The main current application of placebo is in clinical research. The term placebo effect refers to diverse non-specific, desired or non-desired effects of substances or procedures and interactions between patient and therapist. Unpredictability of the placebo effect necessitates placebo-controlled designs for most trials. Therapeutic and diagnostic use of placebo is ethically acceptable only in few well-defined cases. While "therapeutic" application of placebo almost invariably implies deception, this is not the case for its use in research. Conflicts may exist between the (...) therapist's Hippocratic and scientific obligations. The authors provide examples in neuropsychiatry, illustrating that objective scientific data and well-considered guidelines may solve the ethical dilemma. Placebo control might even be considered an ethical obligation but some provisos should be kept in mind: (a) no adequate therapy for the disease should exist and/or (presumed) active therapy should have serious side-effects; (b) placebo treatment should not last too long; (c) placebo treatment should not inflict unacceptable risks, and (d) the experimental subject should be adequately informed and informed consent given. (shrink)

Initial responses to questionnaires used to assess participants' understanding of informed consent for malaria vaccine trials conducted in the United States and Mali were tallied. Total scores were analyzed by age, sex, literacy (if known), and location. Ninety-two percent (92%) of answers by United States participants and 85% of answers by Malian participants were correct. Questions more likely to be answered incorrectly in Mali related to risk, and to the type of vaccine. For adult participants, independent predictors of higher scores (...) were younger age and female sex in the United States, and male sex in Mali. Scores in the United States were higher than in Mali (P = 0.005). Despite this difference participants at both sites were well informed overall. Although interpretation must be qualified because questionnaires were not intended as research tools and were not standardized among sites, these results do not support concerns about systematic low understanding among research participants in developing versus developed countries. (shrink)

Hicks' edition of the De Anima contains valuable commentary from Hicks as well as useful summaries of the views of earlier commentators.

Originally published in 1907, this book contains the ancient Greek text of Aristotle's De Anima, his treatise on the differing souls of living things. An English translation is provided on each facing page, and Hicks supplies a very detailed commentary on each line at the end of the book, as well as a summary of each section. This book will be of value to anyone with an interest in Greek philosophy and the history of classical scholarship.

Requests by patients or their families for treatment which the patient's physician considers to be "inappropriate" are becoming more frequent than refusals of treatment which the physician considers appropriate. Such requests are often based on the patient's religious beliefs about the attributes of God (sovereignty, omnipotence), the attributes of persons (sanctity of life), or the individual's personal relationship with God (communication, commands, etc). We present four such cases and discuss some of the basic religious tenets of the three Abrahamic faith (...) traditions as they relate to such requests. We suggest that religious reasons for requesting "inappropriate" treatment are "special" and deserve serious consideration. We offer guidance to assist clinicians and clinical ethicists as they attempt to resolve these conflicts, emphasising the importance of understanding the religious beliefs of the patient/surrogate and suggesting the assistance of a religious interpreter. We suggest open discussion with patients and families of both the clinical situation and the theological basis for these requests. We also suggest that clinicians use additional religious doctrines or principles from patients' own traditions to balance the reasons behind the requests. We conclude that most persistent requests for "inappropriate" treatment should be honoured. (shrink)

Open peer commentary on the article “Exploring the Depth of Dream Experience: The Enactive Framework and Methods for Neurophenomenological Research” by Elizaveta Solomonova & Xin Wei Sha. Upshot: A neurophenomenological approach to the enactive account of consciousness in general is supported by an account of how the brain functions in creating imagery of non-present objects and situations. Three types of non-sensory imagery are needed to ground our consciousness of sensory imagery: proprioceptive imagery, motor imagery, and what Eugene Gendlin calls the (...) “felt sense” of a situation. Dreams show clearly how we image situations without sensory input, a process that is clearly enactive rather than reactive. This enactive account of imagery then supports Gendlin’s method of interpreting dreams by comparing their “felt sense” to the felt sense of waking situations. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:R. D. Ackerman BELIEVING IN A FICTION: WALLACE STEVENS AT THE LIMITS OF PHENOMENOLOGY The "ring of men" of "Sunday Morning" will chant their "devotion to the sun, / Not as a god, but as a god might be, / Naked among them, like a savage source" (CP, pp. 69-70).' Solar nakedness is deferred even as it is named. The problem for belief is the question of appearance and (...) representation. Things appear as and like.... The phenomenological return to things is also a turn to fiction, as Husserl understood: "If anyone loves a paradox, he can really say... that the element which makes up the life of phenomenology... is fiction. ' " The sun is divine, and it is not; it is both naked and clothed, savage and civilized, source (or end) and means. But such paradox is ultimately unsatisfying, and as we will see with Stevens, the need for belief—for an image or idea of totality—forces the issue of fiction and reality. The Stevens we will have in view is not the Stevens—as if there were such a creature. Our Stevens is the one most persuaded by promises such as those of phenomenology, the one most concerned with decreation (reduction) and fresh beginnings, with discovery and recognition, with imagination, the body, and the earth. This is the Stevens for whom the barrier of language presages at last not absence and difference but fictive recovery of presence and identity, the one for whom poetry represents a way of belief beyond mysticism even as it bodes mythic proximity. Finally, this is the Stevens who predominates throughout the prose (as well as in much of the poetry), who tries mightily to secure a belief while disencumbering himself of metaphysics—but alas, I think, with small success. Although Stevens's association of the problem of belief with the idea of fiction occurs in early poems such as "A High-Toned Old Christian 79 80Philosophy and Literature Woman" and "To the One of Fictive Music," his most intensive involvement with fiction as belief dates from the early 1940s and spans the period of his major essays and his last four volumes of poems. He recounts, for instance, a 1942 conversation with a student: "I said that I thought that we had reached a point at which we could no longer really believe in anything unless we recognized that it was a fiction. The student said that that was an impossibility, that there was no such thing as believing in something that one knew was not true. It is obvious, however, that we are doing that all the time" (L, p. 430). What does it mean to believe in a fiction? That is my main subject here, as we seek out the limits of the phenomenological Stevens. His letters of this period are preoccupied with the problem of fictive belief: "If one no longer believes in God (as truth), it is not possible merely to disbelieve; it becomes necessary to believe in something else.... A good deal of my poetry recently has concerned an identity for that thing.... In one of the short poems that I have just sent to the harvard advocate, I say that one's final belief must be in a fiction. I think that the history of belief will show that it has always been in a fiction" (L, p. 370). The poem referred to, "Asides on the Oboe," begins: The prologues are over. It is a question now, Of final belief. So, say that final belief Must be in a fiction. It is time to choose. (CP, p. 250) Acknowledging that "in the long run, poetry would be the supreme fiction" (L, pp. 430-31), Stevens nonetheless singles out the nominative function of poetry as the essence of its claim to supremacy: "Poetry means not the language of poetry but the thing itself.... The subject matter is what comes to mind when one says of the month of August... 'Thou art not August, unless I make thee so'" (L, p. 377). The quoted line (also from "Asides") underscores the paradox that for Stevens the essence of fiction (the nontrue) is its capacity to nominate the true or the real. This... (shrink)

We show there is only one consistent way to update a probability assignment, that given by Bayes's rule. The price of inconsistent updating is a loss of efficiency. The implications of this for the problem of induction are discussed.

In his article ‘A Cavalry Unit in the Army of Antigonus Monophthalmus: Asthippoi’, N. G. L. Hammond argues that the reading of the manuscript R at Diodorus 19. 29. 2 should be retained and that we should read ⋯π⋯ π⋯σι δ⋯ το⋯ς τε ⋯σθ⋯ππους ⋯νομαζομ⋯νους κα⋯ τοὺς ⋯κ τ⋯ν ἄνω κατοικο⋯ντων ⋯κτακοσιο⋯ς. The readings of F and its copy X, ⋯νθ⋯ππους, and the commonly accepted conjecture of Wesseling ⋯μɸ⋯ππους, should both be abandoned. Hammond's arguments for retaining this reading are that (...) between the variant readings of R and F, R ‘is the more often correct’ ; ⋯σθ⋯ππους, the reading of R, is preferable to F's ⋯νθ⋯ππους on the principle of ‘lectio difficilior’; the ‘difficulty’ of his lectio difficilior is made less by the arguments presented by A. B. Bosworth, 245 ff.), for the restoration at several places in the text of Arrian's Anabasis the word ⋯σθ⋯ταιροι, in place of the editorial emendation of πεζ⋯ταιροι. ‘For just as asthetairoi meant an élite group of Macedonian infantrymen,’ says Hammond, ‘so asthippoi should mean an élite group of Macedonian cavalrymen.’ He then proceeds to examine the passage and its context in an attempt to find confirmation of this proposition and comes to the conclusion that Diodorus' text says that there were 800 cavalrymen, broken into two groups, the asthippoi and ‘the men from the up-country settlers’; these, though having different names, had a close relationship to each other, as is shown by their being brigaded together. Following his derivation of asthetairoi as meaning ‘townsmen-companions’, i.e. companions recruited from the towns of Upper Macedonia, he argues that asthippoi were cavalry recruited from the towns of Upper Macedonia and that τοὺς ⋯κ τ⋯ν ἄνω κατοικο⋯ντων means ‘the sons of settlers in up-country Macedonia’. These 800, says Hammond, were both among Antigonus' best troops and ‘were Macedonians from Europe’. We thus appear, on Hammond's interpretation, to have here a group of 800 Macedonian élite cavalrymen, all of whom were recruited in Upper Macedonia's townships, but of whom some were chosen to be the cavalry-equivalent of the élite ‘townsmen-companions’ by their title of ‘townsmen-cavalry’, whilst the others, similarly recruited – but perhaps of a younger generation? – had no particular distinguishing title beyond ‘sons of settlers in up-country Macedonia’.Now, while it would be exciting to be able to add another one, possibly two Macedonian cavalry units to the Macedonian army of Philip, Alexander and the Successors, there are several aspects of Hammond's arguments that, it seems to me, are less than convincing. Thus, whilst it seems beyond reasonable doubt that ⋯σθ⋯ταιροι should be retained in the text of Arrian, appearing, as it does, six times, this is not an argument that ⋯σθ⋯ππους should be read in Diodorus' text. Both it and F's reading of ⋯νθ⋯ππους are hapax legomena and it is possible that both readings are wrong. But even if we retain ⋯σθ⋯ππους as the correct reading, Hammond's explanation of its meaning is open to objection on several counts. (shrink)

INTRODUCTION! In almost every area of contemporary philosophy the impact of Franz Brentano or his pupils can be detected. ...

Background In Switzerland, right-to-die organisations assist their members with suicide by lethal drugs, usually barbiturates. One organisation, Dignitas, has experimented with oxygen deprivation as an alternative to sodium pentobarbital. Objective To analyse the process of assisted suicide by oxygen deprivation with helium and a common face mask and reservoir bag. Method This study examined four cases of assisted suicide by oxygen deprivation using helium delivered via a face mask. Videos of the deaths were provided by the Zurich police. Dignitas provided (...) protocol and consent information. Results One man and three women were assisted to death by oxygen deprivation. There was wide variation in the time to unconsciousness and the time to death, probably due to the poor mask fit. Swiss law prevented attendants from effectively managing the face mask apparatus. Purposeless movements of the extremities were disconcerting for Dignitas attendants, who are accustomed to assisting suicide with barbiturates. None of the dying individuals attempted self-rescue. Conclusions The dying process of oxygen deprivation with helium is potentially quick and appears painless. It also bypasses the prescribing role of physicians, effectively demedicalising assisted suicide. Oxygen deprivation with a face mask is not acceptable because leaks are difficult to control and it may not eliminate rebreathing. These factors will extend time to unconsciousness and time to death. A hood method could reduce the problem of mask fit. With a hood, a flow rate of helium sufficient to provide continuous washout of expired gases would remedy problems observed with the mask. (shrink)

Savulescu maintains that our paper, which encourages clinicians to honour requests for "inappropriate treatment" is prejudicial to his atheistic beliefs, and therefore wrong. In this paper we clarify and expand on our ideas, and respond to his assertion that medicine, ethics and atheism are objective, rational and true, while religion is irrational and false.