Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

A collection of personal narratives and essays, Living Professionalism is designed to help medical students and residents understand and internalize various aspects of professionalism. These essays are meant for personal reflection and above all, for thoughtful discussion with mentors, with peers, with others throughout the health care provider community who care about acting professionally.

Introduction: Variation across research ethics boards in conditions placed on access to medical records for research purposes raises concerns around negative impacts on research quality and on human subject protection, including privacy.Aim: To study variation in REB consent requirements for retrospective chart review and who may have access to the medical record for data abstraction.Methods: Thirty 90-min face-to-face interviews were conducted with REB chairs and administrators affiliated with faculties of medicine in Canadian universities, using structured questions around a case study (...) with open-ended responses. Interviews were recorded, transcribed and coded manually.Results: Fourteen sites required individual patient consent for the study to proceed as proposed. Three indicated that their response would depend on how potentially identifying variables would be managed. Eleven sites did not require consent. Two suggested a notification and opt-out process. Most stated that consent would be required if identifiable information was being abstracted from the record. Among those not requiring consent, there was substantial variation in recognising that the abstracted information could potentially indirectly re-identify individuals. Concern over access to medical records by an outside individual was also associated with requirement for consent. Eighteen sites required full committee review. Sixteen allowed an external research assistant to abstract information from the health record.Conclusions: Large variation was found across sites in the requirement for consent for research involving access to medical records. REBs need training in best practices for protecting privacy and confidentiality in health research. A forum for REB chairs to confidentially share concerns and decisions about specific studies could also reduce variation in decisions. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

The recent genome sequencing of a non‐vertebrate deuterostome, the ascidian tunicate Ciona intestinalis, makes a substantial contribution to the fields of evolutionary and developmental biology.1 Tunicates have some of the smallest bilaterian genomes, embryos with relatively few cells, fixed lineages and early determination of cell fates. Initial analyses of the C. intestinalis genome indicate that it has been evolving rapidly. Comparisons with other bilaterians show that C. intestinalis has lost a number of genes, and that many genes linked together in (...) most other bilaterians have become uncoupled. In addition, a number of independent, lineage‐specific gene duplications have been detected. These new results, although interesting in themselves, will take on a deeper significance once the genomes of additional invertebrate deuterostomes (e.g. echinoderms, hemichordates and amphioxus) have been sequenced. With such a broadened database, comparative genomics can begin to ask pointed questions about the relationship between the evolution of genomes and the evolution of body plans. BioEssays 25:529–532, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

In the poem which sets the seal on his three books of odes, Horace declares that his monument to himself will be more durable than bronze and higher than the pyramids. As T. E. Page noted in his commentary, aere can suggest not only bronze tablets, but also commemorative statuary, although tablets seems more to the fore here, given the reference to monumentum As for the pyramids, they are a fine example of grandiloquent architecture, but of a kind which is (...) nevertheless subject to the destructive natural forces from which Horace exempts his own commemoration. (shrink)

In the poem which sets the seal on his three books of odes, Horace declares that his monument to himself will be more durable than bronze and higher than the pyramids. As T. E. Page noted in his commentary, aere can suggest not only bronze tablets, but also commemorative statuary, although tablets seems more to the fore here, given the reference tomonumentumAs for the pyramids, they are a fine example of grandiloquent architecture, but of a kind which is nevertheless subject (...) to the destructive natural forces from which Horace exempts his own commemoration. (shrink)

Introduction , Sophie Gibb 1. Mental Causation , John Heil 2. Physical Realization without Preemption , Sydney Shoemaker 3. Mental Causation in the Physical World , Peter Menzies 4. Mental Causation: Ontology and Patterns of Variation , Paul Noordhof 5. Causation is Macroscopic but not Irreducible , David Papineau 6. Substance Causation, Powers, and Human Agency , E. J. Lowe 7. Agent Causation in a Neo-Aristotelian Metaphysics , Jonathan D. Jacobs and Timothy O’Connor 8. Mental Causation and Double Prevention , (...) Sophie Gibb 9. The Identity Theory as a Solution to the Exclusion Problem , David Robb 10. Continuant Causation, Fundamentality, and Freedom , Peter Simons 11. There is no Exclusion Problem , Steinvor Tholl Arnadottir and Tim Crane. (shrink)

One currently popular methodology of metaphysics has it that ‘intuitions’ play an evidential role with respect to metaphysical claims. This chapter defends a realist methodology of metaphysics that implies that any rational being, simply in virtue of being rational, is necessarily capable of grasping the essences of at least some mind-independent entities. The notion of essence in play here is Aristotelian, whereby an entity’s essence is captured by an account of what that entity is, or what it is to be (...) that entity. Concepts are just ways of thinking of things and, as such, may or may not be adequate to the real natures — the essences — of the things being thought of. Our ‘intuitions’, particularly as revealed by aptly constructed thought experiments, may cast interesting light on some of our concepts, but they are not and cannot be reliable guides to mind-independent truths of essence. (shrink)

This chapter contains sections titled: The Syntax and Semantics of Complex Sortal Terms On the Identity of Sorts.

With displacement, time, and force as basic undefined physical quantities, other physical quantities are defined as combinations of two vector quantities and one scalar quantity. Combinations include multiplication and division of vectors by vectors, scalars by vectors, and scalars by scalars. Defined quantities are vectors, scalars or quaternions, depending on directions of vectors in the definitions. Division of a vector by a vector is equivalent to multiplication of vectors divided by a scalar. The unit of a vector (or scalar) is (...) itself a vector (or scalar) quantity. Thesquare meter (a vector) differs from meter 2 (a scalar), and the cubic meter (a scalar) is different frommeter 3 . The characteristics of displacement, time, and force are considered known from experience. (shrink)

Quaternions consist of a scalar plus a vector and result from multiplication or division of vectors by vectors. Division of vectors is equivalent to multiplication divided by a scalar. Quaternions as used here consist of the scalar product with positive sign plus the vector product with sign determined by the right-hand rule. Units are specified by the multiplication process. Trigonometric functions are quaternions with units that can satisfy Hamilton's requirements. The square of a trigonometric quaternion is a real number provided (...) that the product of the scalar number and the vector is not commutative. Maxwell's electromagnetic equations for empty space can be represented by a single quaternion equation. (shrink)

The relations between reason, motivation and value present problems which, though ancient, remain intractable. If values are objective and rational how can they move us and if they are dependent on our contingent desires how can they be rational? E. J. Bond makes a bold attack on this dilemma. The widespread view among philosophers today is that judgements contain an irreducible element of personal commitment. To this Professor Bond proposes an account of values as objective and value judgements as true (...) or false, employing a distinction between grounding and motivating reasons to establish their connection with action. He defines and tests his position against a number of recent theories, providing in the process forceful criticism of Williams, Wiggins, Foot, Narveson and Nagel, among others. A distinctive contribution to the subject, it will stimulate interest and worthwhile debate among philosophers, while also serving as an introduction to this vital topic. (shrink)

本书的论文展示了这位伟大的历史学家对研究历史的重要性热情洋溢的信念,以及深邃的分析、论说的广度和独到的见解,这些足以令他名至实归。.

As thinkers in the market for knowledge and agents aspiring to morally responsible action, we are inevitably subject to luck. This book presents a comprehensive new theory of luck in light of a critical appraisal of the literature's leading accounts, then brings this new theory to bear on issues in the theory of knowledge and philosophy of action.

Luck looms large in numerous different philosophical subfields. Unfortunately, work focused exclusively on the nature of luck is in short supply on the contemporary analytic scene. In his highly impressive recent book Epistemic Luck, Duncan Pritchard helps rectify this neglect by presenting a partial account of luck that he uses to illuminate various ways luck can figure in cognition. In this paper, I critically evaluate both Pritchard’s account of luck and another account to which Pritchard’s discussion draws our attention—viz., that (...) due to Nicholas Rescher. I also assess some novel analyses of luck that incorporate plausible elements of Pritchard’s and Rescher’s accounts. (shrink)

In “The Nature of the Atonement”, Eleonore Stump explores the problem of human sin that the atonement is meant to solve, helpfully uncovering important adequacy conditions for theories of atonement. She then uses those conditions to critically evaluate Anselmian and Thomistic theories of atonement, arguing (among many other interesting things) that the Thomist has a leg up on the Anselmian when it comes to the atonement-motivating problem of human sin (pp.11-12 of ms.). I argue for two claims in what follows. (...) First, Stump’s two seemingly independent “further problems” for theorists of atonement (discussed in the penultimate section of her paper) in fact reduce to a single challenge, which suggests a strategy for future theorizing about the atonement. Second, Stump’s case that the Thomist outperforms the Anselmian on the problem of human sin is weaker than it initially appears. As we’ll see, Stump’s own account of shame implies that the Anselmian’s difficulties on this front are less serious than she thinks. (shrink)

This chapter contains sections titled: The Varieties of ‘Is’ Individuals, Kinds, and Realism Semantics, Metaphysics, and Necessity New Developments.

This chapter contains sections titled: Appendix: An Axiomatic System of Sortal Logic.

This chapter contains sections titled: Matter and Organisms Organisms and Persons Is There a Criterion of Personal Identity?