This essay is a critique of medical/clinical ethics from the personal perspective of a medical historian in an academic health science centre who has interacted with ethicists. It calls for greater transparency and accountability of ethicists involved in ‘bedside consulting;’ it questions the wisdom of the four principles of biomedical ethics and their American cultural origins with respect to training; challenges the authority of ‘core competencies’ for ethicists as identified by the American Society for Bioethics and Humanities; and muses over (...) the apparent reintroduction of religion into clinical medicine through the medium of bioethics. This essay is designed to provoke reflection on the putative ‘professionalism’ of the consulting ethics enterprise for which educational baselines and curricula are not standardized. By analysing sources such as the professional material communicated by the Canadian Bioethics Society, it also critiques the collective ethical shortcoming... (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)

The representation of physics problems in relation to the organization of physics knowledge is investigated in experts and novices. Four experiments examine the existence of problem categories as a basis for representation; differences in the categories used by experts and novices; differences in the knowledge associated with the categories; and features in the problems that contribute to problem categorization and representation. Results from sorting tasks and protocols reveal that experts and novices begin their problem representations with specifiably different problem categories, (...) and completion of the representations depends on the knowledge associated with the categories. For, the experts initially abstract physics principles to approach and solve a problem representation, whereas novices base their representation and approaches on the problem's literal features. (shrink)

The First Conference of the International Society for the Study of Time was held at the Mathematisches Forschungsinstitut at Oberwolfach in the Black Forest, Federal Republic of Germany from Sunday, 31 August to Saturday, 6 September, 1969. The origin of this conference and the formation of the Society goes back to a proposal due to J. T. Fraser that was discussed at a conference on "Interdisciplinary Perspectives of Time" held by the New York Academy of Sciences in January, 1966. It (...) was unanimously agreed than that an international society should be formed on an interdisciplinary basis with the object of stimulating interest in all problems concerning 'time and that this object could best be attained by means of conferences held at regular intervals. J. T. Fraser was elected Secretary, S. Watanabe Treasurer, and I was elected President. It was agreed, at my suggestion, that the organization of the first conference of the newly formed Society be left to a committee of these three officers, on the understanding that they would invite authorities on the role of time in the various special sciences and humanities to form an Advisory Board to assist them. One of the main difficulties in seeking support for an interdisciplinary conference is that most foundations confine their interest exclusively either to the sciences or to the humanities. (shrink)

Objectives: To quantify the use of do-not-resuscitate orders in a tertiary-care children’s hospital and to characterise the circumstances in which such orders are written.Design: Retrospective study conducted in a 500-bed children’s hospital in Taiwan.Patients: The course of 101 patients who died between January 2002 and December 2005 was reviewed. The following data were collected: age at death, gender, disease and its status, place of death and survival. There were 59 males and 42 females with a median age of 103 months (...) . 50 children had leukaemias, and 51 had malignancies other than leukaemia. The t test and the χ2 test were applied as appropriate.Results: The study found that 44% of patient deaths occurred in the paediatric oncology ward; 29% of patient deaths occurred in the intensive care unit; and 28% of patients died in their home or at another hospital. Other findings included the following: 46 of 101 patients died after attempted cardiopulmonary resuscitation and 55 died with a DNR order in effect. The mean age at death was 9.8 years in both groups with or without DNR orders.Conclusions: From the study of patient deaths in this tertiary-care children’s hospital, it was concluded that an explicit DNR order is now the rule rather than the exception, with more DNR orders being written for patients who have been ill longer, who have solid tumours, who are not in remission and who are in the ward. (shrink)

We tested the hypothesis that perception of an alternative image in ambiguous figures would be manifest as high-frequency (gamma) components that become synchronized over multiple scalp sites as a ''cognitive binding'' process occurs. For 171 combinations of data from 19 electrodes, obtained from 17 subjects and 10 replicate stimuli, we calculated the difference in correlation between the response to first seeing an ambiguous figure and when the alternative percept for that figure became consciously realized (cognitively bound). Numerous statistically significant correlation (...) differences occurred in all frequency bands tested with ambiguous-figure stimulation, but not in two kinds of control data (a reaction-time test to sound stimuli and a no-task, mind-wandering test). Statistically significant correlation changes were widespread, involving frontal, parietal, central, and occipital regions of both hemispheres. Correlation changes were evident at each of five frequency bands, ranging up to 62.5 Hz. Most of the statistically significant correlation changes were not between adjacent sites but between sites relatively distant, both ipsilateral and contralateral. Typically, these correlation changes occurred in more than one frequency band. These results suggest that cognitive binding is a distinct mental state that is reliably induced by ambiguous-figure perception tasks. Coherent oscillations at multiple frequencies may reflect the mechanism by which such binding occurs. Moreover, different coherent frequencies may mediate different components of the total cognitive-binding process. (shrink)

Systemic autoimmune diseases are characterized by the production of antibodies against a broad range of self-antigens. Recent evidence indicates that the majority of these autoantigens are modified in various ways during cell death. This has led to the hypothesis that the primary immune response in the development of autoimmunity is directed to components of the dying cell. In this article, we summarize data on the modification of autoantigens during cell death and the possible consequences of this for autoimmunity. BioEssays 22:627–636, (...) 2000. © 2000 John Wiley & Sons, Inc. (shrink)

In this article we would like to scrutinize the particular problems which are connected with the self-reflection of theoretical thinking and its meaning. Often, philosophy is considered as the science of science. In philosophy the demarcation between true knowledge and sheer belief or opinion must be justified. One could say that this task is as old as Western philosophy itself. Since Greek philosophy one of the main questions is how we can know the truth and how we are able to (...) discern true from alleged knowledge. (shrink)