A collection of personal narratives and essays, Living Professionalism is designed to help medical students and residents understand and internalize various aspects of professionalism. These essays are meant for personal reflection and above all, for thoughtful discussion with mentors, with peers, with others throughout the health care provider community who care about acting professionally.

Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

Introduction: Variation across research ethics boards in conditions placed on access to medical records for research purposes raises concerns around negative impacts on research quality and on human subject protection, including privacy.Aim: To study variation in REB consent requirements for retrospective chart review and who may have access to the medical record for data abstraction.Methods: Thirty 90-min face-to-face interviews were conducted with REB chairs and administrators affiliated with faculties of medicine in Canadian universities, using structured questions around a case study (...) with open-ended responses. Interviews were recorded, transcribed and coded manually.Results: Fourteen sites required individual patient consent for the study to proceed as proposed. Three indicated that their response would depend on how potentially identifying variables would be managed. Eleven sites did not require consent. Two suggested a notification and opt-out process. Most stated that consent would be required if identifiable information was being abstracted from the record. Among those not requiring consent, there was substantial variation in recognising that the abstracted information could potentially indirectly re-identify individuals. Concern over access to medical records by an outside individual was also associated with requirement for consent. Eighteen sites required full committee review. Sixteen allowed an external research assistant to abstract information from the health record.Conclusions: Large variation was found across sites in the requirement for consent for research involving access to medical records. REBs need training in best practices for protecting privacy and confidentiality in health research. A forum for REB chairs to confidentially share concerns and decisions about specific studies could also reduce variation in decisions. (shrink)

The recent genome sequencing of a non‐vertebrate deuterostome, the ascidian tunicate Ciona intestinalis, makes a substantial contribution to the fields of evolutionary and developmental biology.1 Tunicates have some of the smallest bilaterian genomes, embryos with relatively few cells, fixed lineages and early determination of cell fates. Initial analyses of the C. intestinalis genome indicate that it has been evolving rapidly. Comparisons with other bilaterians show that C. intestinalis has lost a number of genes, and that many genes linked together in (...) most other bilaterians have become uncoupled. In addition, a number of independent, lineage‐specific gene duplications have been detected. These new results, although interesting in themselves, will take on a deeper significance once the genomes of additional invertebrate deuterostomes (e.g. echinoderms, hemichordates and amphioxus) have been sequenced. With such a broadened database, comparative genomics can begin to ask pointed questions about the relationship between the evolution of genomes and the evolution of body plans. BioEssays 25:529–532, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

In the poem which sets the seal on his three books of odes, Horace declares that his monument to himself will be more durable than bronze and higher than the pyramids. As T. E. Page noted in his commentary, aere can suggest not only bronze tablets, but also commemorative statuary, although tablets seems more to the fore here, given the reference to monumentum As for the pyramids, they are a fine example of grandiloquent architecture, but of a kind which is (...) nevertheless subject to the destructive natural forces from which Horace exempts his own commemoration. (shrink)

In the poem which sets the seal on his three books of odes, Horace declares that his monument to himself will be more durable than bronze and higher than the pyramids. As T. E. Page noted in his commentary, aere can suggest not only bronze tablets, but also commemorative statuary, although tablets seems more to the fore here, given the reference tomonumentumAs for the pyramids, they are a fine example of grandiloquent architecture, but of a kind which is nevertheless subject (...) to the destructive natural forces from which Horace exempts his own commemoration. (shrink)

We live in turbulent times, our world is changing at accelerating speed. Information is everywhere, but wisdom appears in short supply when trying to address key inter-related challenges of our time such as; runaway climate change, the loss of biodiversity, the depletion of natural resources, the on-going homogenization of culture, and rising inequity. Living in such times has implications for education and learning. This book explores the possibilities of designing and facilitating learning-based change and transitions towards sustainability. In 31 chapters (...) contributors from across the world discuss (re)emerging forms of learning that not only assist in breaking down unsustainable routines, forms of governance, production and consumption, but also can help create ones that are more sustainable. The book has been divided into three parts: re-orienting science and society, re-connecting people and planet and re-imagining education and learning. This is essential reading for educators, educational designers, change agents, researchers, students, policymakers and entrepreneurs alike, who are concerned about the well-being of the planet and convinced of our ability to do better. The content and related issues can be discussed on the blog by editor Arjen Wals: Transformative learning. 'We are living in times of incertitude, complexity, and contestation, but also of connectivity, responsibility, and new opportunities. This book analyses the consequences of these times for learning in formal, non-formal, and informal education. It explores the possibilities offered by the concept of sustainability as a central category of a holistic paradigm which harmonizes human beings with Earth. To change people and to change the world are interdependent processes - this book contributes to both.' Moacir Gadotti, Director of Paulo Freire Institute, São Paulo, Brazil 'I hope you share my excitement about the innovations for sustainability that this book catalogues and analyses. While the ecological news is grim, the human news is not. Even in a time of accelerating change, people are showing their enormous capacities to learn, adapt, restore and protect.' From the Foreword by Juliet Schor, author of ‘True Wealth: how and why millions of Americans are creating a time-rich, ecologically-light, small-scale high-satisfaction economy’ 'This book implies a ‘culture of critical commitment’ in educational thinking and practice - engaged enough to make a real difference to social-ecological resilience and sustainability but reflexively critical enough to learn constantly from experience and to keep options open in working for a sustainability transformation.' From the Afterword by Stephen Sterling, Professor of Sustainability Education, Centre for Sustainable Futures, Plymouth University, United Kingdom. (shrink)

"This comprehensive volume - containing 27 chapters and contributions from six continents - presents and discusses key principles, perspectives, and practices of social learning in the context of sustainability. Social learning is explored from a range of fields challenged by sustainability including: organizational learning, environmental management and corporate social responsibility; multi-stakeholder governance; education, learning and educational psychology; multiple land-use and integrated rural development; and consumerism and critical consumer education. An entire section of the book is devoted to a number of (...) reflective case studies of people, organizations and communities using forms of social learning in moving towards sustainability. 'This book brings together a range of ideas, stories, and discussions about purposeful learning in communities aimed at creating a world that is more sustainable than the one currently in prospect....The book is designed to expand the network of conversations through which our society can confront various perspectives, discover emerging patterns, and apply learning to a variety of emotional and social contexts.' From the Foreword by Fritjof Capra, co-founder of the Center of Ecoliteracy. 'Joining what is so clear and refreshing in this book with the larger movements toward a critically democratic and activist education that is worthy of its name, is but one step in the struggle for sustainability. But it is an essential step if we are to use the insights that are included in this book.' From the Afterword by Michael Apple, author of 'Educating the ""Right"" Way: Markets, Standards, God, and Inequality'.". (shrink)

With displacement, time, and force as basic undefined physical quantities, other physical quantities are defined as combinations of two vector quantities and one scalar quantity. Combinations include multiplication and division of vectors by vectors, scalars by vectors, and scalars by scalars. Defined quantities are vectors, scalars or quaternions, depending on directions of vectors in the definitions. Division of a vector by a vector is equivalent to multiplication of vectors divided by a scalar. The unit of a vector (or scalar) is (...) itself a vector (or scalar) quantity. Thesquare meter (a vector) differs from meter 2 (a scalar), and the cubic meter (a scalar) is different frommeter 3 . The characteristics of displacement, time, and force are considered known from experience. (shrink)

Quaternions consist of a scalar plus a vector and result from multiplication or division of vectors by vectors. Division of vectors is equivalent to multiplication divided by a scalar. Quaternions as used here consist of the scalar product with positive sign plus the vector product with sign determined by the right-hand rule. Units are specified by the multiplication process. Trigonometric functions are quaternions with units that can satisfy Hamilton's requirements. The square of a trigonometric quaternion is a real number provided (...) that the product of the scalar number and the vector is not commutative. Maxwell's electromagnetic equations for empty space can be represented by a single quaternion equation. (shrink)

As thinkers in the market for knowledge and agents aspiring to morally responsible action, we are inevitably subject to luck. This book presents a comprehensive new theory of luck in light of a critical appraisal of the literature's leading accounts, then brings this new theory to bear on issues in the theory of knowledge and philosophy of action.

This theory accords to volitions the status of basic mental actions, maintaining that these are spontaneous exercises of the will--a "two-way" power which ...

In discussion on consciousness and the hard problem, there is an unquestioned background assumption, namely, our experience is stored in the brain. Yet Bergson argued that this very question, “Is experience stored in the brain?” is the critical issue in the problem of consciousness. His examination of then-current memory research led him, save for motor or procedural memory, to a “no” answer. Others, for example Sheldrake, have continued this negative assessment of the research findings. So, has this assumption actually been (...) proven since Bergson? Do we know how experience is stored? Or that it is stored? Here, a recent review and model of memory is examined to see where this assumption actually stands. Again, the assessment will be that nothing has changed. The core of the problem, it will be argued, lies in two things: Firstly, the search for how/where experience is stored is motivated—rephrasing Bergson—in the classic metaphysic, a framework on space and time whose logic cannot be coherently, logically adhered to in attempting to explain how experience is stored. Secondly, the search generally assumes an inadequate theory of perception that is implicitly based in this classic metaphysic. If framed within Bergson’s model of perception and his temporal metaphysic, conjoined with J. J. Gibson’s model, the storage-search appears misguided from the start. (shrink)

Lemmon argues that dilemmas occur between classes of 'oughts;' duties, obligations, and moral principles. He claims that there are not conflicts within each class, presumably because he is a utilitarian, and thinks that moral principles will always be univocal.

When we perceive an object, we perceive the object from a perspective. As a consequence of the perspectival nature of perception, when we perceive, say, a circular coin from different angles, there is a respect in which the coin looks circular throughout, but also a respect in which the coin's appearance changes. More generally, perception of shape and size properties has both a constant aspect—an aspect that remains stable across changes in perspective—and a perspectival aspect—an aspect that changes depending on (...) one's perspective on the object. How should we account for the perspectival aspect of spatial perception? We present a framework within which to discuss the perspectival aspect of perception and put forward three desiderata that any account of the perspectival aspect of perception should satisfy. We discuss views on which the perspectival aspect of perception is analyzed in terms of constitutively mind-dependent appearance properties as well as views on which the perspectival aspect of perception is analyzed in terms of representations of mind-independent perspectival properties. (shrink)

In this innovative study of the relationship between persons and their bodies, E. J. Lowe demonstrates the inadequacy of physicalism, even in its mildest, non-reductionist guises, as a basis for a scientifically and philosophically acceptable account of human beings as subjects of experience, thought and action. He defends a substantival theory of the self as an enduring and irreducible entity - a theory which is unashamedly committed to a distinctly non-Cartesian dualism of self and body. Taking up the physicalist challenge (...) to any robust form of psychophysical interactionism, he shows how an attribution of independent causal powers to the mental states of human subjects is perfectly consistent with a thoroughly naturalistic world view. He concludes his study by examining in detail the role which conscious mental states play in the human subject's exercise of its most central capacities for perception, action, thought and self-knowledge. (shrink)

A prominent view holds that perception and memory are distinguished at least partly by their temporal orientation: Perception functions to represent the present, while memory functions to represent the past. Call this view perceptual presentism. This chapter critically examines perceptual presentism in light of contemporary perception science. I adduce evidence for three forms of perceptual sensitivity to the past: (i) shaping perception by past stimulus exposure, (ii) recruitment of mnemonic representations in perceptual processing, and (iii) perceptual representation of present objects (...) as possessing past properties. I argue that forms (i) and (ii) are consistent with perceptual presentism, while form (iii) poses a genuine threat to the view. While the empirical case for form (iii) remains inconclusive, I suggest that the most serious challenges to perceptual presentism derive from representations that integrate mnemonic and present-tensed elements in the performance of canonical perceptual functions, such as perceiving object continuity over time. (shrink)

There is currently intense interest in the question of the source of our presumed knowledge of truths concerning what is, or is not, metaphysically possible or necessary. Some philosophers locate this source in our capacities to conceive or imagine various actual or non-actual states of affairs, but this approach is open to certain familiar and seemingly powerful objections. A different and ostensibly more promising approach has been developed by Timothy Williamson, according to which our capacity for modal knowledge is just (...) an extension, or by-product, of our general capacity to acquire knowledge of true counterfactual conditionals — a capacity that we deploy ubiquitously in everyday life. Williamson’s account crucially involves a thesis to the effect that modal truths can be explained in terms of counterfactual truths. In this paper, I query Williamson’s account on a number of points, including this thesis. My positive proposal, which owes a debt to the work of Kit Fine on modality and essence, appeals instead to our capacity to grasp essences, understood in a neo-Aristotelian fashion, according to which essences are expressed by ‘real definitions’. (shrink)

s div class="title" a terTwo Notions of Being: Entity and Essence s /div a ter - Volume 62 - E. J. Lowe.

If metaphysics is centrally concerned with charting the domain of the possible, the only coherent account of the ground of metaphysical possibility and of our capacity for modal knowledge is to be found in a version of essentialism: a version that I call serious essentialism, to distinguish it from certain other views which may superficially appear very similar to it but which, in fact, differ from it fundamentally in certain crucial respects. This version of essentialism eschews any appeal whatever to (...) the notion of possible worlds in its account of the nature and ground of metaphysical possibility, for reasons that which I shall endeavour to explain and justify in this paper. (shrink)

'Object' and 'criterion of identity' are philosophical terms of art whose application lies at a considerable theoretical remove from the surface phenomena of everyday linguistic usage. This partly explains their highly controversial status, for their point of application lies precisely where the concerns of linguists and philosophers of language merge with those of metaphysicians. This chapter explains the possession of determinate identity‐conditions. It argues that the distinction between 'abstract' and 'concrete' objects is itself a highly controversial one, and although it (...) has indeed been argued that this distinction turns ultimately upon differences between the criteria of identity governing objects of these two broad categories. It examines the role which criteria of identity play in our talk about objects of the least controversial varieties. The chapter concerns the problem of identity over time and the paradoxes to which identity criteria often appear to give rise when time is brought into the picture. (shrink)

Causal closure arguments against interactionist dualism are currently popular amongst physicalists. Such an argument appeals to some principles of the causal closure of the physical, together with certain other premises, to conclude that at least some mental events are identical with physical events. However, it is crucial to the success of any such argument that the physical causal closure principle to which it appeals is neither too strong nor too weak by certain standards. In this paper, it is argued that (...) various forms of naturalistic dualism, of an emergentist character, are consistent with the strongest physical causal closure principles that can plausibly be advocated. (shrink)