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)

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)

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

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)

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)

Consider these three positions about physician-assisted suicide:Physician-assisted suicide should be illegal for everyone.Physician-assisted suicide should be legal for only the terminally ill.Physician-assisted suicide should be legal for all competent adults.So far, the debate in America has been primarily between positions 1 and 2. I think it should be between positions 1 and 3. Both those positions embody reasonable viewpoints, and I will not try to decide between them in this chapter. But I will argue that the double standard embodied in (...) position 2 is morally untenable. (shrink)

In this short text, a distinguished philosopher turns his attention to one of the oldest and most fundamental philosophical problems of all: How it is that we are able to sort and classify different things as being of the same natural class? Professor Armstrong carefully sets out six major theories—ancient, modern, and contemporary—and assesses the strengths and weaknesses of each. Recognizing that there are no final victories or defeats in metaphysics, Armstrong nonetheless defends a traditional account of universals as the (...) most satisfactory theory we have.This study is written for advanced students, but as Armstrong goes considerably beyond his earlier work on this topic, it will interest professional scholars as well. Carefully plotted and clearly written, Universals is both a paradigm of exposition and a case study on the value of careful analysis of fundamental issues in philosophy. (shrink)

In this important study D. M. Armstrong offers a comprehensive system of analytical metaphysics that synthesises but also develops his thinking over the last twenty years. Armstrong's analysis, which acknowledges the 'logical atomism' of Russell and Wittgenstein, makes facts the fundamental constituents of the world, examining properties, relations, numbers, classes, possibility and necessity, dispositions, causes and laws. All these, it is argued, find their place and can be understood inside a scheme of states of affairs. This is a comprehensive and (...) rigorously this-worldly account of the most general features of reality, argued from a distinctive philosophical perspective, and it will appeal to a wide readership in analytical philosophy. (shrink)

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)

Anyone who thinks contemporary American society is hopelessly contentious and lacking in shared values has probably not been paying attention to the way the popular media portray the hospice movement. Over and over, we are told such things as that “Humane care costs less than high-tech care and is what patients want and need,” that hospices are “the most effective and least expensive route to a dignified death,” that hospice personnel are “heroic,” that their “compassion and dedication seem inexhaustible,” and (...) that “few could argue with the powerful message that it is better [for dying patients] to leave wrapped in the love of family and care givers than locked in the cold, metallic embrace of a machine.“. (shrink)