This paper offers a narrative approach to understanding the process of clinical reasoning in complex cases involving medical uncertainty, moral ambiguity, and futility. We describe a clinical encounter in which the pediatric health care team experienced a great deal of conflict and distrust as a result of an ineffective process of interpretation and communication. We propose a systematic method for analyzing the technical, ethical, behavioral, and existential dimensions of the clinical reasoning process, and introduce the Clinical Reasoning Discussion Tool—a dialogical (...) and interpretive device aimed at improving communication, understanding, empathy, and moral deliberation in the clinical setting. (shrink)

We examine the problem of deducing the geodesic motion of test particles from Einstein's vacuum field equations and its extension to include gravitational radiation reaction. In the latter case we obtain an equation of motion for a particle which incorporates radiation reaction of the electrodynamical type, but due to shearing radiation, together with a mass-loss formula of the Bondi-Sachs type.

We derive, from the Einstein-Maxwell field equations, the Lorentz equations of motion with radiation reaction for a charged mass particle moving in a background gravitational and electromagnetic field by utilizing a line element for the background space-time in a coordinate system specially adapted to the world line of the particle. The particle is introduced via perturbations of the background space-time (and electromagnetic field) which are singular only on the source world line.

Previous research has suggested that individuals who identify as being more religious request more aggressive medical treatment at end of life. These requests may generate disagreement over life-sustaining treatment (LST). Outside of anecdotal observation, however, the actual role of religion in conflict over LST has been underexplored. Because ethics committees are often consulted to help mediate these conflicts, the ethics consultation experience provides a unique context in which to investigate this question. The purpose of this paper was to examine the (...) ways religion was present in cases involving conflict around LST. Using medical records from ethics consultation cases for conflict over LST in one large academic medical centre, we found that religion can be central to conflict over LST but was also present in two additional ways through (1) religious coping, including a belief in miracles and support from a higher power, and (2) chaplaincy visits. In-hospital mortality was not different between patients with religiously versus non-religiously centred conflict. In our retrospective cohort study, religion played a variety of roles and did not lead to increased treatment intensity or prolong time to death. Ethics consultants and healthcare professionals involved in these cases should be cognisant of the complex ways that religion can manifest in conflict over LST. (shrink)

Forty‐nine subjects judged the relevancy of sentence parts of a word problem (the Allsports problem). Patterns of subjects' judgments suggest three problem‐solving heuristics: a SETS heuristic, a TIME heuristic, and a QUESTION heuristic. Presentation of the question before the problem tends to suppress SETS and TIME heuristics. A computer program (ATTEND) is presented to simulate subjects' behavior on the Allsports problem. The program is context‐sensitive in that it can change a relevance judgment upon the acquisition of further information. Averaged subject (...) judgments and ATTEND judgments agree for 87% of the items. (shrink)

Sigmund Freuds kritikere Frank J. Sulloway, Jeffrey M. Masson og Adolf Grünbaum og argumenterne mod deres kritik.

What if philosophy, theology, and science spent a little more time together? These fields often seem at odds, butting metaphysical heads. Instead of talking at, how about talking with one another? This book engages three academic disciplines--distinct yet sharing much in common--in a slice of conversation and community in which participants have aimed at validating the other and the way the other sees the world. The result is a collection of essays united by a thread that can be hard to (...) find in academia. In bringing together a wide range of contributors on a project that at first seemed unlikely, Irreconcilable Differences? is also a testament to the spirit of cooperation and hard work--evidence that small acts and events can make a big difference, and that sometimes all you need in order to make something good happen is an idea with a little support along the way. The editors of this collection are hopeful that its contributors and readers will keep looking for ways to bridge academic, social, and political gaps. We need to forge relationships based on personal knowledge and proper confidence seeking to make meaningful claims in an increasingly complex world. (shrink)

Published in 1982 by CUP (pb. 2009) it discusses the forms of materialism then current, including Davidson, early Rorty, but concentrating on Smart and Armstrong, and arguing that central state materialism fails to give a better 'occurrent' account of conscious states than does behaviourism/functionalism, as Armstrong claims. The book starts with a version of the 'knowledge argument' and ends with a chapter claiming that our conception of matter/the physical is more problematic than our conception of mind.

This long-awaited new edition contains eight of the dialogues of Plato, and is the first in a new five-volume complete edition of his works in the OCT series.

Thomas hobbes's papers at chatsworth prove that he had considerable knowledge of legal concepts. apparently he used the chatsworth copy of christopher saint german's "doctor" and "student" in developing his concept of contractual obligation. realizing this is useful for a careful analysis of hobbes's theory of why contracts oblige. the crucial problem is hobbes attempt to explain why we should perform a disadvantageous contract. he suggests different motives in all three of his major political works. in "leviathan" he finally settles (...) on the argument that it is always to our long-term advantage to fail to keep contracts. this argument is not very satisfactory, but it is the best that he can come up with given his account of human nature. (shrink)

Some health care organizations allow physicians to withhold cardiopulmonary resuscitation from a patient, despite patient or surrogate requests that it be provided, when they believe it will be more harmful than beneficial. Such cases usually involve patients with terminal diagnoses whose medical teams argue that aggressive treatments are medically inappropriate or likely to be harmful. Although there is state-to-state variability and a considerable judicial gray area about the conditions and mechanisms for refusals to perform CPR, medical teams typically follow a (...) set of clearly defined procedures for these decisions. The procedures are based on the principle of nonmaleficence and typically include consultation with hospital ethics committees, reflecting the guidelines of relevant professional associations. Ethical debates about when CPR can and should be limited tend to rely more on discussions of theory, principles, and case studies than systematic empirical study of the situations in which such limitations are applied. Sociologists of bioethics call for empirical study, arguing that what ethicists and health professionals believe they are doing when they draft policies or invoke principles does not always mirror what is happening on the ground. In this article, we begin the task of modeling the empirical analyses sociologists call for, focusing on a cohort at Massachusetts General Hospital. We inductively analyzed ethics committee notes and medical records of nineteen patients whose surrogates did not accept the decision to withhold CPR. (shrink)

Introduction -- The ethics of care and global politics -- Rethinking human security -- 'Women's work' : the global care and sex economies -- Humanitarian intervention and global security governance -- Peacebuilding and paternalism : reading care through postcolonialism -- Health and human security : gender, care and HIV/AIDS -- Gender, care, and the ethics of environmental security -- Conclusion. Security through care.

Objective: To assess the adequacy of the process of informed consent for surgical patients at the University Hospital of the West Indies. Method: The study is a prospective, cross-sectional, descriptive study. 210 patients at the University Hospital of the West Indies were interviewed using a standardised investigator-administered questionnaire, developed by the authors, after obtaining witnessed, informed consent for participation in the study. Data were analysed using SPSS V.12 for Windows. Results: Of the patients, 39.4% were male. Of the surgical procedures, (...) 68.6% were scheduled, 7.6% urgent and 23.8% emergency, 35.2% were minor and 64.8% major. Information imparted/received was acceptable in 40% of cases, good in 24% and inadequate (unacceptable) in 36% of cases. Almost all (97.6%) patients stated that they understood why an operation was planned and 93.3% thought that they had given informed consent. Most (95.2%) thought that they had free choice and made up their own mind. A quarter (25.2%) of all patients were told that it was mandatory for them to sign the form. There was a discussion of possible side effects and complications in 56.7% of patients. Conclusions: This study clearly indicates that surgical patients at the University Hospital of the West Indies feel that they have given informed consent. However, it also suggests that more information should be given to patients for consent to be truly informed. (shrink)

This volume seeks to advance and popularise the use of corpus-driven quantitative methods in the study of semantics. The first part presents state-of-the-art research in polysemy and synonymy from a Cognitive Linguistic perspective. The second part presents and explains in a didactic manner each of the statistical techniques used in the first part of the volume. A handbook both for linguists working with statistics in corpus research and for linguists in the fields of polysemy and synonymy.

Epiphenomenalism is the view that mental events are caused by physical events in the brain, but have no effects upon any physical events. Behavior is caused by muscles that contract upon receiving neural impulses, and neural impulses are generated by input from other neurons or from sense organs. On the epiphenomenalist view, mental events play no causal role in this process. Huxley (1874), who held the view, compared mental events to a steam whistle that contributes nothing to the work of (...) a locomotive. James (1879), who rejected the view, characterized epiphenomenalists' mental events as not affecting the brain activity that produces them "any more than a shadow reacts upon the steps of the traveller whom it accompanies". (shrink)

Many situations require the simultaneous processing of auditory and visual information, however, stimuli presented to one sensory modality can sometimes interfere with processing in a second sensory modality (i.e., modality dominance). The current study further investigated modality dominance by examining how task demands and bimodal presentation affect speeded auditory and visual discriminations. Participants in the current study had to quickly determine if two words, two pictures, or two word-picture pairings were the same or different, and we manipulated task demands across (...) three different conditions. In an immediate recognition task, there was only one second between the two stimuli/stimulus pairs and auditory dominance was found. Compared to the respective unimodal baselines, pairing pictures and words together slowed down visual responses and sped up auditory responses. Increasing the interstimulus interval to four seconds and blocking verbal rehearsal weakened auditory dominance effects, however, conflicting and redundant visual cues sped up auditory discriminations. Thus, simultaneously presenting pictures and words had different effects on auditory and visual processing, with bimodal presentation slowing down visual processing and speeding up auditory processing. These findings are consistent with a proposed mechanism underlying auditory dominance, which posits that auditory stimuli automatically grab attention and attenuate/delay visual processing. (shrink)