Who should decide? In When Doctors Say No, philosopher and bioethicist Rubin examines this controversial issue.

Whether surrogate decisionmakers have the authority to refuse pain and symptom management measures on behalf of incapacitated patients is a particularly timely question to ask in this era of growing commitment to ensuring appropriate pain and symptom management measures for all patients.

The debate about what constitutes the discipline of ethics and who qualifies as an ethics consultant is linked unavoidably to a debate that is potentiated by the reality of a rapidly changing and high-stakes health care consultation marketplace. Who we are and what we can offer to the moral gesture that is medicine is shaped by our fundamental understanding of the place of expert knowledge in the transformation of social reality. The struggle for self-definition is particularly freighted since clinical ethics (...) consultation aspires to be more than academic contemplation. Two recent books (Ethics Consultation by John La Puma and David Schiedermayer and The Health Care Ethics Consultant: A Practical Guide, edited by Francoise Baylis) exemplify the two most popular but most widely divergent positions on these issues. We argue that while useful, neither book addresses fully the particular and distinct role of the professional ethicist. (shrink)

In this issue of American Journal of Bioethics, Childress et al. address one of the most challenging modern clinical ethical dilemmas: the awake, competent patient dependent on extracorporeal membr...

In 2015, the major critical care societies issued guidelines outlining a procedural approach to resolving intractable conflict between healthcare professionals and surrogates over life-sustaining treatments (LST). We report our experience with a resolving conflict procedure. This was a retrospective, single-centre cohort study of ethics consultations involving intractable conflict over LST. The resolving conflict process was initiated eleven times for ten patients over 2,015 ethics consultations from 2000 to 2020. In all cases, the ethics committee recommended withdrawal of the contested LST. (...) In seven cases, the patient died or was transferred or a legal injunction was obtained before completion of the process. In the four cases in which LST was withdrawn, the time from ethics consultation to withdrawal of LST was 24.8 ± 12.2 days. Healthcare provider and surrogate were often distressed during the process, sometimes resulting in escalation of conflict and legal action. In some cases, however, surrogates appeared relieved that they did not have to make the final decision regarding LST. Challenges regarding implementation included the time needed for process completion and limited usefulness in emergent situations. Although it is feasible to implement a due process approach to conflict over LST, there are factors that limit the procedure’s usefulness. (shrink)

Clinical ethics, like the broader field of bioethics from which it emerged, is at a critical crossroads in its development, with conflicting paths ahead. It can either claim its distinctive place in the clinical arena, insisting unapologetically on certain minimal standards of professional training, practice and competence, addressing head on debates about various models of and methodological approaches to consultation, and establishing a shared vision of the purpose and meaning of the enterprise of clinical ethics itself. Or, it can devolve (...) into a hobby that untrained, albeit interested, and generally well intentioned individuals can dabble in for fun or even profit, as they see fit, and without regard to the deep history and rich disciplinary roots of the field, the serious debates in the academic literature of bioethics, the foundational case histories and legal theories, or even any sense of professional accountability. (shrink)

Clinical ethics, like the broader field of bioethics from which it emerged, is at a critical crossroads in its development, with conflicting paths ahead. It can either claim its distinctive place in the clinical arena, insisting unapologetically on certain minimal standards of professional training, practice and competence, addressing head on debates about various models of and methodological approaches to consultation, and establishing a shared vision of the purpose and meaning of the enterprise of clinical ethics itself. Or, it can devolve (...) into a hobby that untrained, albeit interested, and generally well intentioned individuals can dabble in for fun or even profit, as they see fit, and without regard to the deep history and rich disciplinary roots of the field, the serious debates in the academic literature of bioethics, the foundational case histories and legal theories, or even any sense of professional accountability. (shrink)

The debate about what constitutes the discipline of ethics and who qualifies as an ethics consultant is linked unavoidably to a debate that is potentiated by the reality of a rapidly changing and high-stakes health care consultation marketplace. Who we are and what we can offer to the moral gesture that is medicine is shaped by our fundamental understanding of the place of expert knowledge in the transformation of social reality. The struggle for self-definition is particularly freighted since clinical ethics (...) consultation aspires to be more than academic contemplation. Two recent books (Ethics Consultation by John La Puma and David Schiedermayer and The Health Care Ethics Consultant: A Practical Guide, edited by Francoise Baylis) exemplify the two most popular but most widely divergent positions on these issues. We argue that while useful, neither book addresses fully the particular and distinct role of the professional ethicist. (shrink)

With “The Zadeh Scenario,” Finder offers us a gift…a rich and thoughtful first-person account of the gradual unfolding of a specific ethics consultation conducted by a specific ethics consultant in a specific context. This is not your average case report, stripped to the bare facts and devoid of the ambiguity of real-time human interactions. It’s also not simply an example of thick description, offering the reader a detailed account of the context out of which an abstract ethical dilemma has emerged, (...) with the ethics consultant describing all from a distance, above the fray. What Finder offers and models for us instead is something entirely new and different. He offers us a case narrative into which he has chosen to place himself squarely and explicitly. And in the spirit of “peer review” he has generously revealed his own inner dialogue in response to twists and turns in the case, sharing his personal reflections as events unfolded, and his musings about various actions he took and choices he made in his role. By inviting us to ponder his story about the story of the case, he generously extends a gift to us: the opportunity to reflect on his—and therefore our own—consultation practice, and the opportunity to try a new kind of peer review. (shrink)

This article argues that we could improve the design of research protocols by developing an awareness of and a responsiveness to the social contexts of all the actors in the research enterprise, including subjects, investigators, sponsors, and members of the community in which the research will be conducted. ?Social context? refers to the settings in which the actors are situated, including, but not limited to, their social, economic, political, cultural, and technological features. The utility of thinking about social contexts is (...) introduced and exemplified by the presentation of a hypothetical case in which one central issue is limitation of the probability of injury to subjects by selection of individuals who are not expected to live long enough for the known risks of the study to become manifest as harms. Benefits of such considerations may include enhanced subject satisfaction and cooperation, community acceptance, and improved data quality, among other desirable consequences. (shrink)

Describes 100 real-life ethical dilemmas faced by school administrators.

This article argues that we could improve the design of research protocols by developing an awareness of and a responsiveness to the social contexts of all the actors in the research enterprise, including subjects, investigators, sponsors, and members of the community in which the research will be conducted. “Social context” refers to the settings in which the actors are situated, including, but not limited to, their social, economic, political, cultural, and technological features. The utility of thinking about social contexts is (...) introduced and exemplified by the presentation of a hypothetical case in which one central issue is limitation of the probability of injury to subjects by selection of individuals who are not expected to live long enough for the known risks of the study to become manifest as harms. Benefits of such considerations may include enhanced subject satisfaction and cooperation, community acceptance, and improved data quality, among other desirable consequences. (shrink)

Several researchers have recently argued that p values lose their meaning in exploratory analyses due to an unknown inflation of the alpha level (e.g., Nosek & Lakens, 2014; Wagenmakers, 2016). For this argument to be tenable, the familywise error rate must be defined in relation to the number of hypotheses that are tested in the same study or article. Under this conceptualization, the familywise error rate is usually unknowable in exploratory analyses because it is usually unclear how many hypotheses have (...) been tested on a spontaneous basis and then omitted from the final research report. In the present article, I argue that it is inappropriate to conceptualize the familywise error rate in relation to the number of hypotheses that are tested. Instead, it is more appropriate to conceptualize familywise error in relation to the number of different tests that are conducted on the same null hypothesis in the same study. Under this conceptualization, alpha level adjustments in exploratory analyses are (a) less necessary and (b) objectively verifiable. As a result, p values do not lose their meaning in exploratory analyses. (shrink)

THEOREM 1. (⋄ ℵ 1 ) If B is an infinite Boolean algebra (BA), then there is B 1 such that $|\operatorname{Aut} (B_1)| \leq B_1| = \aleph_1$ and $\langle B_1, \operatorname{Aut} (B_1)\rangle \equiv \langle B, \operatorname{Aut}(B)\rangle$ . THEOREM 2. (⋄ ℵ 1 ) There is a countably compact logic stronger than first-order logic even on finite models. This partially answers a question of H. Friedman. These theorems appear in §§ 1 and 2. THEOREM 3. (a) (⋄ ℵ 1 ) If (...) B is an atomic ℵ 1 -saturated infinite BA, ψ ε L ω 1ω and $\langle B, \operatorname{Aut} (B)\rangle \models\psi$ then there is B 1 such that $|\operatorname{Aut}(B_1)| \leq |B_1| = \aleph_1$ and $\langle B_1, \operatorname{Aut}(B_1)\rangle\models\psi$ . In particular if B is 1-homogeneous so is B 1 . (b) (a) holds for B = P(ω) even if we assume only CH. (shrink)

Gelman and Loken (2013, 2014) proposed that when researchers base their statistical analyses on the idiosyncratic characteristics of a specific sample (e.g., a nonlinear transformation of a variable because it is skewed), they open up alternative analysis paths in potential replications of their study that are based on different samples (i.e., no transformation of the variable because it is not skewed). These alternative analysis paths count as additional (multiple) tests and, consequently, they increase the probability of making a Type I (...) error during hypothesis testing. The present article considers this forking paths problem and evaluates four potential solutions that might be used in psychology and other fields: (a) adjusting the prespecified alpha level, (b) preregistration, (c) sensitivity analyses, and (d) abandoning the Neyman-Pearson approach. It is concluded that although preregistration and sensitivity analyses are effective solutions to p-hacking, they are ineffective against result-neutral forking paths, such as those caused by transforming data. Conversely, although adjusting the alpha level cannot address p-hacking, it can be effective for result-neutral forking paths. Finally, abandoning the Neyman-Pearson approach represents a further solution to the forking paths problem. (shrink)

We prove that the logics of Magidor-Malitz and their generalization by Rubin are distinct even for PC classes. Let $M \models Q^nx_1 \cdots x_n \varphi(x_1 \cdots x_n)$ mean that there is an uncountable subset A of |M| such that for every $a_1, \ldots, a_n \in A, M \models \varphi\lbrack a_1, \ldots, a_n\rbrack$ . Theorem 1.1 (Shelah) $(\diamond_{\aleph_1})$ . For every n ∈ ω the class $K_{n + 1} = \{\langle A, R\rangle \mid \langle A, R\rangle \models \neg Q^{n + (...) 1} x_1 \cdots x_{n + 1} R(x_1, \ldots, x_{n + 1})\}$ is not an ℵ 0 -PC-class in the logic L n , obtained by closing first order logic under Q 1 , ..., Q n . I.e. for no countable L n -theory T, is K n + 1 the class of reducts of the models of T. Theorem 1.2 (Rubin) $(\diamond_{\aleph_1}).^3$ . Let $M \models Q^E x y\varphi(x, y)$ mean that there is $A \subseteq |M|$ such that $E_{A, \varphi} = \{\langle a, b \rangle \mid a, b \in A$ and $M \models \varphi\lbrack a, b\rbrack\}$ is an equivalence relation on A with uncountably many equivalence classes, and such that each equivalence class is uncountable. Let $K^E = \{\langle A, R\rangle\mid \langle A, R\rangle\models \neg Q^Exy R(x, y)\}$ . Then K E is not an ℵ 0 -PC-class in the logic gotten by closing first order logic under the set of quantifiers {Q n ∣ n ∈ ω} which were defined in Theorem 1.1. (shrink)

This paper analyzes Kierkegaard's Religiousness A sphere of existence, presented in his edifying works, and Heidegger's concept of authenticity, proposed in Being and Time, as responses to modern nihilism. While Kierkegaard argues that Religiousness A is an unsuccessful response to modern nihilism, Heidegger claims that authenticity, a secularized version of Religiousness A, is a successful response. We argue that Heidegger's secularization of Religiousness A is incomplete and unsuccessful, that Heidegger's later work offers a reconsideration of the problem of modern nihilism, (...) and that later Heidegger suggests a way out of nihilism which is compatible with Kierkegaard's Religiousness B sphere of existence. (shrink)

For a complete first order theory of Boolean algebras T which has nonisomorphic countable models, we determine the first limit ordinal α = α(T) such that We show that for some and for all other T‘s, A nonprincipal ideal I of B is almost principal, if a is a principal ideal of B} is a maximal ideal of B. We show that the theory of Boolean algebras with an almost principal ideal has complete extensions and characterize them by invariants similar (...) to the Tarski’s invariants. (shrink)

A Boolean algebra B that has a well-founded sublattice L which generates B is called a well-generated Boolean algebra. If in addition, L is generated by a complete set of representatives for B , then B is said to be canonically well-generated .Every WG Boolean algebra is superatomic. We construct two basic examples of superatomic non well-generated Boolean algebras. Their cardinal sequences are 1,0,1,1 and 0,0,20,1.Assuming MA , we show that every algebra with one of the cardinal sequences , α<1, (...) λ<20, or 0,20,1,1 is CWG.Assuming CH, or alternatively assuming MA , we determine which cardinal sequences admit only WG Boolean algebras.We find a necessary and sufficient condition for the canonical well-generatedness of algebras whose cardinal sequence has the form , α<1. We conclude that if such an algebra is CWG, then all of its quotients are CWG. We show that the above is not true for general Boolean algebras. We also conclude that if the cardinality of such an algebra is less than the cardinal defined below, then it is CWG. The cardinal is the least cardinality of an unbounded subset of {f f : ω → ω}.We investigate questions concerning embeddability, quotients and subalgebras of WG and CWG Boolean algebras, and construct various counter-examples. (shrink)

Let B be a superatomic Boolean algebra (BA). The rank of B (rk(B)), is defined to be the Cantor Bendixon rank of the Stone space of B. If a ∈ B - {0}, then the rank of a in B (rk(a)), is defined to be the rank of the Boolean algebra $B b \upharpoonright a \overset{\mathrm{def}}{=} \{b \in B: b \leq a\}$ . The rank of 0 B is defined to be -1. An element a ∈ B - {0} is (...) a generalized atom $(a \in \widehat{At}(B))$ , if the last nonzero cardinal in the cardinal sequence of B $\upharpoonright$ a is 1. Let a,b $\in\widehat{At}$ (B). We denote a ∼ b, if rk(a) = rk(b) = rk(a · b). A subset H $\subseteq \widehat{At}$ (B) is a complete set of representatives (CSR) for B, if for every a $\in \widehat{At}$ (B) there is a unique h ∈ H such that h ∼ a. Any CSR for B generates B. We say that B is canonically well-generated (CWG), if it has a CSR H such that the sublattice of B generated by H is well-founded. We say that B is well-generated, if it has a well-founded sublattice L such that L generates B. THEOREM 1. Let B be a Boolean algebra with cardinal sequence $\langle\aleph_0: i . If B is CWG, then every subalgebra of B is CWG. A superatomic Boolean algebra B is essentially low (ESL), if it has a countable ideal I such that rk(B/I) ≤ 1. Theorem 1 follows from Theorem 2.9, which is the main result of this work. For an ESL BA B we define a set F B of partial functions from a certain countably infinite set to ω (Definition 2.8). Theorem 2.9 says that if B is an ESL Boolean algebra, then the following are equivalent. (1) Every subalgebra of B is CWG; and (2) F B is bounded. THEOREM 2. If an ESL Boolean algebra is not CWG, then it has a subalgebra which is not well-generated. (shrink)

Assuming GCH, we prove that for every successor cardinal μ > ω1, there is a superatomic Boolean algebra B such that |B| = 2μ and |Aut B| = μ. Under ◊ω1, the same holds for μ = ω1. This answers Monk's Question 80 in [Mo].

For a complete theory of Boolean algebras T, let MT denote the class of countable models of T. For B1, B2 ∈ MT, let B1 ≤ B2 mean that B1 is elementarily embeddable in B2. Theorem 1. For every complete theory of Boolean algebras T, if T ≠ Tω, then $\langle M_T, \leq\rangle$ is well-quasi-ordered. ■ We define Tω. For a Boolean algebra B, let I(B) be the ideal of all elements of the form a + s such that $B\upharpoonright (...) a$ is an atomic Boolean algebra and $B\upharpoonright s$ is an atomless Boolean algebra. The Tarski derivative of B is defined as follows: B(0) = B and B(n + 1) = B(n)/I(B(n)). Define Tω to be the theory of all Boolean algebras such that for every n ∈ ω, B(n) ≠ {0}. By Tarski [1949], Tω is complete. Recall that $\langle A, \leq\rangle$ is a partial well-quasi-ordering, if it is a partial quasi-ordering and for every $\{a_i\mid i \in \omega\} \subseteq A$ , there are $i < j < \omega$ such that ai ≤ aj. Theorem 2. $\langle M_{T_\omega}, \leq\rangle$ contains a subset M such that the partial orderings $\langle M, \leq \upharpoonright M \rangle$ and $\langle\mathscr{P}(\omega), \subseteq\rangle$ are isomorphic. ■ Let M'0 denote the class of all countable Boolean algebras. For B1, B2 ∈ M'0, let B1 ≤' B2 mean that B1 is embeddable in B2. Remark. $\langle M'_0, \leq'\rangle$ is well-quasi-ordered. ■ This follows from Laver's theorem [1971] that the class of countable linear orderings with the embeddability relation is well-quasi-ordered and the fact that every countable Boolean algebra is isomorphic to a Boolean algebra of a linear ordering. (shrink)

This book brings together essays on themes of human rights and legal history, reflecting the long and distinguished career of Brian Simpson as an academic writer and a human rights activist. The collection opens with a biography of Simpson's academic life, noting his major contribution to legal thought, and closes with an account of his career in the United States.

While the HVTN 505 trial showed no overall efficacy of the tested vaccine to prevent HIV infection over placebo, markers measuring immune response to vaccination were strongly correlated with infection. This finding generated the hypothesis that some marker-defined vaccinated subgroups were partially protected whereas others had their risk increased. This hypothesis can be assessed using the principal stratification framework (Frangakis and Rubin, 2002) for studying treatment effect modification by an intermediate response variable, using methods in the sub-field of principal (...) surrogate (PS) analysis that studies multiple principal strata. Unfortunately, available methods for PS analysis require an augmented study design not available in HVTN 505, and make untestable structural risk assumptions, motivating a need for more robust PS methods. Fortunately, another sub-field of principal stratification, survivor average causal effect (SACE) analysis (Rubin, 2006) – which studies effects in a single principal stratum – provides many methods not requiring an augmented design and making fewer assumptions. We show how, for a binary intermediate response variable, methods developed for SACE analysis can be adapted to PS analysis, providing new and more robust PS methods. Application to HVTN 505 supports that the vaccine partially protected individuals with vaccine-induced T-cells expressing certain combinations of functions. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Bioethics Commissions: Town Meetings with a “Blue, Blue Ribbon”Susan Cartier Poland (bio)Town meetings are characteristic of New England. In theory, a quorum of registered voters in a small municipality meets annually to decide local public policy. In fact, special interests and the town bureaucracy control the meeting.Like a town meeting, a commission (or committee or council) comes into being, whether on an ad hoc or permanent basis, to direct (...) a government function. Bioethics commissions specialize in one area: the intersection of public policy with developments, either real or anticipated, in the basic and applied sciences.That specialization of commissions carries over into the selection of the members. More often than not commission members are appointed on the basis of expertise in a specific area. Although some commissions are still made up entirely of one kind of expert, usually medical, the majority of these government bodies seek breadth between the fields of law, religion, ethics, and science (including medicine and the social sciences).In the words of Mrs. Rigenbach, the law clerk to Chief Judge Carl B. Rubin of the United States District Court for the Southern District of Ohio, selection of persons “knowledgeable in the field” constitutes a “blue, blue ribbon” jury. In contrast, a “blue ribbon” jury is composed of those persons having “the greatest amount of formal education” (In re Richardson-Merrill, Inc. (Bendectin litigation), 624 Federal Supplement 1212 at 1217 (1985)). The problem with persons knowledgeable in the field is that their minds may have already been made up. For a jury, this is a disaster; for a bioethics commission, this directs and shapes the research, investigation, and discussion, or, in short, it makes for more efficient decision making.For this Scope Note, the definition of commission begins with the Bioethicsline description of its index term “advisory committees” as committees or commissions set up to advise government bodies on public policy. Furthermore, a commission [End Page 91] (or committee) receives government funding and support in exchange for its expertise in research, investigation, reporting, and recommendations.Six functions served by bioethics commissions have been clearly and succinctly described by LeRoy Walters (Commissions and Bioethics. Journal of Medicine and Philosophy 14 (4): 363–68, August 1989). The functions are: (1) to legitimize action; (2) to delay action or resolution; (3) to identify duplication; (4) to be representative; (5) to do research and find facts; and (6) to provide education and support (pp. 364–65). Since 1989, however, another government function has moved to the forefront. Instead of remaining within the legislative arena, government commissions serve the judiciary as well, in cases involving complex and technical questions. The now defunct Law Reform Commission of Canada recognized this use when it included in its annual reports a section on its “Influence on Law Reform through Judicial Decisions.”In mid-1997, the United States Supreme Court in its consolidated cases on assisted suicide used extensively the writings from a state commission, the New York State Task Force on Life and the Law, to support its rationale. Not only did the Court make use of the Task Force’s work, but in so doing the Court extended the efforts of the commission beyond its jurisdiction of New York into another jurisdiction on the opposite coast, Washington state. Furthermore, although the commission was chartered by one state, through the federal court system, its influence became national.Outside the U.S., the United Nations recently adopted its first bioethics text on the ethics of genetic research, and Canada is reworking its human research guidelines into a single set of guidelines that will apply to research in both the natural sciences and the social sciences.This Scope Note attempts to compile for the researcher and the reference librarian those commissions, existing and defunct, that have addressed bioethics issues. Only one other such attempt is known to the author, an Office of Technology Assessment [OTA] Background Paper, Biomedical Ethics in U.S. Public Policy (1993). Due to space limitations, not all publications could be listed; the selections included represent the range of topics from a particular group or the more frequently cited sources. Future updates of this compilation are planned, so please notify the... (shrink)

The concept of the gene has been the central organizing theme of 20th century biology. Biology has become increasingly influential both for philosophers seeking a naturalized basis for epistemology, ethics, and the understanding of the mind, as well as for the human sciences generally. The central task of this work is to get the story right about genes and in so doing provide a critical and enabling resourse for use in the further pursuit of human self-understanding. ;The work begins with (...) a wide-ranging historical reconstruction and conceptual analysis of the meaning of "the gene" that results in defining and distinguishing two different "genes". Each of these can be seen as an heir to one of the two major historical trends in explaining the source of biological order---preformationism and epigenesis. The preformationist gene predicts phenotypes but only on an instrumental basis where immediate medical and/or economic benefits can be had. The gene of epigenesis , by contrast, is a developmental resource that provides templates for RNA and protein synthesis but has in itself no determinate relationship to organismal phenotypes. The seemingly prevalent idea that genes constitute information for traits is based, I argue, upon an unwarranted conflation of these two senses which is in effect held together by rhetorical glue. Beyond this historical, conceptual, and rhetorical inquiry the bulk of the dissertation then concerns itself with an empirically up-to-date analysis of the cell and molecular basis of biological order and of the pathological loss of same. In each of these chapters I structure my analysis with the idea in mind that the "conflated" view can be held empirically accountable. Major touchpoints in this work include the ideas of I. Kant, J. Blumenbach, K. E. von Baer, J. Muller, R. Virchow, W. Johannsen, R. Falk, J. Sapp, E. Schrodinger, M. Delbruick, G. Gamow, R. Doyle, L. Kay, S. Kauffman, E. Jablonka, J. Rothman, K. Yamamoto, P. Rous, H. Temin, J. M. Bishop, H. Harris, E. Stanbridge, D. L. Smithers, B. Vogelstein, E. Farber and H. Rubin. (shrink)

Summary The present article is a partly ontological, partly Gestalt-psychological discussion of the thinkability of structures in which parts and whole are interdependent (MI). In the first section, I show that in the framework of E. Husserl’s formal part–whole ontology, the conceptualization of such an interdependence leads to (mereo)logical problems. The second section turns to and affirms the experience of this interplay between parts and whole, exemplified with B. Pinna’s recent research on meaningful Gestalt perception. In the final section, I (...) take the experienceability of MI as a justification to suggest a way of rethinking it. This entails an implementation of the process of foregrounding and backgrounding displayed by reversible figures and originally described by E. Rubin. This can avoid both an identity relation between parts and whole and their mutual exclusion as well as hierarchization due to their apparent differences. It would also guarantee the inherent dynamics of interdependence. (shrink)

"The definitive work by B.K.S. Iyengar, the world's most respected yoga teacher. B.K.S. Iyengar has devoted his life to the practice and study of yoga. It was B.K.S. Iyengar's unique teaching style, bringing precision and clarity to the practice, as well as a mindset of 'yoga for all', which has made it into the worldwide phenomenon it is today. 'Light on Yoga' is widely called 'the bible of yoga' and has served as the source book for generations of yoga students (...) around the world. It is the classic text for all serious students of yoga." --Publisher description. (shrink)