This manuscript reports on a landmark symposium on the ethical, legal and technical challenges of xenotransplantation in the UK. King’s College London, with endorsement from the British Transplantation Society (BTS), and the European Society of Organ Transplantation (ESOT), brought together a group of experts in xenotransplantation science, ethics and law to discuss the ethical, regulatory and technical challenges surrounding translating xenotransplantation into the clinical setting. The symposium was the first of its kind in the UK for 20 years. This paper (...) summarises the content of the expert lectures showcasing the progress which has been made in xenotransplantation including—the history of xenotransplantation, advances in gene edited animals and progress towards clinical xenotransplantation. We then set out the ethical and legal issues still to be resolved. Finally, we report the themes of the roundtable discussion highlighting areas of consensus and controversy. While the detail of the legal discussion was directed towards the UK, the principles and summary reported here are intended to be applicable to any jurisdiction seeking to implement clinical xenotransplantation. (shrink)

Some practical problems in the teaching of ethics to medical students are described. The definition of the objectives of the course remains the central aspect, and is more important than the specific content. The use of student projects, buzz groups, case histories and discussion points is described. There is a need for student assessment or examination at the end of the course. The teachers require a broad background in philosophy, clinical medicine and teaching skills. The learning of the teachers may (...) be as important as that of the students. (shrink)

The purpose of this article is to investigate how cultural meanings associated with the left ventricular assist device inform acceptance and experience of this innovative technology when it is used as a destination therapy. We conducted open-ended, semistructured interviews with family caregivers and patients who had undergone LVAD-DT procedures at six U.S. hospitals. A grounded theory approach was used for the analysis. Thirty-nine patients and 42 caregivers participated. Participants described a sense of obligation to undergo the procedure because of its (...) promise for salvation. However, once the device was implanted, patients described being placed into a liminal state of being neither sick nor healthy, with no culturally scripted role. Consideration of end-of-life decisions was complicated by the uncertainties about how patients with LVADs die. Pre-implantation communications among patient, family, and clinicians should take into account the impact of the technology on meaning, identity, and patient experience. (shrink)

The hypothesis that values change and evolve is examined by this paper. The discussion is based on a series of examples where, over a period of a few decades, new ethical issues have arisen and values have changed. From this analysis it is suggested that there are a series of core values around which most people would agree. These are unlikely to change over long time periods. There are then a series of secondary or derived values around which there is (...) much more controversy and within which differences of view occur. Such changes need to be documented if we are to understand the process involved in the evolution of differences in ethical views. (shrink)

Welcome to the world of cutting-edge math, physics, and neuroscience, where the search for the ultimate vacuum, the point of nothingness, ground zero of theory, has rendered the universe deep, rich, and juicy. "Modern physics has animated the void," says K. C. Cole in her entrancing journey into the heart of Nothing. Every time scientists and mathematicians think they have reached the ultimate void, new stuff appears: a black hole, an undulating string, an additional dimension of space or time, repulsive (...) anti-gravity, universes that breed like bunnies. Cole's exploration at the edge of everything is as animated and exciting as the void itself. Take Cole's hand on this adventure into the unknown, and you'll come back informed, amused, and excited. (shrink)

I Propose to re-explore here some aspects of a very shop-worn question: ‘Was Hobbes in any sense an atheist?’ Three centuries ago, Hobbes's personal security in part depended on the way his contemporaries answered this question; today, the validity of several current accounts of his philosophy are similarly bound up with it. These accounts vary extraordinarily, all the way from Polin's confident assertion that ‘ pour qui sait lire entre les lignes, … c'est ľatheísme qui triomphe implicitement ’, to Taylor's (...) equally firm belief that ‘a certain kind of theism is necessary to make [Hobbes's] theory work.’ 1 And now the latest of the Taylorians, Prof. Howard Warrender, has published his book The Political Philosophy of Hobbes , in which Hobbes's statements regarding the place of God are again treated as an essential part of his theory; and the charge explicitly made, that there are no sound grounds for regarding them as ‘the product of confusion or pretence on Hobbes's part’. (shrink)

I am grateful for Mr Bagger's thoughtful remarks, as well as those of Professors Cousins, Smith, Katz, and Gimello at a recent American Academy of Religion panel devoted to The Problem of Pure Consciousness . But I cannot help but be struck by the tone of Mr Bagger's notice. As one colleague communicated to me after reading the piece, this is one of the most gratuitously rude pieces he had ever seen! If our book is really as bad as all (...) this, it makes one wonder why Religious Studies , or Mr Bagger, would bother to give it such attention, and whether it indicates how deeply we have touched a nerve in the contemporary debate. (shrink)

Quality of life is a difficult concept to define and to measure. An hypothesis is proposed which suggests that the quality of life measures the difference, or the gap, at a particular period of time between the hopes and expectations of the individual and that individual's present experiences. Quality of life can only be described by the individual, and must take into account many aspects of life. The approach is goal-orientated, and one of task analysis. The hypothesis is developed in (...) a diagramatic way, and several methods of testing the hypothesis suggested. (shrink)

Context: In the literature concerning the theory of social systems, interest in epistemological and ontological questions has increased in recent years. The controversies regarding a realist vs. constructivist interpretation of Luhmann’s theory, as well as the concept of many realities that correspond to many ontologies, deserve attention. Problem: The paper discusses interrelated ontological and epistemological problems in Luhmann’s systems theory, such as ontology and de-ontologization, realism vs. constructivism, contingency and its limits and one vs. many realities. Method: The paper proposes (...) an interpretation, according to which systems theory is based on an epistemology - radical operative constructivism. Results: Luhmann is not a realist. The last word belongs to radical operative constructivism, and naïve realism with reference to social systems has only a preliminary, methodological significance. However, taking a position in the dispute between realism and constructivism inevitably involves an ontological “vocabulary,” that is, usage of the reality/construction distinction. Furthermore, operative constructivism formulates the necessary conditions of the possibility of cognition, which limit the contingency of the theory and constitute one reality that is a construction of systems theory. Luhmann rejects ontology, but he does not renounce epistemology, and consequently the project of de-ontologization remains incomplete. Implications: The paper offers a new, coherent interpretation of ontological and epistemological questions in Luhmann’s theory, and also throws light on some problems of radical constructivism in general, such as the ontological implications of epistemology or the constructivist self-reference of theories. Key words: Radical operative constructivism, social systems, Luhmann, ontology, reality, contingency. (shrink)

Upshot: The commentaries concentrate mostly on ontological issues but overlook the main epistemological argument in my target article. This argument refers to the conditions that make cognition possible, and to the limits of cognition. These are important for two reasons: they have ontological consequences and they limit the theory’s contingency.

The third volume of Professor Guthrie's great history of Greek thought, entitled The Fifth-Century Enlightenment, deals in two parts with the Sophists and Socrates, the key figures in the dramatic and fundamental shift of philosophical interest from the physical universe to man. Each of these parts is now available as a paperback with the text, bibliography and indexes amended where necessary so that each part is self-contained. The Sophists assesses the contribution of individuals like Protagoras, Gorgias and Hippias to the (...) extraordinary intellectual and moral fermant in fifth-century Athens. They questioned the bases of morality, religion and organized society itself and the nature of knowledge and language; they initiated a whole series of important and continuing debates, and they provoked Socrates and Plato to a major restatement and defence of traditional values. (shrink)

Resource allocation is a central part of the decision-making process in any health care system. Resources have always been finite, thus the ethical issues raised are not new. The debate is now more open, and there is greater public awareness of the issues. It is increasingly recognised that it is the technology which determines resources. The ethical issues involved are often conflicting and relate to issues of individual rights and community benefits. One central feature of resource allocation is the basing (...) of decisions on the outcomes of health care and on their subsequent economic evaluation. The knowledge base is therefore of great importance as is the audit of results of clinical treatment. Public involvement is seen as an integral part of this process. For all parts of the process, better methodologies are required. (shrink)