6 - Human Cockfighting in the Squared Circle -- 7 - Perfect Praxis in Aikido -- Section III - Reflexivity, Self, and Other -- 8 - Tension, Reflection, and Agency in the Life of a Hausa Grain Trader -- 9 - Reflexivity in Intersubjective and Intercultural Borderlinking -- Section IV - Reflexivity, Democracy, and Government -- 10 - The Latent Effects of the Distribution of Political Reflexivity in Contemporary Democracies -- Postscript - Reflexivity and Social Science -- Index.

I argue here that in the end Bourdieu's theory of practice fails to overcome the problem on which it expressly centers, namely, subject-object dualism. The failure is registered in his avowed materialism, which, though significantly "generalized," remains what it says: a materialism. In order to substantiate my criticism, I examine for their ontological presuppositions three areas of his theoretical framework pertaining to the questions of (1) human agency (as seen through the conceptual glass of the habitus), (2) otherness, and (3) (...) the gift. By scrutinizing Bourdieu's powerful and progressive social theory, with an eye to finding fault, I hope to show the need to take a certain theoretical action, one that is patently out of keeping with the usual self-presentation and self-understanding of social science. The action I have in mind is this: because the problem of subject-object dualism is in the first place a matter of ontology, in order successfully to address it there must take place a direct shift of ontological starting point, from the received starting point in Western thought to one that projects reality in terms of ambiguity that is basic. With this shift the dualism of subject and object dissolves by definition, leaving a social reality that, for reasons of its basic ambiguity, is best approached as a question of ethics before power. (shrink)

Nondualism, ontology, and anthropology -- Anthropology and the synthetic a priori: Wittgenstein and Merleau-Ponty -- Blind faith and the binding of Isaac: the Akedah -- Excursus I: sacrifice as human existence -- Counter-sacrifice and instrumental reason: the Holocaust -- Bourdieu's anti-dualism and "generalized materialism" -- Habermas's anti-dualism and "communicative rationality" -- Technological efficacy, mythic rationality, and non-contradiction -- Epistemic efficacy, mythic rationality, and non-contradiction -- Contradiction and choice among the Dinka and in Genesis -- Contradiction in Azande oracular practice and (...) in psychotherapeutic interaction -- Epistemic and ethical gain -- Transcending dualism and amplifying choice -- Excursus II: what good, ethics? -- Anthropology and the generative primacy of moral order -- Conclusion: Emancipatory selfhood and value-rationality. (shrink)

[T. M. Scanlon] It is clearly impermissible to kill one person because his organs can be used to save five others who are in need of transplants. It has seemed to many that the explanation for this lies in the fact that in such cases we would be intending the death of the person whom we killed, or failed to save. What makes these actions impermissible, however, is not the agent's intention but rather the fact that the benefit envisaged does (...) not justify an exception to the prohibition against killing or the requirement to give aid. The difference between this explanation and one appealing to intention is easily overlooked if one fails to distinguish between the prospective use of a moral principle to guide action and its retrospective use to appraise the way an agent governed him or herself. Even if this explanation is accepted, however, it remains an open question whether and how an agent's intention may be relevant to the permissibility of actions in other cases. \\\ [Jonathan Dancy] My first four sections concentrate on the second section of Professor Scanlon's contribution, where he lays out his conception of moral principles and of the role they play in theory and practice. I will raise questions on the following issues: 1. Scanlon's initial introduction of the notion of a principle. 2. His rejection of the standard view that principles are concerned with the forbidding, permitting and requiring of actions. 3. His rejection of pro tanto conceptions of principles in favour of a conception of them as conclusive. 4. The resulting account of what it is for a principle to face and survive exceptions. Scanlon's discussion of these matters here both appeals to and is in some respects more detailed than the relevant section of his recent What We Owe to Each Other. The topic is interesting both for the role played by principles in Scanlon's present discussion of intention and permissibility, and more generally because of his account of wrongness: an act is wrong iff it is ruled out by principles that nobody could reasonably reject. The remainder of my contribution is concerned with the ostensible focus of IP, namely the relevance of agent-intentions to the permissibility of what is done. (shrink)

[T. M. Scanlon] It is clearly impermissible to kill one person because his organs can be used to save five others who are in need of transplants. It has seemed to many that the explanation for this lies in the fact that in such cases we would be intending the death of the person whom we killed, or failed to save. What makes these actions impermissible, however, is not the agent's intention but rather the fact that the benefit envisaged does (...) not justify an exception to the prohibition against killing or the requirement to give aid. The difference between this explanation and one appealing to intention is easily overlooked if one fails to distinguish between the prospective use of a moral principle to guide action and its retrospective use to appraise the way an agent governed him or herself. Even if this explanation is accepted, however, it remains an open question whether and how an agent's intention may be relevant to the permissibility of actions in other cases. \\\ [Jonathan Dancy] My first four sections concentrate on the second section of Professor Scanlon's contribution, where he lays out his conception of moral principles and of the role they play in theory and practice. I will raise questions on the following issues: 1. Scanlon's initial introduction of the notion of a principle. 2. His rejection of the standard view that principles are concerned with the forbidding, permitting and requiring of actions. 3. His rejection of pro tanto conceptions of principles in favour of a conception of them as conclusive. 4. The resulting account of what it is for a principle to face and survive exceptions. Scanlon's discussion of these matters here both appeals to and is in some respects more detailed than the relevant section of his recent What We Owe to Each Other. The topic is interesting both for the role played by principles in Scanlon's present discussion of intention and permissibility, and more generally because of his account of wrongness: an act is wrong iff it is ruled out by principles that nobody could reasonably reject. The remainder of my contribution is concerned with the ostensible focus of IP, namely the relevance of agent-intentions to the permissibility of what is done. (shrink)

It is clearly impermissible to kill one person because his organs can be used to save five others who are in need of transplants. It has seemed to many that the explanation for this lies in the fact that in such cases we would be intending the death of the person whom we killed, or failed to save. What makes these actions impermissible, however, is not the agent's intention but rather the fact that the benefit envisaged does not justify an (...) exception to the prohibition against killing or the requirement to give aid. The difference between this explanation and one appealing to intention is easily overlooked if one fails to distinguish between the prospective use of a moral principle to guide action and its retrospective use to appraise the way an agent governed him or herself. Even if this explanation is accepted, however, it remains an open question whether and how an agent's intention may be relevant to the permissibility of actions in other cases. \\\ [Jonathan Dancy] My first four sections concentrate on the second section of Professor Scanlon's contribution, where he lays out his conception of moral principles and of the role they play in theory and practice. I will raise questions on the following issues: 1. Scanlon's initial introduction of the notion of a principle. 2. His rejection of the standard view that principles are concerned with the forbidding, permitting and requiring of actions. 3. His rejection of pro tanto conceptions of principles in favour of a conception of them as conclusive. 4. The resulting account of what it is for a principle to face and survive exceptions. Scanlon's discussion of these matters here both appeals to and is in some respects more detailed than the relevant section of his recent What We Owe to Each Other. The topic is interesting both for the role played by principles in Scanlon's present discussion of intention and permissibility, and more generally because of his account of wrongness: an act is wrong iff it is ruled out by principles that nobody could reasonably reject. The remainder of my contribution is concerned with the ostensible focus of IP, namely the relevance of agent-intentions to the permissibility of what is done. (shrink)

In a well known British case, the relatives of a dead man consented to the use of his organs for transplant on the condition that they were transplanted only into white people. The British government condemned the acceptance of racist offers and the panel they set up to report on the case condemned all conditional offers of donation. The panel appealed to a principle of altruism and meeting the greatest need. This paper criticises their reasoning. The panel’s argument does not (...) show that conditional donation is always wrong and anyway overlooks a crucial distinction between making an offer and accepting it. But even the most charitable reinterpretation of the panel’s argument does not reject selective acceptance of conditional offers. The panel’s reasoning has no merit. (shrink)

ABSTRACT This paper considers what should be done about offers of organs for transplant that come with racist strings attached. Saving lives or improving their quality seem powerful reasons to accept the offer. Fairness, justice, and rejecting racism seem like powerful reasons against. This paper argues that conditional allocation should occur when it would provide access to organs for at least one person without costing others their access to organs. The bulk of the paper concentrates on defending this claim against (...) these objections: (i) that the good that might come about through conditional allocation does so through wrongful complicity in the racist's wrongdoing; (ii) that conditional allocation symbolizes support for racism; and (iii) that conditional allocation is unjust or unfair and is, for that reason, impermissible. The final section, on conditional allocation as a policy, considers the speculative possibility that conditional allocation would reduce access to organs for some, but it argues that, even then, conditional allocation could be justified. (shrink)

There are many ways of enhancing human performance. For military aviation in general, and for spaceflight in particular, the most important tools are selection, training, equipment, pharmacology, and surgery. In the future, genetic manipulation may be feasible. For each of these tools, the specific modalities available range from the ethically acceptable to the ethically unacceptable. Even when someone consents to a particular procedure to enhance performance, the action may be ethically unacceptable to society as a whole and the burden of (...) risk for the individual may be too great. In addition, there are several characteristics that define the quality and the acceptability of the consent. Each method of enhancing performance will be examined in the context of the principles of medical ethics in a western society: autonomy, non-maleficence, beneficence, and justice. The aim is to draw the attention of aeromedical practitioners to the complexities of ethical dilemmas such as this particular one in order to help them to develop a morally justifiable code of practice that balances society’s needs against individual ambitions and corporate goals. (shrink)

H.B. Acton, professor successively in South Wales, London, and Edinburgh, died in June 1974 when he was just sixty-six. His loss is deeply lamented by his friends, not least by students of Hegel; and they extend their profound sympathy to his widow. He was much interested in political, economic and social questions, and his publications on these matters are expressive of a humane and liberal outlook. His remarkable short book on Kant’s moral philosophy shed fresh light on a well-worn topic, (...) and his posthumously printed Comte lecture on The Idea of A Spiritual Power must have many readers wish that he could have seen his idea translated into reality. It is sad that his notes for a book on Hegel in Perspective did not reach a stage at which they could be worked up for publication, but his long preface to a translation of Hegel’s essay on Natural Law is to appear in 1975 from the University of Pennsylvania Press. Not even the shortest notice could exclude mention of his effectiveness as a teacher, his untiring devotion to his students, or the respect and admiration which in them and others he inspired. (shrink)

Cultural competence, a clinical skill to recognise patients' cultural and religious beliefs, is an integral element in patient‐centred medical practice. In the area of death and dying, physicians' understanding of patients' and families' values is essential for the delivery of culturally appropriate care. Dementia is a neurodegenerative condition marked by the decline of cognitive functions. When the condition progresses and deteriorates, patients with advanced dementia often have eating and swallowing problems and are at high risk of developing malnutrition. Enteral tube (...) feeding is a conventional means of providing artificial nutrition and hydration to meet nutritional needs, but its benefits to the frail population are limitedly shown in the clinical evidence. Forgoing tube feeding is ethically challenging when patients are mentally incompetent and in the absence of an advance directive. Unlike some developed countries, like the United States of America, death and dying is a sensitive issue or even a taboo in some cultures in developing countries that forgoing enteral tube feeding is clinically and ethically challenging, such as China and Malaysia. This article in three parts 1) discusses the clinical and ethical issues related to forgoing tube feeding among patients with advanced dementia, 2) describes how Hong Kong Chinese, North American, and Malaysian Islamic cultures respond differently in the decision‐making patterns of forgoing tube feeding for patients with advanced dementia, and 3) reiterates the clinical implications of cultural competence in end‐of‐life care. (shrink)

To localize wheat ESTs on chromosomes, 882 homoeologous group 6-specific ESTs were identified by physically mapping 7965 singletons from 37 cDNA libraries on 146 chromosome, arm, and sub-arm aneuploid and deletion stocks. The 882 ESTs were physically mapped to 25 regions flanked by 23 deletion breakpoints. Of the 5154 restriction fragments detected by 882 ESTs, 2043 were localized to group 6 chromosomes and 806 were mapped on other chromosome groups. The number of loci mapped was greatest on chromosome 6B and (...) least on 6D. The 264 ESTs that detected orthologous loci on all three homoeologs using one restriction enzyme were used to construct a consensus physical map. The physical distribution of ESTs was uneven on chromosomes with a tendency toward higher densities in the distal halves of chromosome arms. About 43% of the wheat group 6 ESTs identified rice homologs upon comparisons of genome sequences. Fifty-eight percent of these ESTs were present on rice chromosome 2 and the remaining were on other rice chromosomes. Even within the group 6 bins, rice chromosomal blocks identified by 1-6 wheat ESTs were homologous to up to 11 rice chromosomes. These rice-block contigs were used to resolve the order of wheat ESTs within each bin. (shrink)

Competency to be executed evaluations are conducted with a clear understanding that no physician-patient relationship exists. Treatment however, is not so neatly re-categorized in large measure because it involves the physician's active provision of the healing arts. A natural tension exists between what practices may be legally permissible and what are ethically acceptable. We present an overview of the existing positions on this matter in the process of framing our argument.

The history of physician involvement in capital proceedings is longstanding and ripe with controversy and conflicts of ethical concerns. Previously one of us has written that the controversy is more appropriately characterized as a conflict of moral position rather than one of ethical dilemma.In hindsight, we believe that analysis, while true, does not capture the depth or complexity of the issue.Forensic psychiatric evaluations, including competency to be executed evaluations, are done with a clear understanding that no physician-patient relationship exists. Treatment, (...) however, is not so neatly re-categorized in large measure because it involves the physician’s active provision of the healing arts. (shrink)

Early versions of satellite and radiosonde datasets suggested that the tropical surface had warmed more than the troposphere, while climate models consistently showed tropospheric amplification of surface warming in response to human-caused increases in greenhouse gases. We revisit such comparisons here using new observational estimates of surface and tropospheric temperature changes. We find that there is no longer a serious discrepancy between modeled and observed trends in the tropics. Our results contradict a recent claim that all simulated temperature trends in (...) the tropical troposphere are inconsistent with observations. This claim was based on the use of older radiosonde and satellite datasets and on two methodological errors: the neglect of observational trend uncertainties introduced by interannual climate variability and application of an inappropriate statistical “consistency test”.This emerging reconciliation of models and observations has two primary explanations. First, because of changes in the treatment of buoy and satellite information, new surface temperature datasets yield slightly reduced tropical warming relative to earlier versions. Second, recently developed satellite and radiosonde datasets now show larger warming of the tropical lower troposphere. In the case of a new satellite dataset from remote sensing systems, enhancedRSS warming is due to an improved procedure of adjusting for inter-satellite biases. When the RSS-derived tropospheric temperature trend is compared with four different observed estimates of surface temperature change, the surface warming is invariably amplified in the tropical troposphere, consistent with model results. Even if we use data from a second satellite dataset with smaller tropospheric warming than in remote sensing systems RSS, observed tropical lapse rates are not significantly different from those in all model simulations.Our results contradict a recent claim that all simulated temperature trends in the tropical troposphere and in tropical lapse rates are inconsistent with observations. This claim was based on the use of older radiosonde and satellite datasets and on two methodological errors: the neglect of observational trend uncertainties introduced by interannual climate variability and application of an inappropriate statistical “consistency test”. (shrink)

This powerful, original, and tendentious book was written in 1940, published in Russia in 1965, and is now available in English. It suffers from many shortcomings--repetitiousness, oversimplification, the exclusion of material which fails to fit the author's thesis. It also inevitably reflects ignorance of scholarship since the thirties, which has tended to deny Rabelais' alleged agnosticism and nudged him closer to orthodoxy. But it represents nonetheless an important advance in the understanding of Rabelais' book, and defends provocatively an unfashionable theory (...) of the Renaissance. Bakhtin lays heaviest stress on his author's freedom to play with authorized symbols and solemn institutions in the spirit of the carnival, a spirit deriving from folk humor. The common folk of town and country delighted in improprieties, turned all serious values and structures upside down, dwelt subversively and coarsely on the "bodily lower stratum." Just as food enters the body and is eliminated, so all authorized solemnity enters Pantagruel and is turned into fun. This peasant laughter remains unafraid before age and death because it recognizes the simultaneous destruction and creation in all experience. The medieval hierarchical conception of the universe is replaced in Rabelais and in the entire Renaissance by a new horizontal perspective upon the individual in history. This new perspective fastens particularly upon the body and renders it good-humoredly grotesque. Bakhtin seriously underestimates the breadth of both Renaissance religious feeling and neo-Platonic speculation as well as the strength of medieval survivals. But specific readings of Rabelais' text are genuinely enlightening even when they distort or simplify his meaning.--T. M. G. (shrink)

Objectives To conduct an independent evaluation of the first phase of the Health Foundation’s Safer Patients Initiative (SPI), and to identify the net additional effect of SPI and any differences in changes in participating and non-participating NHS hospitals. Design Mixed method evaluation involving five substudies, before and after design. Setting NHS hospitals in the United Kingdom. Participants Four hospitals (one in each country in the UK) participating in the first phase of the SPI (SPI1); 18 control hospitals. Intervention The SPI1 (...) was a compound (multi-component) organisational intervention delivered over 18 months that focused on improving the reliability of specific frontline care processes in designated clinical specialties and promoting organisational and cultural change. Results Senior staff members were knowledgeable and enthusiastic about SPI1. There was a small (0.08 points on a 5 point scale) but significant (P<0.01) effect in favour of the SPI1 hospitals in one of 11 dimensions of the staff questionnaire (organisational climate). Qualitative evidence showed only modest penetration of SPI1 at medical ward level. Although SPI1 was designed to engage staff from the bottom up, it did not usually feel like this to those working on the wards, and questions about legitimacy of some aspects of SPI1 were raised. Of the five components to identify patients at risk of deterioration—monitoring of vital signs (14 items); routine tests (three items); evidence based standards specific to certain diseases (three items); prescribing errors (multiple items from the British National Formulary); and medical history taking (11 items)—there was little net difference between control and SPI1 hospitals, except in relation to quality of monitoring of acute medical patients, which improved on average over time across all hospitals. Recording of respiratory rate increased to a greater degree in SPI1 than in control hospitals; in the second six hours after admission recording increased from 40% (93) to 69% (165) in control hospitals and from 37% (141) to 78% (296) in SPI1 hospitals (odds ratio for “difference in difference” 2.1, 99% confidence interval 1.0 to 4.3; P=0.008). Use of a formal scoring system for patients with pneumonia also increased over time (from 2% (102) to 23% (111) in control hospitals and from 2% (170) to 9% (189) in SPI1 hospitals), which favoured controls and was not significant (0.3, 0.02 to 3.4; P=0.173). There were no improvements in the proportion of prescription errors and no effects that could be attributed to SPI1 in non-targeted generic areas (such as enhanced safety culture). On some measures, the lack of effect could be because compliance was already high at baseline (such as use of steroids in over 85% of cases where indicated), but even when there was more room for improvement (such as in quality of medical history taking), there was no significant additional net effect of SPI1. There were no changes over time or between control and SPI1 hospitals in errors or rates of adverse events in patients in medical wards. Mortality increased from 11% (27) to 16% (39) among controls and decreased from 17% (63) to 13% (49) among SPI1 hospitals, but the risk adjusted difference was not significant (0.5, 0.2 to 1.4; P=0.085). Poor care was a contributing factor in four of the 178 deaths identified by review of case notes. The survey of patients showed no significant differences apart from an increase in perception of cleanliness in favour of SPI1 hospitals. Conclusions The introduction of SPI1 was associated with improvements in one of the types of clinical process studied (monitoring of vital signs) and one measure of staff perceptions of organisational climate. There was no additional effect of SPI1 on other targeted issues nor on other measures of generic organisational strengthening. (shrink)

Transoral laser microsurgery applies to the piecemeal removal of malignant tumours of the upper aerodigestive tract using the CO2 laser under the operating microscope. This method of surgery is being increasingly popularised as a single modality treatment of choice in early laryngeal cancers (T1 and T2) and occasionally in the more advanced forms of the disease (T3 and T4), predomi- nantly within the supraglottis. Thomas Kuhn, the American physicist turned philosopher and historian of science, coined the phrase ‘paradigm shift’ in (...) his groundbreaking book The Structure of Scientific Revolutions. He argued that the arrival of the new and often incompatible idea forms the core of a new paradigm, the birth of an entirely new way of thinking. This article discusses whether Steiner and col- leagues truly brought about a paradigm shift in oncological surgery. By rejecting the principle of en block resection and by replacing it with the belief that not only is it oncologically safe to cut through the substance of the tumour but in doing so one can actually achieve better results, Steiner was able to truly revolutionise the man- agement of laryngeal cancer. Even though within this article the repercussions of his insight are limited to the upper aerodigestive tract oncological surgery, his willingness to question other peoples’ dogma makes his contribution truly a genuine paradigm shift. (shrink)

‘Actus non facit reum nisi mens sit rea.’ But when is a mens rea? In the last twenty years discussions of this question have been stimulated by controversial decisions in the English House of Lords in the cases of Smith, Morgan and Majewski.The case of Smith decided that a man might be guilty of murder if a reasonable person, knowing the circumstances, would have foreseen that death would result even if the agent himself did not so foresee. This appeal to (...) the ‘reasonable person’ imports what is known as the ‘objective test’ as opposed to the ‘subjective test’ of the agent's actual foresight or knowledge. The case of Morgan inclined per contra to the subjective test. (shrink)

‘Actus non facit reum nisi mens sit rea.’ But when is a mens rea? In the last twenty years discussions of this question have been stimulated by controversial decisions in the English House of Lords in the cases of Smith, Morgan and Majewski.The case of Smith decided that a man might be guilty of murder if a reasonable person, knowing the circumstances, would have foreseen that death would result even if the agent himself did not so foresee. This appeal to (...) the ‘reasonable person’ imports what is known as the ‘objective test’ as opposed to the ‘subjective test’ of the agent's actual foresight or knowledge. The case of Morgan inclined per contra to the subjective test. (shrink)

Biological evolution provides a creative fount of complex and subtle adaptations, often surprising the scientists who discover them. However, because evolution is an algorithmic process that transcends the substrate in which it occurs, evolution’s creativity is not limited to nature. Indeed, many researchers in the field of digital evolution have observed their evolving algorithms and organisms subverting their intentions, exposing unrecognized bugs in their code, producing unexpected adaptations, or exhibiting outcomes uncannily convergent with ones in nature. Such stories routinely reveal (...) creativity by evolution in these digital worlds, but they rarely fit into the standard scientific narrative. Instead they are often treated as mere obstacles to be overcome, rather than results that warrant study in their own right. The stories themselves are traded among researchers through oral tradition, but that mode of information transmission is inefficient and prone to error and outright loss. Moreover, the fact that these stories tend to be shared only among practitioners means that many natural scientists do not realize how interesting and lifelike digital organisms are and how natural their evolution can be. To our knowledge, no collection of such anecdotes has been published before. This paper is the crowd-sourced product of researchers in the fields of artificial life and evolutionary computation who have provided first-hand accounts of such cases. It thus serves as a written, fact-checked collection of scientifically important and even entertaining stories. In doing so we also present here substantial evidence that the existence and importance of evolutionary surprises extends beyond the natural world, and may indeed be a universal property of all complex evolving systems. (shrink)

According to the prevailing paradigm in social-cognitive neuroscience, the mental states of individuals become shared when they adapt to each other in the pursuit of a shared goal. We challenge this view by proposing an alternative approach to the cognitive foundations of social interactions. The central claim of this paper is that social cognition concerns the graded and dynamic process of alignment of individual minds, even in the absence of a shared goal. When individuals reciprocally exchange information about each other's (...) minds processes of alignment unfold over time and across space, creating a social interaction. Not all cases of joint action involve such reciprocal exchange of information. To understand the nature of social interactions, then, we propose that attention should be focused on the manner in which people align words and thoughts, bodily postures and movements, in order to take one another into account and to make full use of socially relevant information. (shrink)

Mental timing studies may be influenced by powerful cognitive illusions that can produce an asymmetry in their rate of progress relative to neuronal timing studies. Both types of timing research are also governed by a temporal asymmetry, expressed by the fact that the direction of causation must follow time's arrow. Here we refresh our earlier suggestion that the temporal asymmetry offers promise as a means of timing mental activities. We update our earlier analysis of Libet's data within this framework. Then (...) we consider the surprises which often occur on those rare occasions when neural timing experiments parallel mental timing work exactly. Together, these surprises and asymmetries prescribe a relentlessly meticulous and fully transparent exposition of timing methods, terms, and concepts which shuns plausible narratives, even when buttressed by rigorous formal models, unless guided by apposite empirical evidence. (shrink)

Competent patients have considerable legal authority to control life‐and‐death care. They may refuse medical life support, including medically delivered food and fluids. Even when they are not in need of any life‐saving care, they may expedite death by refusing food and water by mouth—voluntarily stopping eating and drinking, or VSED. Neither right is limited to terminal illness. In addition, in four U.S. states, competent patients, if terminally ill, may obtain lethal drugs for aid‐in‐dying.For people who have dementia and are no (...) longer competent, however, control over the end of life is much less extensive. They may have written a clear advance directive for refusing life‐saving care in specified circumstances yet subsequently find themselves living for years in severe dementia with no need for life‐saving care that could be refused. Chronic progressive dementia is not itself life threatening until its very final stage. Even in jurisdictions that permit active aid‐in‐dying, individuals with advanced dementia are not eligible; they lack the required current competence, and they are seldom deemed terminally ill. As for the right to VSED, its very name—voluntarily stopping eating and drinking—is seen as excluding noncompetent persons.One option for ensuring that one does not live years in severe dementia is to use advance directives to withhold food and water by mouth. The driving element behind VSED is that forcing people to ingest food is as objectionable an intrusion on bodily integrity, privacy, and liberty as imposing unwanted medical treatment. Thus, if incompetent people do not lose their rights to refuse life‐saving treatment, and if people when competent have just as strong a right to VSED as they do to refuse life‐saving treatment, then people do not lose their right to VSED when incompetent either. They only have to exercise it by AD. (shrink)

We provide the results of a systematic key-informant review of medical humanities curricula at fourteen of Canada’s seventeen medical schools. This survey was the first of its kind. We found a wide diversity of views among medical educators as to what constitutes the medical humanities, and a lack of consensus on how best to train medical students in the field. In fact, it is not clear that consensus has been attempted – or is even desirable – given that Canadian medical (...) humanities programs are largely shaped by individual educators’ interests, experience and passions. This anarchic approach to teaching the medical humanities contrasts sharply with teaching in the clinical sciences where national accreditation processes attempt to ensure that doctors graduating from different schools have roughly the same knowledge (or at least have passed the same exams). We argue that medical humanities are marginalized in Canadian curricula because they are considered to be at odds philosophically with the current dominant culture of evidence-based medicine (EBM). In such a culture where adhering to a consensual standard is a measure of worth, the medical humanities – which defy easy metrical appraisal – are vulnerable. We close with a plea for medical education to become more comfortable in the borderlands between EBM and humanities approaches. (shrink)

This study examines the cross‐cultural generality of Hering's (1878/1964) color‐opponent theory of color appearance. English‐speaking and Somali‐speaking observers performed variants of two paradigms classically used to study color‐opponency. First, both groups identified similar red, green, blue, and yellow unique hues. Second, 25 English‐speaking and 34 Somali‐speaking observers decomposed the colors present in 135 Munsell color samples into their component Hering elemental sensations—red,green,blue, yellow, white, and black—or else responded “no term.” Both groups responded no term for many samples, notably purples. Somali (...) terms for yellow were often used to name colors all around the color circle, including colors that are bluish according to Hering's theory. Four Somali Grue speakers named both green and blue elicitation samples by their term for green. However, that term did not name the union of all samples called blue or green by English speakers. A similar pattern was found among three Somali Achromatic speakers, who called the blue elicitation sample black or white. Thus, color decomposition by these Somali‐speaking observers suggests a lexically influenced re‐dimensionalization of color appearance space, rather than a simple reduction of the one proposed by Hering. Even some Somali Green‐Blue speakers, whose data were otherwise similar to English, showed similar trends in yellow and blue usage. World Color Survey data mirror these results. These within‐ and cross‐cultural violations of Hering's theory do not challenge the long‐standing view that universal sensory processes mediate color appearance. However, they do demonstrate an important contribution of language in the human understanding of color. (shrink)

For economists, sustainability and environmental valuation are connected in two ways. At the micro level, proper environmental valuation is required if projects are to be approved and rejected consistently with sustainability requirements. This is cost benefit analysis. At the macro level, many take the view that sustainability requires that national income measurement be modified so as to account for environmental damage. Such natural resource accounting is possible only if environmental damage is valued for incorporation into the economic accounts. The paper (...) reviews the techniques that economists have developed for environmental valuation. In regard to cost benefit analysis and sustainability, it is noted that the technique on which most interest focuses, the Contingent Valuation Method, involves the extension of the domain of consumer demand analysis to include the natural environment. Contributions questioning the appropriateness of this are reviewed, and it is argued that they merit more attention from economists than they have received to date. In regard to natural resource accounting, it is argued that while there is little prospect of it achieving what its proponents claim for it, the modelling that it necessarily implies has the potential to both clarify valuation issues and play an important role in informing the policy process. (shrink)

The editors welcome letters from readers, although we cannot guarantee that all will be published. To ensure timeliness, correspondents must respond to an article within seven weeks and not exceed two double‐spaced pages. Letters become the property of the editors and may be edited and shortened at our discretion.

Although there has been critical analysis of how the informed consent process functions in relation to participation in research and particular ethical 'dilemmas', there has been little examination of consenting to more routine medical procedures. We report a qualitative study of 25 women who consented to surgery. Of these, nine were ambivalent or opposed to having an operation. When faced with a consent form, women's accounts suggest that they rarely do anything other than obey professionals' requests for a signature. An (...) interactionist analysis suggests that women's capacity to act is reduced by the hospital structure of tacit, socially-imposed rules of conduct. Bourdieu's concepts of habitus, capital and symbolic power/violence show how the practical logic that women apply confers a 'sense of place' relative to professionals. Women experience deficits in capital that constrain their ability to exercise choice. This work demonstrates the weakness of the consent process as a safeguard of autonomy. (shrink)

A new class of program-oriented logical formalisms is investigated – renominative logics with extended renominations, equality predicates, and predicate complement composition. Composition algebras and languages of such logics are described; their semantic properties are investigated. For these logics, a number of logical consequence relations are proposed and investigated, in particular, the logical consequence relations with undefinedness conditions. Properties of these relations form the semantic basis for further construction of sequent-type calculi for the proposed logics.

Timothy Scheie’s book on the importance of the theatre in Roland Barthes’ oeuvre begins with what Scheie poses as an enigma: Barthes wrote frequently of the theatre at the beginning of his career and then ceased to do so, without comment, after 1960. Scheie argues that Barthes’ abandonment of the theatre reveals something important about the development of his thoughts and even about his life. Scheie also considers Barthes’ early theatrical criticism and later use of theatrical metaphors to be an (...) under-considered aspect of the critic’s work. Performance Degree Zero is an ambitious work not so much because of what it argues, but because of its attempt to trace the theatre’s presence (or absence) during Barthes’ .. (shrink)

Two kinds of claims of responsibility arise in regard to health and medical care. Claims of one kind are obligation-limiting claims about individuals’ responsibility for coming to need health care. It may be argued, for example, that individuals have no claim to state-sponsored care for injuries they suffer as a result of risky activities such as mountain climbing, sky diving, or smoking. The claim is that because these individuals are responsible for what has happened to them, others are not obligated (...) to pay for their care. In a different context, it is claimed that because patients are, or should be, responsible for the kind of treatment they receive. They therefore need to be informed about the treatment options available to them so that they can decide which of these treatments, if any, they will undergo. The lecture provides an account of responsibility that explains claims of both of these kinds and explains how they are related. There follows a response to comments by Peter Chau, dealing in particular with “libertarian paternalism” and with the adequacy of my value of choice account of responsibility. (shrink)

This chapter contains sections titled: Introduction The Parable of the King's Palace Intellectual Perfection, Immortality, and Matter Achieving Ultimate Happiness: Four Types of Perfection The Fifth Perfection: Teacher, Leader, or Scholar? Conclusion further reading.

This chapter contains sections titled: The Unity and Incorporeality of the Deity Divine Predication: What Can We Say about God? Maimonides' Negative Theology On the Existence of God Conclusion: Implications of Maimonides' Negative Theology further reading.

This chapter contains sections titled: Introduction How to Read Maimonides' Guide of the Perplexed Belief and Articles of Faith The Art of Biblical Exegesis: Harvesting “Apples of Gold” Language and Logic Philosophy and the Art of Demonstration Conclusion: Implications of Maimonides' Views further reading.

This chapter contains sections titled: Introduction The Nature of Virtue Morality Virtue and the mean: Aristotle and Torah contrasted Saintliness, Asceticism, and the Mean: Is the Hasid a Sinner? On Knowing the Good and Doing the Good Morality and Law: The Purpose of the Commandments Maimonides' Moral Theory: Universalist or Particularist? Conclusion further reading.

This chapter contains sections titled: Introduction Supernatural vs. Naturalistic Prophecy: Historical and Philosophical Precedents Prophecy in Maimonides' Halakhic Works Prophecy in the Guide On Miracles: Natural or Supernatural? Conclusion further reading.