Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a (...) tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (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)

Voyages et exils au cinéma, rencontres de l'altérité s'intéresse aux phénomènes d'hybridation entre cultures tels qu'ils se traduisent à l'écran, sans restriction géographique (cinémas américain, italien, africain, libanais, indien, taïwanais, japonais etc.). Si le voyage et l'exil des cinéastes sont sources de transferts culturels et esthétiques, le thème du voyage et de l'exil représenté au cinéma questionne la notion d'altérité en proposant une vision diversifiée de la rencontre entre autochtones et nouveaux arrivants. Dans un monde globalisé, mais qui continue de (...) s'interroger à la fois sur la mixité culturelle et le sens de la nation, le cinéma reflète ainsi les cultures plurielles dans leur richesse et leur vivacité, mais aussi les replis communautaires, les phénomènes d'imprégnation et bien entendu de domination culturelle. La caméra se désigne alors comme acteur, témoin et exégète de ces processus qui, s'ils ont une longue histoire et se développent tout au long du XXe siècle, culminent dans notre temps présent. (shrink)

Comment un État constitutionnel peut-il faire face aux menaces terroristes d’une façon qui soit compatible avec son engagement démocratique, les droits fondamentaux et l’état de droit? En pleine opposition tant avec les arguments juridiques avancés par l’administration Bush qu’avec la thèse selon laquelle les menaces et les défis posés par le terrorisme peuvent être gérés dans le cadre constitutionnel et réglementaire actuel, Bruce Ackermann rejette la caractérisation du 11 septembre comme le début d’une « guerre » tout autant que quelque (...) chose qui pourrait être traité comme un crime ordinaire. Sur le terrain prescriptif, Bruce Ackermann appelle à des mesures qui relèvent de la « Constitution d’un état d’urgence ». La loi-cadre qu’il appelle de ses vœux doit garantir que les institutions de l’État soient bien équipées pour faire face à cette menace et que les pouvoirs conférés ne soient pas utilisés pour anéantir les droits fondamentaux et les libertés. Bruce Ackerman pense notamment que le pouvoir du Gouvernement de déclarer l’état d’urgence doit rapidement être endossé par le Congrès mais aussi qu’un système dit d’escalateur supermajoritaire doit rendre de plus en plus difficile de l’obtenir. (shrink)

Abstract It is usually attempted teleologically to demonstrate the rationality of the so?called scientific method. Goals or aims are posited (and their specification defended) and it is then argued that conformity with some body of methodological rules is conducive to the realization of these goals or aims. A ? deontological? alternative to this approach is offered, adapting insights of contemporary political philosophers, especially John Rawls and Bruce Ackerman. The ?circumstances of method? are defined as those circumstances in which it alone (...) makes sense to seek some method for the resolution of disputed issues. It is then shown that individuals who find themselves in these circumstances have reason to conduct themselves in conformity with certain simple rules of argumentation?have reason, indeed, in the very fact that they do so find themselves and altogether without reference to any goals or aims which it might be hoped to achieve. These rules require non?interference, responsiveness, relevance, and publicity, and are, arguably, the rules which define the concept (and which therefore provide a framework for various conceptions,) of scientific method. (shrink)

Terrence Ackerman has suggested that we ought to view general bioethical principles as generalizations which summarize our previous bioethical decisions rather than as moral rules. He would have us derive our ethical views instead principally from the facts of the cases in question and our intuitions about them. The proposal is attractive because of its similarity to medical decision-making, but it fails because it allows for no higher order standard of reference against which conflicting ethical intuitions may be judged. CiteULike (...) Connotea Del.icio.us What's this? (shrink)

Should a brain-dead woman be artificially maintained for the sake of her fetus? Does a physician have the right to administer a life-saving transfusion despite the patient's religious beliefs? Can a family request a hysterectomy for their retarded daughter? Physicians are facing moral dilemmas with increasing frequency. But how should these delicate questions be resolved and by whom? A Casebook of Medical Ethics offers a real-life view of the central issue involved in clinical medical ethics. Since the analysis of cases (...) plays a critical role in this study, the authors have assembled a broad collection of histories encountered in their work as medical ethics educators and consultants. The cases are developed in substantial detail to reflect the rich medical and psychosocial complexity involved, and each is brought to a decision point at which a course of action must be chosen. Among the issues examined are conflicts between patients' wishes and respect for their well-being, tensions concerning duties to patients unable to care for themselves and obligations to family members, and clashes between patient care obligations and the interests of other persons, including physicians, third parties, and the general public. The book also includes commentaries that combine general discussion of ethical principles with specific analysis of the cases examined in the text, as well as various options for resolving conflicts. Readers are invited to assess the comparative merits and liabilities of these approaches. An ideal text for undergraduate and medical school courses, A Casebook of Medical Ethics brings readers to the forefront of medicine, where they share in the determination of crucial ethical decisions. (shrink)

A substantial guide providing an overview of both physicalism and metaphysical naturalism, reviewing both questions of formulation and justification for both doctrines. Includes a diagnostic strategy for understanding talk of naturalism as a metaphysical thesis.

Fiction can help make students better thinkers about some philosophical issues, but this does not mean it will make them morally better people.

The relationship between metacognition and mindreading was investigated by comparing the monitoring of one’s own learning and another person’s learning . Previous studies indicated that in self-paced study judgments of learning for oneself are inversely related to the amount of study time invested in each item. This suggested reliance on the memorizing-effort heuristic that shorter ST is diagnostic of better recall. In this study although an inverse ST–JOL relationship was observed for Self, it was found for Other only when the (...) Other condition followed the Self condition. The results were interpreted in terms of the proposal that the processes underlying experience-based metacognitive judgments are largely unconscious. However, participants can derive insight from observing themselves as they monitor their own learning, and transfer that insight to Other, thus exhibiting a shift from experience-based to theory-based judgments. Although different processes mediate metacognition and mindreading, metacognition can inform mindreading. (shrink)

This paper describes a practice innovation: the addition of formal weekly discussions of patients with prolonged PICU stay to reduce healthcare providers’ moral distress and decrease length of stay for patients with life-threatening illnesses. We evaluated the innovation using a pre/post intervention design measuring provider moral distress and comparing patient outcomes using retrospective historical controls. Physicians and nurses on staff in our pediatric intensive care unit in a quaternary care children's hospital participated in the evaluation. There were 60 patients in (...) the interventional group and 66 patients in the historical control group. We evaluated the impact of weekly meetings to establish goals of care for patients with longer than 10 days length of stay in the ICU for a year. Moral distress was measured intermittently and reported moral distress thermometer scores fluctuated. "Clinical situations" represented the most frequent contributing factor to moral distress. Post intervention, overall moral distress scores, measured on the moral distress scale revised, were lower for respondents in all categories, and on three specific items. Patient outcomes before and after PEACE intervention showed a statistically significant decrease in PRISM indexed LOS, a statistically significant increase in both code status changes DNR, and in-hospital death, with no change in patient 30 or 365 day mortality. The addition of a clinical ethicist and senior intensivist to weekly inter-professional team meetings facilitated difficult conversations regarding realistic goals of care. The study demonstrated that the PEACE intervention had a positive impact on some factors that contribute to moral distress and can shorten PICU length of stay for some patients. (shrink)

Depuis près d'un demi-siècle, Madame Hélène ACKERMANS a coopéré très activement à l'organisation de l'École des sciences philosophiques et religieuses des F.U.S.L. Avec Monseigneur Henri van Camp, elle a donné à la tribune des leçons publiques sa renommée internationale ; auprès de l'actuel comité de direction, elle n'a cessé de prodiguer ses multiples compétences et ses conseils avisés. En hommage à son travail, il a été demandé à quelques-uns des penseurs avec lesquels Madame Hélène ACKERMANS a noué des liens d'amitié, (...) de réfléchir au rôle de la philosophie dans la Cité. (shrink)

Inside What Would Plato Do?, you'll find the basics of philosophy, written in an easy, digestible way we can all understand, along with questions to help you apply these important theories to your own life. So, after you've learned about a philosophical concept, you'll then be challenged to test yourself and see how the results can impact your daily life. For instance, after learning about Kant's theory of morality and the importance of intention you're challenged with questions like: Can good (...) people do bad things? Was there a time when you intended to do something helpful that ended up being hurtful? Does that make you a good person (because you intended to do good) or a bad person (because the results were bad)? What Would Plato Do? will not only help you better understand some of the greatest thinkers ever but will also help you think of the world around you in a whole new way! (shrink)

Ne vers 1180 a Aurillac, mort le 30 mars 1249, Guillaume d'Auvergne est nomme eveque de Paris des 1228. Son oeuvre est contemporaine de la querelle de l'aristotelisme qui gagne la faculte de theologie, et du bouleversement de l'histoire theorique qui l'accompagne. Quelle est la cause efficiente de la pensee? D'ou vient l'intelligible necessairement present dans l'ame qui pense? C'est a cela que repondent les neuf premieres parties du chapitre sept du De anima, ecrit vers 1240. La noetique de Guillaume (...) d'Auvergne, complexe, s'y deploie et sensiblement se demarque de l' augustinisme avicennisant qui traditionnellement la caracterise. L'ame, dans son rapport au sensible, est principium agens, lectrice, en tant qu'elle pense, d'un livre dont elle-meme est l'auteur, et dont la verite se passe en partie de l'illumination divine. (shrink)

There have been essentially two types of theoretical approaches to account for the grammatical relations associated with the causee argument of causative constructions. Ignoring the specifics of particular theories, there are transitivity based approaches in which the causee is a direct object when the embedded clause is intransitive, and an indirect object or oblique when the embedded clause is transitive. This pattern finds considerable cross-linguistic support. On the other hand, there are languages in which the causee exhibits alternative grammatical relations (...) irrespective of transitivity: the causee direct object correlates with direct causation, while indirect object or oblique causees are associated with indirect causation. Such phenomena have motivated a semantic approach.Focusing primarily on data from Spanish, we account for both sorts of phenomena by proposing a novel extension of Dowty's [(1991) Language 67, 547–619] proto-property proposal, thereby rendering it a comprehensive model of argument selection for both simple and complex predicates. According to Dowty's original Argument Selection Principle, the most proto-patientive argument in a single argument structure tends to be encoded as a direct object. In the case of causatives with intransitive base predicates, the most proto-patientive argument will be the causee. However, if the embedded clause is transitive, the causee will be less proto-patientive that the embedded patient, and will not be encoded as a direct object. Thus, the Argument Selection Principle, operating in a syntagmatic fashion over co-arguments, effectively derives the transitivity-determined causee encodings. In order to address the effects associated with the semantic approach, we develop paradigmatic interpretation of the Argument Selection Principle. That is, when the causee argument varies in degree of proto-patientivity, the most proto-patientive alternant is encoded as a direct object, and any decrease in proto-patientivity is reflected by relational encodings that are sequentially lower than direct object on the relational hierarchy. Thus, the transitivity and semantic effects of causee encoding are accounted for by the interaction of the syntagmatic and paradigmatic argument selection strategies. We propose that these two strategies represent organizing principles for argument selection information associated with lexical entries. (shrink)