The notion of patients’ duties has received periodic scholarly attention but remains overwhelmed by attention to the duties of healthcare professionals. In a previous paper the author argued that patients in publicly funded healthcare systems have a duty to participate in clinical research, arising from their debt to previous patients. Here the author proposes a greatly extended range of patients’ duties grounding their moral force distinctively in the interests of contemporary and future patients, since medical treatment offered to one patient (...) is always liable to be an opportunity cost in terms of medical treatment needed by other patients. This generates both negative and positive duties. Ten duties—enjoining obligations ranging from participation in healthcare schemes to promoting one’s own earliest recovery from illness—are proposed. The characteristics of these duties, including their basis, moral force, extent and enforceability, are considered. They are tested against a range of objections—principled, societal, epistemological and practical—and found to survive. Finally, the paper suggests that these duties could be thought to reinforce a regrettably adversarial characteristic, shared with rights-based approaches, and that a preferable alternative might be sought through the notion of a “virtuous patient” contributing to a problem-solving partnership with the clinician. However, in defining and giving content to that partnership, there is a clear role for most, if not all, of the proposed duties; their value thus extends beyond the adversarial context in which they might first be thought to arise. (shrink)

Patients participating in the shared benefits of publicly funded health care enjoy the benefits of treatments tested on previous patients. Future patients similarly depend on treatments tested on present patients. Since properly designed research assumes that the treatments being studied are—so far as is known at the outset—equivalent in therapeutic value, no one is clinically disadvantaged merely by taking part in research, provided the research involves administering active treatments to all participants. This paper argues that, because no other practical or (...) moral considerations count decisively against so doing, we could and should oblige patients to agree to receive indicated treatment within the terms of any concurrent research protocols. This ensures their treatment will benefit not only themselves but also future patients through contributing to new knowledge. By analogy with the paying of income tax, patients should not be allowed to “veto” their social responsibility to take part in clinical research. (shrink)

Using a fictional but representative general practice consultation, involving the diagnosis of irritable bowel syndrome in a patient who is anxious for some relief from the discomfort his condition entails, this paper argues that when both a drug fails to out-perform placebo and the condition in question is a functional illness with no demonstrable underlying pathology, then the action of the drug is not only no better than placebo, and it is also no different from it either. The paper also (...) argues that, in the circumstances of the consultation described, it is striking that current governance deems it ethical for a practitioner to prescribe either a drug or a placebo, both of which appear to rely for their effectiveness on a measure of concealment on the part of the doctor, yet deems it unethical for a practitioner openly to prescribe a harmless and enjoyable substance which is likely to be no less effective than either drug or placebo and is also likely to be better-tolerated and cheaper than the drug. (shrink)

While there may be a place in some contexts for high handed, “blanket” legislative prohibitions on dissenting views of what constitutes death, the paper under consideration does not describe such a contextThis stimulating and provocative paper by Professor Appel, Defining death: when physicians and families differ, asks us to consider “whether patients’ families should be permitted to opt out of widely accepted definitions of death in favour of their own standards”. This is a striking question in many ways. It reminds (...) us that, as a simple description of fact, there are indeed different standards for human death in so far as different groups or communities have accepted and continue to accept varying notions of what constitutes human death. The question’s reference to “opting out” suggests, perhaps reasonably, that it seems prima facie odd to think of adopting a definition of death as being a matter of individual choice. The reference to “permission” invites us to suppose limitations, primarily legal, upon the extent to which such a choice could be tolerated. Also, the question ascribes to certain “definitions of death” the authority of being widely accepted. The definitions thus favoured are, we learn, the various formulations of death referring to the state of the brain, chief among them “whole brain death” although the author is troublingly vague over whether all such formulations are morally, legally, or conceptually equivalent; and the relevant communities of acceptance turn out to consist of many—but, as the author admits, not all—physicians labouring under varying and inconsistent jurisdictions in the United States.My preface to the criticisms that follow is a …. (shrink)

In terms of intervening in embodied experience, medical treatment is wonder-full in its ambition and its metaphysical presumption; yet, wonder’s role in clinical medicine has received little philosophical attention. In this paper, I propose, to doctors and others in routine clinical life, the value of an openness to wonder and to the sense of wonder. Key to this is the identity of the central ethical challenges facing most clinicians, which is not the high-tech drama of the popular conceptions of medical (...) ethics but, rather, the routine of patients’ undramatic but unremitting demands for the clinician’s time and respectful attention. Wonder (conceived as an intense and transfiguring attentiveness) is a ubiquitous ethical source, an alternative to the more familiar respect for rational autonomy, a source of renewal galvanizing diagnostic imagination, and a timely recalling of the embodied agency of both patient and clinician. (shrink)

Is it possible to distinguish, as sociologist Arthur Frank proposes, an ‘ideal of wonder’ within which ill persons could recover some of their former sense of life and flourishing, even within the constraints of ill-health? Beyond this, are there more general benefits in terms of health and well-being that could accrue from cultivating an openness to wonder? In this paper I will first outline and defend a notion of wonder that gives philosophical support to Frank’s proposal, noting why thinking about (...) medical treatment may readily provoke a sense of wonder. Second I will however limit the normative force of such an ‘ideal of wonder’ noting its demands and some of the challenges facing it. The paper goes on, third, to conjecture wider benefits within and beyond the clinical encounter arising from being mindful of the wonder of embodied human agency. Fourth the paper will consider alignments between the foregoing analysis and some theoretical commitments in recent work in health geography. Finally I will briefly reconsider the notion of the body-as-territory, and the role of the imagination in bringing it under wonder’s gaze. (shrink)

In the UK, many fundamentally important policy decisions that are likely to affect the relationship between citizens and care services are now made at the sublegislative level and without adequate ethical consideration and scrutiny. This is well exemplified in the proposed guidance on the disclosure of information on children. A recent consultation paper by the UK government on the subject proposes an approach that seeks a simple technical solution to a complex problem, emphasising control and surveillance. This reflects pressure to (...) be seen to act. The document fails with regard to ethical reflection appropriate to the complexity of the issue, an appreciation of complex relationships of trust, and a proper sense of the richness and complexity of the public interest. Such policies would, if implemented, fundamentally change the relationships between citizens and their carers, and among carers and the law and the state. This and similar proposals require far more ethical scrutiny and consideration of the public interest in the widest sense. (shrink)

This paper first distinguishes governance (collective, autonomous self-regulatory processes) from government (externally-imposed mandatory regulation); it proposes that the second of these is essentially incompatible with a conception of the medical humanities that involves imagination and vision on the part of medical practitioners. It next develops that conception of the medical humanities, as having three distinguishable aspects (all of them distinct from the separate phenomena popularly known as “arts-in-health”): first, an intellectual enquiry into the nature of clinical medicine; second, an important (...) dimension of medical education; third, a resource for moral and aesthetic influences upon clinical practice, supporting “humane health care” as the moral inspirations behind organised medicine. Medical humanities sustains these three aspects through paying proper attention to the existential and subjective aspects of medicine. By encouraging authentic imagination among health care practitioners, medical humanities aligns well with both humane health care and governance in the sense of self-regulation. However, it can neither be achieved mechanistically nor well-measured through proxies such as patient satisfaction. Above all, it should not be allowed to supply, through inappropriate qualitative “targets,” new forms of management tyranny. (shrink)

“Medical humanities” is a phrase whose currency is wider than its agreed meaning or denotation. What sort of study is it, and what is its relation to the study of philosophy of medicine? This paper briefly reviews the origins of the current flowering of interest and activity in studies that are collectively called “medical humanities” and presents an account of its nature and central enquiries in which philosophical questions are unashamedly central. In the process this paper argues that the field (...) of enquiry is well-conceived as being philosophical in character, and as having philosophy — albeit pursued over a larger canvas — at the core of its contributing humanities disciplines. The paper characterises humanities disciplines as having an important focus on human experience and subjectivity, of which the experiences and subjectivities at stake in health, medicine and illness form an important sub-set, the preoccupation of the medical humanities as a whole. Claims of interdisciplinarity (as distinct from multidisciplinarity) are noted, but such claims need to be recognised for the high and stern ambition that they embody, and should not be made lightly. (shrink)

Two well-recognised, but inherently reductionist, relations between medicine and music are the attempted neuro-scientific understanding of responses to music and interest in music’s contributions to clinical therapy. This paper proposes a third relation whereby music is seen as an organising metaphor for clinical medicine as a practice. Both music and clinical medicine affirm human well-being, and both do this inter alia through varieties of skilful, crafted yet spontaneous mutual engagement between a ‘performer’ and an ‘audience’. I argue that this organising (...) metaphor offers a corrective to the reductionist influences of the first two relations, illuminates a number of medicine’s important features, and reaffirms the existential as being at the core of medicine’s telos. (shrink)

At the beginning of the 20th century, the shorter Greek version of the book of Tobit, GI, which is included in the Catholic Bible, was thought to be the oldest version. It was defined as ‘a lesson on almsgiving and its redeeming powers’. As the discoveries of the Semitic copies of Tobit at Qumran, GI is recognised to be a reworking of the longer version GII, most probably originally written in Aramaic, between 225 and 175 BCE. In all versions of (...) Tobit, the theme of almsgiving is introduced as specifically directed to Jewish kinsmen, but towards the end, is to be directed to all poor, suggesting that it may have been written by a Hellenistic Jew. Although the surface context of the narrative of Tobit is the Jewish tradition of proper observation of mitzvot and sacrifice and eventual reward, the various versions contain varying degrees of ancient Near Eastern wisdom, and an ironic, subversive reflection of hypocritical righteousness. This article questioned why the endings differ markedly in different versions. To try to find answers, a semantic comparison was made between GI and the most complete Aramaic version 4Q196. Contribution: This article considered the implications of source criticism in the reception of the various versions of Tobit. The possibility was examined that the pre-Christian, Aramaic version 4Q196Tobit does not confirm the excessive focus on almsgiving as righteousness apparent in the GI version of LXX Tobit. (shrink)

Gareth Evans' proposal, as amended by Steven Neale –that a definite pronoun with a quantifiedantecedent that does not bind it has the sense ofa definite description – has been challenged inthe singular case by appeal to counter-examplesinvolving failure of the uniqueness condition forthe legitimacy of a singular description. Thischallenge is here extended to the plural.Counter-examples are provided by cases in which aplural description `the Fs' does not denote,despite the propriety of the use of `they' or`them' it is to replace, (...) because of failure ofcumulativeness. A noncumulative predicate isnot distributive, and conditions for thelegitimacy of `the Fs' designed to accommodatenondistributive `Fs' are given in the context ofa two sorted theory with generalized quantifiers.Failure of cumulativeness is not to be confusedwith failure of maximality as Neale and othersdefine it. If not all Fs are Gs, `The Fs are Gs'is false; but it does not follow that `the Fs' isillegitimate; and if `Fs' is distributive. it isso only if there are no Fs. These differencesgranted, I give a partial defense of theEvans–Neale proposal from deficiencies in analternative based on the views of P. T.Geach. (shrink)

Gareth Evans'' proposal, as amended by Steven Neale –that a definite pronoun with a quantifiedantecedent that does not bind it has the sense ofa definite description – has been challenged inthe singular case by appeal to counter-examplesinvolving failure of the uniqueness condition forthe legitimacy of a singular description. Thischallenge is here extended to the plural.Counter-examples are provided by cases in which aplural description `the Fs'' does not denote,despite the propriety of the use of `they'' or`them'' it is to replace, (...) because of failure ofcumulativeness. A noncumulative predicate isnot distributive, and conditions for thelegitimacy of `the Fs'' designed to accommodatenondistributive `Fs'' are given in the context ofa two sorted theory with generalized quantifiers.Failure of cumulativeness is not to be confusedwith failure of maximality as Neale and othersdefine it. If not all Fs are Gs, `The Fs are Gs''is false; but it does not follow that `the Fs'' isillegitimate; and if `Fs'' is distributive. it isso only if there are no Fs. These differencesgranted, I give a partial defense of theEvans–Neale proposal from deficiencies in analternative based on the views of P. T.Geach. (shrink)

IPCC SPECIAL REPORT ON CLIMATE CHANGE AND LAND (SRCCL) -/- Chapter 3: Climate Change and Land: An IPCC special report on climate change, desertification, land degradation, sustainable land management, food security, and greenhouse gas fluxes in terrestrial ecosystems.

Professors are increasingly encouraged to adopt multiple role relationships with their students. Regardless of professor intent, these relationships carry risks. Left unexamined is whether student–faculty social multiple relationships impact student in-class behaviors. Provocatively, our exploratory study provides empirical support suggesting that when undergraduate students perceive that their professors engage in the multiple faculty–student relationships of friendships, drinking relationships, and sexual partnerships, students report they are more likely to engage in uncivil behaviors in the professor’s classroom. Accordingly, our study provides a (...) backdrop against which to think more substantively about the professorial role and the boundaries that accompany it. (shrink)

This article presents the Pilgrimage Model as a template for educators wishing to lead students on site-specific studies of engaged learning. During the 2015–2016 academic year, a group of Georgeto...

Under higher education’s contemporary consumer model, students are treated as customers and professors are encouraged to increase student engagement through more personal out-of-class interactions, often in social settings. In the course of this more personal student-faculty involvement, students inevitably encounter or learn of their professors’ occasional inappropriate or unethical behavior. In the present study, we investigated the impact of 145 American undergraduate Business students’ perceptions of their professors’ inappropriate out-of-class behavior on student beliefs and in-class behavior. Results indicate that student (...) perceptions of professors engaging in inappropriate out-of-class behavior were associated with students viewing these professors as lower in ethical character and reporting a stronger likelihood of attending these professors’ classes under the influence of alcohol and illicit drugs, swearing and using vulgarity in these professors’ class discussions, and showing disregard for these professors’ rules, time, and effort. These relationships held even when student grade satisfaction and professor in-class behavior were accounted for. Our results suggest professors’ behavior outside the classroom may impact students’ behavior inside the classroom, re-igniting dialogue regarding the professorial role and the boundaries on oversight of that role. We offer suggestions as to how higher education may address these concerns without infringing upon professors’ personal freedoms. (shrink)

The computations involved in statistical learning have long been debated. Here, we build on work suggesting that a basic memory process, chunking, may account for the processing of statistical regularities into larger units. Drawing on methods from the memory literature, we developed a novel paradigm to test statistical learning by leveraging a robust phenomenon observed in serial recall tasks: that short‐term memory is fundamentally shaped by long‐term distributional learning. In the statistically induced chunking recall (SICR) task, participants are exposed to (...) an artificial language, using a standard statistical learning exposure phase. Afterward, they recall strings of syllables that either follow the statistics of the artificial language or comprise the same syllables presented in a random order. We hypothesized that if individuals had chunked the artificial language into word‐like units, then the statistically structured items would be more accurately recalled relative to the random controls. Our results demonstrate that SICR effectively captures learning in both the auditory and visual modalities, with participants displaying significantly improved recall of the statistically structured items, and even recall specific trigram chunks from the input. SICR also exhibits greater test–retest reliability in the auditory modality and sensitivity to individual differences in both modalities than the standard two‐alternative forced‐choice task. These results thereby provide key empirical support to the chunking account of statistical learning and contribute a valuable new tool to the literature. (shrink)

Introduction: Schools have become a primary setting for providing mental health care to youths in the U.S. School-based interventions have proliferated, but their effects on mental health and academic outcomes remain understudied. In this study we will implement and evaluate the effects of a flexible multidiagnostic treatment called Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems on students' mental health and academic outcomes.Methods and Analysis: This is an assessor-blind randomized controlled effectiveness trial conducted across five (...) school districts. School clinicians are randomized to either MATCH or usual care treatment conditions. The target sample includes 168 youths referred for mental health services and presenting with elevated symptoms of anxiety, depression, trauma, and/or conduct problems. Clinicians randomly assigned to MATCH or UC treat the youths who are assigned to them through normal school referral procedures. The project will evaluate the effectiveness of MATCH compared to UC on youths' mental health and school related outcomes and assess whether changes in school outcomes are mediated by changes in youth mental health.Ethics and Dissemination: This study was approved by the Harvard University Institutional Review Board. We plan to publish the findings in peer-reviewed journals and present them at academic conferences.Clinical Trial Registration:ClinicalTrials.gov ID: NCT02877875. Registered on August 24, 2016. (shrink)

The existence of the longitudinal field B (3) in the vacuum implies that the gauge group of electrodynamics is O(3),and not U(1) [or O(2)].This results directly in the charge quantization condition e=h(ϰ/A (0)).This condition is derived independently in this paper from the relativistic motion of one electron in the field and is shown to he that in which the electron travels infinitesimally close to the speed of light.

The role of the novel longitudinal vacuum fieldB (3)is discussed in relation to fundamental radiation laws: the Rayleigh-Jeans law, the Planck law, and the Einstein coefficients. The circular index (3) ofB (3)causes electromagnetic energy density to be redistributed from the other indices (1) and (2) of the circular basis, but the presence ofB (3)in the vacuum does not change the value of the Planck constant h. TheB (3)field does not affect, furthermore, the understanding of quantized radiation absorption first proposed by (...) Einstein. Therefore, the experimental observableB (3) does not imply modification of these fundamental, radiation laws, and experimental isolation ofB (3) must take place through its characteristic square root power density dependence when used to magnetize an électron plasma. (shrink)

Required reading for anyone who believes in the equality of the sexes. A long awaited, highly acclaimed new translation of Simone De Beauvoir's landmark work.

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work was reproduced from the original artifact, and remains as true to the original work as possible. Therefore, you will see the original copyright references, library stamps (as most of these works have been housed in our most important libraries around the world), and other notations in the work. This work is in the public domain (...) in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. As a reproduction of a historical artifact, this work may contain missing or blurred pages, poor pictures, errant marks, etc. Scholars believe, and we concur, that this work is important enough to be preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

Geleitwort von Prof. P. Nicki -- Dr. Hermann Freund im Gespräch mit Prof. Dr. Dr. Hinderk M. Emrich -- Die Angst und der existentielle Sprung -- Die neue Zeit -- Der gedachte Gott -- Wie kommt das Ich zum Du? - Hysterie als Lebensform -- Was heisst, sich entscheiden? - Zur Theologie der Freiheit -- Re-formation der Reformation -- Das metaphysische und zugleich dämonische Wesen des Schlosses in Franz Kafkas Schloss-Roman -- Nachwort von Wolfgang Teichert: Epiphanie oder wo sprechende Philosophie (...) und Theologie aufhören müssen -- Literatur -- Verzeichnis der Mitwirkenden -- Abbildungsverzeichnis. (shrink)