Background Regarding controversial medical services, many have argued that if physicians cannot in good conscience provide a legal medical intervention for which a patient is a candidate, they should refer the requesting patient to an accommodating provider. This study examines what US physicians think a doctor is obligated to do when the doctor thinks it would be immoral to provide a referral. Method The authors conducted a cross-sectional survey of a random sample of 2000 US physicians from all specialties. The (...) primary criterion variable was agreement that physicians have a professional obligation to refer patients for all legal medical services for which the patients are candidates, even if the physician believes that such a referral is immoral. Results Of 1895 eligible physicians, 1032 (55%) responded. 57% of physicians agreed that doctors must refer patients regardless of whether or not the doctor believes the referral itself is immoral. Holding this opinion was independently associated with being more theologically pluralistic, describing oneself as sociopolitically liberal, and indicating that respect for patient autonomy is the most important bioethical principle in one's practice (multivariable ORs, 1.6–2.4). Conclusions Physicians are divided about a professional obligation to refer when the physician believes that referral itself is immoral. These data suggest there is no uncontroversial way to resolve conflicts posed when patients request interventions that their physicians cannot in good conscience provide. (shrink)

Several lines of evidence suggest that children born via Cesarean section are at greater risk for adverse health outcomes including allergies, asthma and obesity. Vaginal seeding is a medical procedure in which infants born by C-section are swabbed immediately after birth with vaginal secretions from the mother. This procedure has been proposed as a way to transfer the mother's vaginal microbiome to the child, thereby restoring the natural exposure that occurs during vaginal birth that is interrupted in the case of (...) babies born via C-section. Preliminary evidence indicates partial restoration of microbes. However, there is insufficient evidence to determine the health benefits of the procedure. Several studies, including trial, are currently underway. At the same time, in the clinic setting, doctors are increasingly being asked to by expectant mothers to have their babies seeded. This article reports on the current research on this procedure and the issues it raises for regulators, researchers, physicians, and patients. (shrink)

For most observers of economics from both inside and outside the science, the term ‘economics’ is synonymous with neoclassical economics. It is the methodology of neoclassical economics that defines the discipline of economics. ‘Mainstream economics’ is neoclassical economics and anyone entering the discipline today who wishes to obtain an appointment at one of the leading universities of the world is well advised to master its techniques. The fact that virtually every winner of a Nobel prize from Paul Samuelson up to (...) his student Joseph Stiglitz has been a practitioner of neoclassical economics is ample proof of the methodology’s triumph. Despite the dominance of this methodology, however, neoclassical economics has been subject to a steady stream of criticisms and proposals for alternative methodological approaches throughout its life. This article focuses on two relatively recent challenges to the neoclassical orthodoxy that seem to have taken hold of a non-negligible minority of the profession, some of whom can be found at leading universities. These two challenges come from behavioural economics and evolutionary economics. The article describes the strengths and weaknesses of both of these methodological approaches and contrasts them with that of neoclassical economics. It concludes that all three methodologies have something positive to contribute to the study of human behaviour. Key Words: neoclassical economics • behavioural economics • evolutionary economics. (shrink)

ABSTRACT In its attempt to prove that voters, politicians, and bureaucrats are motivated by the public interest, Self-Interest and Public Interest in Western Politics overlooks a great deal of public-choice research, to which much has been added during the two decades since it was published. The importance of self-interest at both the micro and macro levels of politics becomes clear once one looks not simply at the ?inputs? of a democracy but at its ?outputs? as well. The prevalence of interest (...) groups, the dysfunction of the United States tax code, the lobbying by unions for their members? self-interest, the earmarks in the Patriot Act, the numerous cases of corruption in Western democracies, and the dissatisfaction of citizens with their governments? failings all point to the importance of self-interest in politics. (shrink)

In its attempt to prove that voters, politicians, and bureaucrats are motivated by the public interest, Self-Interest and Public Interest in Western Politics overlooks a great deal of public-choice research, to which much has been added during the two decades since it was published. The importance of self-interest at both the micro and macro levels of politics becomes clear once one looks not simply at the “inputs” of a democracy but at its “outputs” as well. The prevalence of interest groups, (...) the dysfunction of the United States tax code, the lobbying by unions for their members’ self-interest, the earmarks in the Patriot Act, the numerous cases of corruption in Western democracies, and the dissatisfaction of citizens with their governments’ failings all point to the importance of self-interest in politics. (shrink)

This book also emphasizes the difference between religion and science as means for understanding causal relationships, but it focuses much more heavily on the challenge religious extremism poses for liberal democratic institutions. The treatment contains a discussion of human psychology, describes the salient characteristics of all religions, and contrasts religion and science as systems of thought. Historical sketches are used to establish a link between modernity and the use of the human capacity for reasoning to advance human welfare. The book (...) describes the conditions under which democratic institutions can advance human welfare, and the nature of constitutional rights as protectors of individual freedoms. Extremist religions are shown to pose a threat to liberal democracy, a threat that has implications for immigration and education policies and the definition of citizenship. (shrink)

Though we agree with their argument that language is shaped by domain-general learning processes, Christiansen & Chater (C&C) neglect to detail how the development of these processes shapes language change. We discuss a number of examples that show how developmental processes at multiple levels and timescales are critical to understanding the origin of domain-general mechanisms that shape language evolution.

Public choice or rational politics differs from other approaches to the study of political behavior in that it builds on models in which rational individuals seek to advance their own interests. This five-part volume surveys the main ideas and contributions of the field. It contains twenty-five essays written by thirty scholars, both economists and political scientists, from North America and Europe. Part I discusses the nature and justification for the existence of government and various forms it can take, including mixed, (...) private, and public institutions, international organizations, federalisms, and constitutional governments. Part II examines the properties of different voting rules and preference aggregation procedures. Part III explores multiparty systems, interest groups, logrolling and political business cycles. The individual decisionmaker is the focus of Part IV, with surveys of the experimental literature on individual behavior, and why people vote as they do. The final section applies public-choice reasoning to bureaucracy, taxation, and the size of government. (shrink)

Amartya Sen has demonstrated a possible inconsistency between a (liberal) right and Pareto optimality. Neither Sen nor the subsequent literature have discussed the origin of the rights that lead to the liberal paradox. In this article I examine one possible origin of rights definitions-a constitutional contract agreed to by all members of the community. Constitutional rights are show to be vulnerable to a similar paradox as with liberal rights, but if the writers of the constitution were correct in their choice (...) of actions to protect, such paradoxes will be unlikely and involve small welfare losses when they do occur. The article demonstrates that both the origin of rights and their potential role in advancing the interests of citizens can be explained using a utilitarian/welfarist methodology. (shrink)

Starting with The Calculus of Consent James M. Buchanan published many books and articles emphasizing the importance of constitutional institutions and the promise of constitutional reforms. In this chapter I review some of these publications. The review begins with The Calculus, and then goes on to The Limits of Liberty, The Power to Tax, The Reason of Rules, Politics by Principle, Not Reason, and essays about the importance of constitutions in the European Union. The chapter closes with discussions of the (...) prospects of and impediments to constitutional reform in the United States and the European Union. (shrink)

This article employs the methodology of public choice, or constitutional political economy, to the question of how citizenship should be defined in a constitution. All members of a community or an assembly representative of all members writes a constitution. Each participant in the constitution-drafting process is uncertain of his or her future identity under the constitution and thus chooses a constitution that maximizes the expected utility of all future citizens. The article describes the optimal conditions within this framework for: granting (...) citizenship to those born and raised in the country; granting citizenship to those immigrating into the country; and withdrawing citizenship from those who emigrate from the country. The article also discusses why it might be desirable to require that people pass certain tests and take a loyalty oath to the constitution before being awarded the privilege of voting. (shrink)

The present paper is a survey of the economics of survival, a branch of ecological economics that stresses the preservation of the opportunities of future generations over an extended time horizon. It outlines the main analytical foundation of the branch - in which the concept of entropy is a major building block -, and its analysis of the interaction between the economic system and the environment. Regarding its outlook of the future, we see that the founders of the branch were (...) mainly concerned with the consequences of a serious depletion of natural resources - particularly the energetic capital of the earth. More recently, however, emphasis is being placed on problems that stem from the fragility of the global ecosystem in face of the disturbances caused by the entropic acceleration imposed by mankind. It is feared that the ongoing expansion of the scale of the economy may bring about irreversible damages to vital environmental functions, such as protection against undesirable consequences of solar radiation, maintenance of temperature within a range that will support life, and preservation of ecosystem resiliency. (shrink)

Is it possible that all of the social sciences could employ a common methodology? If so, what would it be? This article adresses these questions. It takes off from James Coleman’s recent book, The Foundations of Social Theory. Coleman’s social theory is built on the postulate that individuals are rational actors, the same postulate that most of modern economics is built upon. This article critiques the use of this postulate in economics, and thus questions whether it is a useful building (...) block for the methodological foundations of social science research. It proposes an adaptive view of human behavior as an alternative in which preferences are conditioned by past experience. The work of Joseph Schumpeter is discussed as an exemplar of the methodology advocated here. (shrink)

Background Following passage of the Patient Self Determination Act in 1990, health care institutions that receive Medicare and Medicaid funding are required to inform patients of their right to make their health care preferences known through execution of a living will and/or to appoint a surrogate-decision maker. We evaluated the impact of external factors and perceived patient preferences on physicians’ decisions to honor or forgo previously established advance directives (ADs). In addition, physician views regarding legal risk, patients’ ability to comprehend (...) complexities involved with their care, and impact of medical costs related to end-of-life care decisions were explored. Methods Attendees of two Mayo Clinic continuing medical education courses were surveyed. Three scenarios based in part on previously court-litigated matters assessed impact of external factors and perceived patient preferences on physician compliance with patient-articulated wishes regarding resuscitation. General questions measured respondents’ perception of legal risk, concerns over patient knowledge of idiosyncrasies involved with their care, and impact medical costs may have on compliance with patient preferences. Responses indicating strength of agreement or disagreement with statements were treated as ordinal data and analyzed using the Cochran Armitage trend test. Results Three hundred eighty-eight of 951 surveys were completed (41% response rate). Eighty percent reported they were likely to honor a patient’s AD despite its 5 year age. Fewer than half (41%) would honor the AD of a patient in ventricular fibrillation who had expressed a desire to “pass away in peace.” Few (17%) would forgo an AD following a family’s request for continued resuscitative treatment. A majority (52%) considered risk of liability to be lower when maintaining someone alive against their wishes than mistakenly failing to provide resuscitative efforts. A large percentage (74%) disagreed that patients could not appreciate complexities surrounding their care while 69% agreed that costs should never impact a physician’s decision as to whether to comply with a patient’s AD. Conclusions Our findings highlight the impact, albeit small, external factors have on physician AD compliance. Most respondents based their decision on the clinical situation at hand and interpretation of the patient’s initial wishes and preferences expressed by the AD. (shrink)

BackgroundAn analysis of the position statements of secular US medical and surgical professional societies on physician-assisted suicide (PAS) and euthanasia have not been published recently. Available statements were evaluated for position, content, and sentiment.MethodsIn order to create a comprehensive list of secular medical and surgical societies, the results of a systematic search using Google were cross-referenced with a list of societies that have a seat on the American Medical Association House of Delegates. Societies with position statements were identified. These statements (...) were divided into 5 categories: opposed to PAS and/or euthanasia, studied neutrality, supportive, acknowledgement without statement, and no statement. Linguistic analysis was performed using RapidMinder in order to determine word frequency and sentiment respective to individual statements. To ensure accuracy, only statements with word counts > 100 were analyzed. A 2-tailed independentttest was used to test for variance among sentiment scores of opposing and studied neutrality statements.ResultsOf 150 societies, only 12 (8%) have position statements on PAS and euthanasia: 11 for PAS (5 opposing and 4 studied neutrality) and 9 for euthanasia (6 opposing and 2 studied neutrality). Although the most popular words used in opposing and studied neutrality statements are similar, notable exceptions exist (suicide,medicine, andtreatmentappear frequently in opposing statements, but not in studied neutrality statements, whereaspsychologists,law, andindividualsappear frequently in studied neutrality statements, but not in opposing statements). Sentiment scores for opposing and studied neutrality statements do not differ (mean, 0.094 vs. 0.104;P = 0.90).ConclusionsFew US medical and surgical societies have position statements on PAS and euthanasia. Among them, opposing and studied neutrality statements share similar linguistic sentiment. Opposing and studied neutrality statements have clear differences, but share recommendations. Both opposing and studied neutrality statements cite potential risks of PAS legalization and suggest that good palliative care might diminish a patient’s desire for PAS. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bibliography of Resources by and about André E. Hellegers*Compiled by Doris Mueller Goldstein (bio)This bibliography is derived from the holdings of the National Reference Center for Bioethics Literature and the BIOETHICSLINE© database (both of which are at the Kennedy Institute of Ethics and supported by the National Library of Medicine); the archives of Lauinger Library, Georgetown University; the Medline databases of the National Library of Medicine; the WorldCat database (...) of OCLC, Dublin, Ohio, and selected Internet sites.Primarily comprised of writings by Dr. Hellegers, the list also includes interviews and media programs in which he participated, as well as writings about him that were written following his death. The arrangement within each section is by date. The 231 authored pieces reflect the transition from Dr. Hellegers’s early career as a researcher in fetal physiology at Johns Hopkins Medical School, where he published his first research report at the age of 29, to the early years of the Kennedy Institute, where he produced so many provocative columns on bioethical issues that influenced the growth of the field.Due to the diversity of sources and the 40-year time span covered, there are some variations in bibliographic style. Time and availability constraints precluded verifying all of the citations with the original documents. Any additions or corrections should be submitted to the compiler.Works Authored by André E. HellegersNo Date Ethical Issues in Sterilization of the Retarded. Unpublished paper.1956Vitamin B12 Serum Level and Pregnancy. American Journal of Clinical Nutrition 4: 440+, 1956. [With Bacon F. Chow and Kunio Okuda] [End Page 89]1957Vitamin B12 Absorption in Pregnancy and in the Newborn. American Journal of Clinical Nutrition 5: 327+, 1957. [With Bacon F. Chow, Robert E. L. Nesbitt, Kunio Okuda, and David W. Smith]1958The Effects of Acute Hypoxia on the Osmotic Pressure of the Plasma. Quarterly Journal of Experimental Physiology 43: 197+, 1958. [With Donald H. Barron, Frederick C. Battaglia, and Giacomo Meschia]Studies on the Absorption of Vitamin B12 in Human Pregnancy with Especial Reference to the Effect of D-Sorbitol. American Journal of Obstetrics and Gynecology 76: 91+, 1958. [With Bacon F. Chow, Harry Prystowsky, and Vernon Wong]1959The Alveolar PCO2 and PO2 in Pregnant and Nonpregnant Women at Altitude. Proceedings of the Society for Clinical Investigation 38: 1010+, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, James Metcalfe, and Harry Prystowsky]A Comparison of the Oxygen Dissociation Curves of the Bloods of Maternal and Fetal Goats at Various pHs. Quarterly Journal of Experimental Physiology 44: 215–21, July 1959. [With Donald Barron, Giacomo Meschia, Harry Prystowsky, and A. Stark Wolkoff]Fetal Blood Studies. XII. On the Relationship Between the Position of the Oxygen Dissociation Curve of Human Fetal Blood and Adult Fetal Hemoglobin. American Journal of Obstetrics and Gynecology 77: 585+, 1959. [With Paul D. Bruns, Julian Cotter, and Harry Prystowsky]Fetal Blood Studies. XIV. A Comparative Study of the Oxygen Dissociation Curve of Nonpregnant, Pregnant and Fetal Human Blood. American Journal of Obstetrics and Gynecology 78: 489–93, September 1959. [With Paul D. Bruns and Harry Prystowsky]Fetal Blood Studies. XVI. On the Changes in Total Osmotic Pressure and Sodium and Potassium Concentration of Amniotic Fluid During the Course of Human Gestation. Surgery, Gynecology and Obstetrics 109: 509–12, October 1959. [With Frederick Battaglia, Paul D. Bruns, Harry Prystowsky, and Clayton Smisson]Further Observations on the Metabolism of Vitamin B12 in Human Pregnancy. American Journal of Obstetrics and Gynecology 77: 1+, 1959. [With Bacon F. Chow, Harry Prystowsky, Bruno Ranke, and Elma Ranke]The Oxygen Dissociation Curves of the Bloods of Adult and Fetal Llamas. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, James Metcalfe, and Harry Prystowsky] [End Page 90]Transfer of Oxygen Across the Sheep Placenta at High Altitude. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, and Harry Prystowsky]Uterine Blood Flow and Metabolism in Pregnant Sheep at High Altitude. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo Meschia, James Metcalfe, and Harry Prystowsky]Uterine Blood Flow and Metabolism in Unanesthetized Pregnant Sheep. Federation Proceedings 18, 1959. [With Donald Barron, William Huckabee, Giacomo... (shrink)

An ethnographic field study about the informed consent process in investigational drug trials for seriously ill persons with hepatitis C suggests that nurses and physicians referred to these trials as giving treatment, even though they involved placebos. Interview data and informed consent documents contained frequent references to the term `treatment trial' or `treatment'. Although these findings were unexpected and not the original focus of our study, we consider them in the light of an extensive literature on the `therapeutic misconception' that (...) has been described among physicians and patients with AIDS and other serious illnesses. We also suggest that certain organizational and professional characteristics of nursing and medicine reinforce this tendency to refer to the trials as treatment. Implications for further research are provided. (shrink)

Two things about Hilary Putnam have not changed throughout his career: some (including Putnam himself) have regarded him as a “realist” and some have seen him as a philosopherwho changed his positions (certainly with respect to realism) almost continually. Apparently, what realism meant to him in the 1960s, in the late seventies and eighties, and in the nineties, respectively, are quite different things. Putnam indicates this by changing prefixes: scientific, metaphysical, internal, pragmatic, commonsense, but always realism. Encouraged by Putnam’s own (...) attempts to distinguish his views from one time to another, his work is often regarded as split between an early period of “metaphysical realism” (his characterization) and a later and still continuing period of “internal realism”. Late Putnam is understood to be a view that insists on the primacy of our practices, while the early period is taken to be a view from outside these, a “God’s Eye view”. As Putnam himself stresses (1992b), this way of dividing his work obscures continuities, the most important of which is a continuing attempt to understand what is involved in judging practices of inquiry, like science, as being objectively correct. Thus Putnam’s early and his current work appear to have more in common than the division between “early” and “late” suggests. In fact, Putnam’s earlier writings owe much of their critical force to his adopting the pragmatic perspective of an open-minded participant in practices of empirical inquiry, a stance not explicitly articulated in these writings but rather taken simply as a matter of course.1 Thus insofaras Putnam’s early writings defend a form of representational realism, they can be regarded as attempts to articulate a realist position at work inside our ordinary practices of making empirical judgments. For this reason, we begin our review of Putnam’s realisms by extracting from the early writings a core of principles that carries over into his current work but underwent significantly different interpretations over time.. (shrink)

In his critical study of Speusippus Leonardo Tarán (T.) expounds an interpretation of a considerable part of the controversial books M and N of Aristotle's Metaphysics. In this essay I want to consider three aspects of the interpretation, the account of Plato's ‘ideal numbers’ (section I), the account of Speusippus’ mathematical ontology (section II), and the account of the principles of that ontology (section III). T. builds his interpretation squarely on the work of Harold Cherniss (C.), to whom I will (...) also refer. I concentrate on T. because he has brought the ideas in which I am interested together and given them a concise formulation; he is also meticulous in indicating the secondary sources with which he agrees or disagrees, so that anyone interested in pursuing particular points can do so easily by consulting his book. (shrink)

Background: Magnetic resonance spectroscopic imaging is a neuroimaging technique that may be useful for non-invasive mapping of brain temperature over a large brain volume. To date, intra-subject reproducibility of MRSI-based brain temperature has not been investigated. The objective of this repeated measures MRSI-t study was to establish intra-subject reproducibility and repeatability of brain temperature, as well as typical brain temperature range.Methods: Healthy participants aged 23–46 years were scanned at two time points ~12-weeks apart. Volumetric MRSI data were processed by reconstructing (...) metabolite and water images using parametric spectral analysis. Brain temperature was derived using the frequency difference between water and creatine for 47 regions of interest delineated by the modified Automated Anatomical Labeling atlas. Reproducibility was measured using the coefficient of variation for repeated measures, and repeatability was determined using the standard error of measurement. For each region, the upper and lower bounds of Minimal Detectable Change were established to characterize the typical range of TCRE values.Results: The mean global brain temperature over all subjects was 37.2°C with spatial variations across ROIs. There was a significant main effect for time [F = 37.0, p < 0.0001] and for brain region [F = 2.66, p < 0.0001]. The time*brain region interaction was not significant [F = 0.80, p = 0.83]. Participants' TCRE was stable for each ROI across both time points, with ROIs' COVrep ranging from 0.81 to 3.08% ; majority of ROIs had a COVrep <2.0%.Conclusions: Brain temperature measurements were highly consistent between both time points, indicating high reproducibility and repeatability of MRSI-t. MRSI-t may be a promising diagnostic, prognostic, and therapeutic tool for non-invasively monitoring brain temperature changes in health and disease. However, further studies of healthy participants with larger sample size and numerous repeated acquisitions are imperative for establishing a reference range of typical brain TCRE, as well as the threshold above which TCRE is likely pathological. (shrink)

This bibliography signals a monumental event in philosophical research and for the future of comparative philosophy, East and West. It is in effect the first volume of the proposed multi-volumed Encyclopedia of Indian Philosophies which has been inaugurated with this research tool. The outline of the bibliography will constitute the table of contents for the subsequent volumes of the forthcoming encyclopedia, now being written by an international team of scholars. The entire enterprise is sponsored by the American Institute of Indian (...) Studies and is under their general supervision. The bibliography, which has taken five years to complete and consists of 9222 entries, will be revised periodically as more material is compiled from the Indian languages and as contemporary work continues. Since Indian thought systems do not clearly differentiate between religious and philosophical expression, the compiler limited his selections to the Indian darsanas and vyakaranas. Indian literature is included if it is philosophical throughout, theoretical in function, and expository in content. This excludes the more didactic literature such as religious scriptures and classics. Three general sections divide the work: Sanskrit texts with authors known; Sanskrit texts with authors unknown; secondary literature arranged according to the various philosophical schools. General sections on Jainism, the traditions of Buddhism, and Hinduism offer philosophical sources for the major Indian religions. The listings are chronological within a particular subject. This not only facilitates additions to the bibliography but also gives a focus to scholarly discussion on a particular point. The work ends with three indices: Index of Names of Persons; Index of Titles ; Index of Books and Articles. The final index should prove the most useful to the researcher and general scholar. The publishing of the bibliography, done in India and according to Indian standards, is inferior in binding and paper stock. The price, Rs.80., has been listed in American bookstores at various prices from $18.00 to $24.00 for those who do not wish to order directly from the Indian publisher. The American Institute of Indian Studies should be commended for directing this work and every effort should be made for the completion of the entire encyclopedia. In terms of Asian studies it is the most significant publishing venture since the appearance of Max Mueller’s Sacred Books of the East over a century ago. Mueller opened the world of Asian religions to Western investigation while this bibliography should expose the breadth of Indian philosophy both in its intrinsic value and its effect upon world philosophy.—W. C. C. (shrink)

The historical antecedents of Frege's treatment of binocular vision in "The thought" were the physiological writings of Johannes Mueller, Hermann von Helmholtz, and Emil du Bois-Reymond. In their research on human vision, logic was assigned an unexpected role: it was to be the means by which knowledge of a world extended in three dimensions arises from stimuli that are at best two-dimensional. An examination of this literature yields a richer understanding of Frege's insistence that a proper epistemology requires us to (...) recognize the existence and importance of nonsensible sources of knowledge. (shrink)

De Interpretatione is among Aristotle's most influential and widely read writings; C. W. A. Whitaker presents the first systematic study of this work, and offers a radical new view of its aims, its structure, and its place in Aristotle's system. He shows that De Interpretatione is not a disjointed essay on ill-connected subjects, as traditionally thought, but a highly organized and systematic treatise on logic, argument, and dialectic.