includes a candidate for the isospin T = 1, 6(+) state of the 1f(7/2)(-2) multiplet. The results are compared to large-scale shell-model (...) calculations in the fp shell. Effective interactions with and without isospin-breaking terms have been used to probe isospin symmetry and isospin mixing. A quest for deformed high-spin rotational cascades proved negative. This feature is discussed by means of cranking calculations. (shrink)

The article sets out aspects of locke's theory of personal identity which were seen by contemporaries to be not only fallacious but also to conflict with christian doctrine regarding the soul. A modified theory is then educed, From berkeley, Butler, William law and other divines, Which avoids these fallacies, Is epistemologically more rigorous and arguably expressed christian doctrine more accurately. This is seen as a forerunner of some central concerns of romantic theology.

1 Evidence-based policy requires researchers to provide the answers to ecological questions that are of interest to policy makers. To find out what those questions are in the UK, representatives from 28 organizations involved in policy, together with scientists from 10 academic institutions, were asked to generate a list of questions from their organizations. 2 During a 2-day workshop the initial list of 1003 questions generated from consulting at least 654 policy makers and academics was used as a basis for (...) generating a short list of 100 questions of significant policy relevance. Short-listing was decided on the basis of the preferences of the representatives from the policy-led organizations. 3 The areas covered included most major issues of environmental concern in the UK, including agriculture, marine fisheries, climate change, ecosystem function and land management. 4 The most striking outcome was the preference for general questions rather than narrow ones. The reason is that policy is driven by broad issues rather than specific ones. In contrast, scientists are frequently best equipped to answer specific questions. This means that it may be necessary to extract the underpinning specific question before researchers can proceed. 5 Synthesis and applications. Greater communication between policy makers and scientists is required in order to ensure that applied ecologists are dealing with issues in a way that can feed into policy. It is particularly important that applied ecologists emphasize the generic value of their work wherever possible. (shrink)

In this Festschrift some of Paul Weiss's friends, colleagues, and students have produced a splendid collection of original philosophical essays. Contributions by Charles Hendel, Charles Hartshorne, Robert Brumbaugh, Nathan Rotenstreich, A. Boyce Gibson, John Wild, and fourteen others are included. Outstanding are Father Johann's introduction of a contemporary view of experience into Neo-Thomism, William Earle's phenomenological analysis of love, and Father Clarke's discussion of causality. While the doctrines urged are not uniform, the standard of excellence is. I. C. Lieb, (...) whose editorial skill is evident throughout, has produced a distinguished volume which honors Paul Weiss by its contribution to contemporary philosophical inquiry. --R. C. N. (shrink)

A study of the influences which helped to shape the language and the logic of Charles Darwin from 1837 to 1844, the period in which he composed the first drafts of the theory of natural selection. The textual basis of this book is provided by two sets of notebooks which deal with the "transmutation of species" and "metaphysics... morals and speculations on expression." That Darwin preferred metaphors borrowed from ordinary language to the technical idiom of other scientific theories Manier attributes (...) to the influence of both Dugald Stewart’s philosophy of natural language and William Wordsworth’s conviction that nature is of itself expressive. The theme that nature has its own language suggested a continuity between the processes of the inanimate world and the spiritual capacities of man and hence provided a congenial philosophic context for the elaboration of Darwin’s theory of natural selection. Darwin’s rhetorical style thus reinforces his own theory, because the highest human activities are explainable in images taken from nature. These metaphors had both a cognitive and an affective dimension, since they enabled his readers to see the evidence of natural history in a new light, and served to soften the shocking theological implications of this new perspective. The idea of nature as an outcome of struggle among random variants obviously clashed with the contemporary religious view of nature as God’s handiwork, but the metaphor of selection personifies nature and suggests the possibility of a divinity immanent in nature. In this regard, it is interesting to note that Darwin was quite impressed by Wordsworth’s version of natural religion. William Paley’s theodicy also intrigued the young Darwin. Paley argued that chance was compatible with divine design, since God’s moral purposes could be represented through the metaphor of a fair lottery where the chances are evenly distributed but the results unforeseeable. Darwin took this concept of chance out of its apologetical context and employed it in the construction of his scientific theory. (shrink)