In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Dr. Ambedkar and Untouchability: Fighting the Indian Caste SystemChristopher S. QueenDr. Ambedkar and Untouchability: Fighting the Indian Caste System. By Christophe Jaffrelot. New York: Columbia University Press, 2005. xiii + 205 pp.Outside of India, Bhimrao Ramji Ambedkar remains virtually unknown. Everyone knows that Mahatma Gandhi led the fight for Indian independence and that his nonviolent marches inspired Dr. King and the American civil rights movement. Most educated men (...) and women have heard of Nehru and some of the political and literary figures that India has produced in modern times. But few know of the first Untouchable to attend college, who went on to earn advanced degrees in the social sciences and law at Columbia University, the London School of Economics, and Grays Inn, who returned to India in the 1920s to launch a civil rights movement for Untouchables, [End Page 168] who drafted the constitution for the Republic of India as its first law minister, and who led a mass conversion to Buddhism weeks before this death.Dr. B. R. Ambedkar (1891–1956) is venerated by millions of Buddhist and low-caste followers in India today, and at the same time feared by politicians determined to preserve the Hindu caste system he vowed to destroy. Admirers call him Babasaheb Ambedkar or simply Baba, using a traditional term of respect for a guiding elder, and many use the greeting Jai Bhim (“Victory to Bhimrao”) within the Untouchable communities. Ambedkar is portrayed on ubiquitous wall calendars, public statues, and home altars alongside that of the Buddha, wearing a Western suit and tie, with the horn-rimmed glasses and pocket pens of a scholar and diplomat. Although widely regarded as a bodhisattva or Buddhist saint, he is never pictured in the robes of a holy man or entreated in prayer by his devotees. And while most of his campaigns for Untouchable human rights were driven back by the Hindu nationalists, many of the provisions of his path-breaking legislation were eventually adopted after his death. In the intervening decades, amid deepening polarization over his legacy, the state government of Maharashtra has published eighteen volumes of Ambedkar’s collected works and the government of India has bestowed on him its highest civilian honor, the Bharat Ratna.Given the dearth of Western scholarship on Ambedkar’s place in the history of modern India and the emergence of socially engaged Buddhism, I welcome Chris-tophe Jaffrelot’s Dr. Ambedkar and Untouchability: Fighting the Indian Caste System. As a social scientist and director of the Centre d’Études et de Recherches Internatio-nales (CERI) who has published more than a dozen books on South Asian politics, Jaffrelot is well qualified to assess Ambedkar’s life and thought. Drawing on a wide range of materials on the social reform movements of the nineteenth and twentieth centuries and Ambedkar’s contributions to sociology and politics, the author aims to redress Ambedkar’s neglect by Indian scholars before the 1990s, when the low-caste movement began finally to gain traction. However, he does not address the anomaly of Ambedkar’s neglect by all but a small circle of Western authors.1The strength of Dr. Ambedkar and Untouchability is its concise analysis of the geographical, political, and social context of Ambedkar’s career. Jaffrelot shows how British recruitment of the Mahars, members of Ambedkar’s lowly but numerous caste, for service in the colonial army resulted in disproportionate levels of literacy. Ambedkar was the fourteenth child in such a military family, whose father held the rank of major and served as a school master for the barracks. Both parents and all of Bhimrao’s uncles could read and write, compared to less than one percent of Mahars in village life. Moreover, in spite of his brilliance and determination, Ambedkar could not have continued his education without the financial support of Maratha maharajahs who opposed the Brahmins’ monopoly in education. “Ambedkar was the heir to a regional tradition; his struggle harked back to the anti-Brahmin movements which emerged in western Maharashtra from the mid-nineteenth century onward, a precocity that only the Dravidian South—the other key area of anti-Brahmin mobilization—could match.”Jaffrelot presents... (shrink)

These pleasant memories of my teachers lead to some not-so-pleasant memories, as I disregarded their warnings and I immersed myself in the Buddhist canonical writings, commentaries and modern interpreters. As a graduate student, I wanted desperately to find a central idea or principle on which to hang all the others, if only to prepare more efficiently for the comprehensive examinations I would face before proceeding to the dissertation. And I discovered, to my surprise and delight, that there were many commentators (...) ready to argue that a certain teaching, doctrine, or perspective was indeed what Buddhism is all about. (shrink)

This chapter examines a sampling of the beliefs and practices to ascertain whether there are emerging patterns that link the otherwise independent, globally dispersed movements of engaged Buddhism. The rise of socially engaged Buddhism since the middle of the last century has been intensively documented and analyzed by scholars for more than 30 years. The doctrines of suffering (dukkha) and action‐rebirth (karma‐sasāra), and the moral guidelines known as Five Precepts (pañcasila), may be taken as markers of the philosophical breadth and (...) depth of the new Buddhism, and of its readiness to enter into dialogue with philosophies and theologies beyond its borders. (shrink)

Compiled by scholars at the court of Liu An, king of Huainan, in the second century B.C.E, _The Huainanzi_ is a tightly organized, sophisticated articulation of Western Han philosophy and statecraft. Outlining "all that a modern monarch needs to know," the text emphasizes rigorous self-cultivation and mental discipline, brilliantly synthesizing for readers past and present the full spectrum of early Chinese thought. _The Huainanzi_ locates the key to successful rule in a balance of broad knowledge, diligent application, and the penetrating (...) wisdom of a sage. It is a unique and creative synthesis of Daoist classics, such as the _Laozi_ and the _Zhuangzi_; works associated with the Confucian tradition, such as the _Changes_, the _Odes_, and the _Documents_; and a wide range of other foundational philosophical and literary texts from the _Mozi_ to the _Hanfeizi_. The product of twelve years of scholarship, this remarkable translation preserves _The Huainanzi_'s special rhetorical features, such as parallel prose and verse, and showcases a compositional technique that conveys the work's powerful philosophical appeal. This path-breaking volume will have a transformative impact on the field of early Chinese intellectual history and will be of great interest to scholars and students alike. (shrink)

A major resource expanding the study of early Chinese philosophy, religion, literature, and politics, this book features the first complete English-language translation of the_ Luxuriant Gems of the "Spring and Autumn"_,_ _one of the key texts of early Confucianism. The work is often ascribed to the Han scholar and court official Dong Zhongshu, but, as this study reveals, the text is in fact a compendium of writings by a variety of authors working within an interpretive tradition that spanned several generations, (...) depicting a utopian vision of a flourishing humanity that they believed to be Confucius's legacy to the world. The Spring and Autumn is a chronicle kept by the dukes of the state of Lu from 722 to 481 B.C.E. _The Luxuriant Gems_ follows the interpretations of the _Gongyang Commentary_, whose transmitters belonged to a tradition that sought to explicate the special language of the _Spring and Autumn_. The Gongyang masters believed that the_ Spring and Autumn_ had been written by Confucius himself, employing subtle and esoteric phrasing to indicate approval or disapproval of important events and personages. The _Luxuriant Gems_ augments Confucian ethical and philosophical teachings with chapters on cosmology, statecraft, and other topics drawn from contemporary non-Confucian traditions, reflecting the brilliance of intellectual life in the Han dynasty during the formative decades of the Chinese imperial state. To elucidate the text, Sarah A. Queen and John S. Major divide their translation into eight thematic sections with extensive introductions that address dating, authorship, authenticity, and the relationship between the original text and the evolving _Gongyang_ approach. (shrink)

Compiled in the second century B.C.E, the _Huainanzi_ clarifies a crucial period in the development of Chinese conceptions of the cosmos, human nature, and the social order. Outlining "all that a modern monarch needs to know," the text emphasizes rigorous self-cultivation and mental discipline, attributing successful rule to a balance of broad knowledge, diligent application, and penetrating wisdom. In 2010, the editors of this volume completed the first complete English-language translation of the _Huainanzi_, opening exciting new pathways in the study (...) of philosophy, Asian studies, political science, and Asian literature. This abridgement contains essential selections from each of the _Huainanzi_'s twenty-one chapters and adds a new introduction and chapter descriptions. The text represents a remarkable synthesis of Daoist classics, such as the _Laozi_ and the _Zhuangzi_; works associated with the Confucian tradition, such as the _Changes_, the _Odes_, and the _Documents_; and a range of other foundational philosophical and literary works, from the _Mozi_ to the _Hanfeizi_. The abridgement preserves the _Huainanzi_'s special rhetorical features, such as its parallel prose, verse, and unique compositional techniques. For decades, Western scholars overlooked the _Huainanzi'_s sophisticated structure, creative content, and rich historical value, yet all that changed with the translation of the full text. Designed for classroom use and general readers, _The Essential Huainanzi_ continues to increase awareness of this brilliant work and change our understanding of early Chinese history. (shrink)

_Action Dharma_ charts the emergence of a new chapter in an ancient faith - the rise of social service and political activism in Buddhist Asia and the West. Fourteen new essays treat the historical origins, global range, teachings and practices, and leaders and organizations that make up the latest turning of the Dharma. Environmentalism and peace walks through the minefields of Southeast Asia, the future of the 'untouchables' of Japan, and outreach to minorities and inmates of the criminal justice system (...) in the West are some of the challenging topics considered. (shrink)

This paper explores Confucius’ views on warfare according to the Gongyang Commentary. Though often overlooked as a source for understanding Confucius’ position on warfare, the Gongyang Commentary is replete with comments and anecdotes on the topic. It articulates a complex set of ethico‐ritual principles pertaining to warfare in which certain kinds of warfare are clearly condoned and praised while others are clearly condemned and criticized. What according to the Gongyang Commentary was the Gentleman's position on warfare? The paper explores this (...) central question through a close reading of anecdotal narratives and selected passages from the Gongyang Commentary and related texts on the subject of warfare. (shrink)

Advances in artificial intelligence (AI) raise important questions about whether people view moral evaluations by AI systems similarly to human-generated moral evaluations. We conducted a modified Moral Turing Test (m-MTT), inspired by Allen et al. (Exp Theor Artif Intell 352:24–28, 2004) proposal, by asking people to distinguish real human moral evaluations from those made by a popular advanced AI language model: GPT-4. A representative sample of 299 U.S. adults first rated the quality of moral evaluations when blinded to their source. (...) Remarkably, they rated the AI’s moral reasoning as superior in quality to humans’ along almost all dimensions, including virtuousness, intelligence, and trustworthiness, consistent with passing what Allen and colleagues call the comparative MTT. Next, when tasked with identifying the source of each evaluation (human or computer), people performed significantly above chance levels. Although the AI did not pass this test, this was not because of its inferior moral reasoning but, potentially, its perceived superiority, among other possible explanations. The emergence of language models capable of producing moral responses perceived as superior in quality to humans’ raises concerns that people may uncritically accept potentially harmful moral guidance from AI. This possibility highlights the need for safeguards around generative language models in matters of morality. (shrink)

What endogenous factors contribute to minority (Red Queen) or majority (Red King) domination under conditions of coercive bargaining? We build on previous work demonstrating minority disadvantage in non-coercive bargaining games to show that under neutral initial conditions, majorities are advantaged in high conflict situations, and minorities are advantaged in low conflict games. These effects are a function of the relationship between (1) relative proportions of the majority and minority groups and (2) costs of conflict. Although both Red King and Red (...) Queen effects can occur, we further show that agents’ increased initial propensity toward conflict advantages majorities. (shrink)

Following her abdication, Queen Christina of Sweden took up residence in the Palazzo Farnese, Rome from 1655. She had already developed a keen interest in music, gained from tuition from a French dancing master, and playing the star role in the ballet The Captured Cupid in honour of her mother's birthday in 1649. Christina's arrival in Rome was marked by performances in her honour in the Palazzo Barberini and Palazzo Pamphili of specially commissioned works by contemporary composers Marco Marazzoli (...) and A.F. Tenaglia, and by her favourite Giacomo Carissimi. Inspired by the chamber music proportions of the cappella of the Collegio Germanico, many of Carissimi's secular arias were composed for his royal Swedish patron. After two years in France, Christina returned to Rome, where she took up residence in the Palazzo Riario on the Janiculum. Inventories record her musical instruments and describe the contents of the Great Hall in which concerts were held. (shrink)

In 1991 the United Nations General Assembly adopted the Principles for Older Persons as a framework for international policy responses to population ageing. These principles promote independence, participation, care, self-fulfilment and dignity as legitimate entitlements of all older people. Although these principles, or variations of them, are embedded in standards of best-practice in residential aged care facilities, the literature shows that in reality institutional care can deny older people opportunities to exercise some of these entitlements. More specifically, residential aged care (...) facilities can deprive older people of access and support to pursue opportunities for the full development of their potential, i.e. their entitlement to self-fulfilment. This discussion article explores the influence of institutional care on older people’s ability to exercise their entitlement to self-fulfilment. We identify the characteristics of a ‘good life’ in institutional care, according to aged care residents themselves. The Eden Alternative™ is presented as a model of aged care that aims to create the conditions for a ‘good life’ and self-fulfilment for aged care residents. (shrink)

OBJECTIVES: To measure the preference regarding disclosure of a serious diagnosis, and its determinants, of the Lebanese public. DESIGN AND SETTING: Non-random sample survey of 400 persons interviewed in health care facilities in Beirut in 1995. RESULTS: Forty-two per cent of respondents generally preferred truth not to be disclosed directly to patients. Preference for disclosure was associated with younger age, better education and tendency to rapport-building with physicians. There were no meaningful associations between place of residence (urban/rural), level of (...) religious practice, or religious affiliation, and preference for disclosure. CONCLUSIONS: Under one plausible interpretation, this survey suggests that the expectation for concealment will decrease as the advantage of knowledge in better coping with disease is understood by an increasingly better educated public, and that the Lebanese public will increasingly come to expect direct and full disclosure of serious diagnoses. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Nancy Scheper-Hughes is one of the most prominent critics of markets in human organs. Unfortunately, Scheper-Hughes rejects the view that markets should be used to solve the current shortage of transplant organs without engaging with the arguments in favour of them. Scheper-Hughes’s rejection of such markets is of especial concern, given her influence over their future, for she holds, among other positions, the status of an adviser to the World Health Organization on issues related to global transplantation. Given her influence, (...) it is important that Scheper-Hughes’s moral condemnation of markets in human organs be subject to critical assessment. Such critical assessment, however, has not generally been forthcoming. A careful examination of Scheper-Hughes’s anti-market stance shows that it is based on serious mischaracterisations of both the pro-market position and the medical and economic realities that underlie it. In this paper, the author will expose and correct these mischaracterisations and, in so doing, show that her objections to markets in human organs are unfounded. (shrink)

Medical student and resident participation in global health experiences (GHEs) has significantly increased over the last decade. In response to growing student interest and the proven impact of such experiences on the education and career decisions of resident physicians, many medical schools have begun to establish programmes dedicated to global health education. For the innumerable benefits of GHEs, it is important to note that medical students have the potential to do more harm than good in these settings when they exceed (...) their actual capabilities as physicians-in-training. While medical training programmes are beginning to provide students with the knowledge to put their GHEs in context, they must remember that they also bear the responsibility of training their students in a framework to approach these experiences in a principled and professional way. It is necessary that these institutions provide adequate and formalised preparation for both clinical and ethical challenges of working in resource-poor settings. This paper outlines potential benefits and risks of GHEs and delineates recommendations to some of the current issues. (shrink)

Where does consciousness come from? For most scientists and laypeople, it is axiomatic that something in the substance of the brain - neurons, synapses and grey matter in just the right combination - create perception, self-awareness, and intentionality. Yet despite decades of neurological research, that ""something"" - the mechanism by which this process is said to occur - has remained frustratingly elusive. This is no accident, as the authors of this book argue, given that the evidence increasingly points to a (...) startling fact: consciousness may not, in fact, reside in the brain at all. In this wide-ranging and deeply scientific book, Imants Baruss and Julia Mossbridge utilise findings from special relativity and quantum mechanics, modern and ancient philosophers, and paranormal psychology to build a rigorous, detailed investigation into the origins and nature of human consciousness. Along the way, they examine the scientific literature on concepts including mediumship, out-of-body and near-death experiences, telekinesis, ""apparent"" versus ""deep time,"" and mind-to-mind communication, and introduce eye-opening ideas about our shared reality. The result is a revelatory tour of the ""post-materialist"" world, and a roadmap for consciousness research in the twenty-first century. (shrink)

BackgroundThere is increasing need for peer reviewers as the scientific literature grows. Formal education in biostatistics and research methodology during residency training is lacking. In this pilot study, we addressed these issues by evaluating a novel method of teaching residents about biostatistics and research methodology using peer review of standardized manuscripts. We hypothesized that mentored peer review would improve resident knowledge and perception of these concepts more than non-mentored peer review, while improving review quality.MethodsA partially blinded, randomized, controlled multi-center study (...) was performed. Seventy-eight neurology residents from nine US neurology programs were randomized to receive mentoring from a local faculty member or not. Within a year, residents reviewed a baseline manuscript and four subsequent manuscripts, all with introduced errors designed to teach fundamental review concepts. In the mentored group, mentors discussed completed reviews with residents. Primary outcome measure was change in knowledge score between pre- and post-tests, measuring epidemiology and biostatistics knowledge. Secondary outcome measures included level of confidence in the use and interpretation of statistical concepts before and after intervention, and RQI score for baseline and final manuscripts.ResultsSixty-four residents (82%) completed initial review with gradual decline in completion on subsequent reviews. Change in primary outcome, the difference between pre- and post-test knowledge scores, did not differ between mentored (−8.5%) and non-mentored (−13.9%) residents (p = 0.48). Significant differences in secondary outcomes (using 5-point Likert scale, 5 = strongly agree) included mentored residents reporting enhanced understanding of research methodology (3.69 vs 2.61; p = 0.001), understanding of manuscripts (3.73 vs 2.87; p = 0.006), and application of study results to clinical practice (3.65 vs 2.78; p = 0.005) compared to non-mentored residents. There was no difference between groups in level of interest in peer review (3.00 vs 3.09; p = 0.72) or the quality of manuscript review assessed by the Review Quality Instrument (RQI) (3.25 vs 3.06; p = 0.50).ConclusionsWe used mentored peer review of standardized manuscripts to teach biostatistics and research methodology and introduce the peer review process to residents. Though knowledge level did not change, mentored residents had enhanced perception in their abilities to understand research methodology and manuscripts and apply study results to clinical practice. (shrink)

IntroductionThe objectives of this study are to assess and compare differences in the intensity, frequency, and overall severity of moral distress among a diverse group of healthcare professionals.MethodsParticipants from within Baylor Health Care System completed an online seven-point Likert scale (range, 0 to 6) moral distress survey containing nine core clinical scenarios and additional scenarios specific to each participant’s discipline. Higher scores reflected greater intensity and/or frequency of moral distress.ResultsMore than 2,700 healthcare professionals responded to the survey (response rate 18.14 (...) percent); survey respondents represented multiple healthcare disciplines across a variety of settings in a single healthcare system. Intensity of moral distress was high in all disciplines, although the causes of highest intensity varied by discipline. Mean moral distress intensity for the nine core scenarios was higher among physicians than nurses, but the mean moral distress frequency was higher among nurses. Taking into account both intensity and frequency, the difference in mean moral distress score was statistically significant among the various disciplines. Using post hoc analysis, differences were greatest between nurses and therapists.ConclusionsMoral distress has previously been described as a phenomenon predominantly among nursing professionals. This first-of-its-kind multidisciplinary study of moral distress suggests the phenomenon is significant across multiple professional healthcare disciplines. Healthcare professionals should be sensitive to situations that create moral distress for colleagues from other disciplines. Policy makers and administrators should explore options to lessen moral distress and professional burnout that frequently accompanies it. (shrink)

Objectivité veut dire coercition. Où réside ce caractère dans le cas des plus hautes valeurs? Elles sont toutes des artifices, et une satisfaction donnée à certaines tendances des hommes. C’est pourquoi leur objectivité consiste non dans la contrainte de la nature sur l’esprit, mais dans celle de l’esprit sur l’esprit. De là naissent des étalons de valeur. Objections : 1° tirée de la valeur absolue : en quel sens elle existe, 2° de la valeur « subhumaine ». La valeur comme (...) forme universelle, son existence comme « élection naturelle ». (shrink)

We argue that developing a human ethics application is an effective method for refining the intent and design of research studies. Our study aimed to investigate the delivery of end-of-life and palliative care nursing to residents of an aged care unit in a Multi-purpose Service/centre in rural Victoria. We used the ethics application process as a strategy to focus the study, and to refine the data collection and analysis techniques. It is our contention that the process of completing the application (...) and gaining ethics approval is laborious; however, the intellectualising that occurs provides researchers with an opportunity to reflect upon and refine their studies, thus ensuring the ultimate success and timely completion of research investigations. (shrink)

Cheating is fairly commonplace at both Tiers 1 and 2 AACSB accredited business schools. Distinct differences exist between Tiers 1 and 2 students with regard to cheating. Tier 1 students are more likely to cheat on written assignments, they believe sanctions impact cheating, and that a stigma is attached to cheating. Tier 2 students are more likely to cheat on exams, and nearly as likely to cheat on written assignments. Tier 2 students accept the notion that moral and ethical people (...) cheat. Tier 2 students who are Business Administration majors, those who are employed 40 h or more per week, married students, and married students with children are more likely to cheat. At both Tiers 1 and 2 schools Asian students are less likely to cheat, but resident members of fraternities and sororities and those who drink frequently are more likely to cheat. (shrink)

Moral distress has been widely reviewed across many care contexts and among a range of disciplines. Interest in this area has produced a plethora of studies, commentary and critique. An overview of the literature around moral distress reveals a commonality about factors contributing to moral distress, the attendant outcomes of this distress and a core set of interventions recommended to address these. Interventions at both personal and organizational levels have been proposed. The relevance of this overview resides in the implications (...) moral distress has on the nurse and the nursing workforce: particularly in regard to quality of care, diminished workplace satisfaction and physical health of staff and increased problems with staff retention. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases. Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s. Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz (E) and Dignitas (D) between 2001 and 2004 and (...) investigated by the University of Zurich’s Institute of Legal Medicine (E: n = 147; D: n = 274, total: 421). Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 (n = 149) were compared with the data of the present study. Results: More women than men were assisted in both organisations (D: 64%; E: 65%). Dignitas provided more assistance to non-residents (D: 91%; E: 3%; p = 0.000), younger persons (mean age in years (SD): D: 64.5 (14.1); E: 76.6 (13.3); p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis (D: 79%; E: 67%; p = 0.013). Lethal medications were more often taken orally in cases assisted by Dignitas (D: 91%; E: 76%; p = 0.000). The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s (women: 52% to 65%, p = 0.031; mean age in years (SD): 69.3 (17.0) to 76.9 (13.3), p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026). Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Background: In Switzerland, non-medical right-to-die organisations such as Exit Deutsche Schweiz and Dignitas offer suicide assistance to members suffering from incurable diseases.Objectives: First, to determine whether differences exist between the members who received assistance in suicide from Exit Deutsche Schweiz and Dignitas. Second, to investigate whether the practices of Exit Deutsche Schweiz have changed since the 1990s.Methods: This study analysed all cases of assisted suicide facilitated by Exit Deutsche Schweiz and Dignitas between 2001 and 2004 and investigated by the University (...) of Zurich’s Institute of Legal Medicine. Furthermore, data from the Exit Deutsche Schweiz study which investigated all cases of assisted suicide during the period 1990–2000 were compared with the data of the present study.Results: More women than men were assisted in both organisations. Dignitas provided more assistance to non-residents, younger persons : D: 64.5 ; E: 76.6 ; p = 0.001), and people suffering from fatal diseases such as multiple sclerosis and amyotrophic lateral sclerosis. Lethal medications were more often taken orally in cases assisted by Dignitas. The number of women and the proportion of older people suffering from non-fatal diseases among suicides assisted by Exit Deutsche Schweiz has increased since the 1990s : 69.3 to 76.9, p = 0.000), non-fatal diseases: 22% to 34%, p = 0.026).Conclusions: Weariness of life rather than a fatal or hopeless medical condition may be a more common reason for older members of Exit Deutsche Schweiz to commit suicide. The strong over-representation of women in both Exit Deutsche Schweiz and Dignitas suicides is an important phenomenon so far largely overlooked and in need of further study. (shrink)

Our study presents an overview of the issues that were brought forward by participants of a moral case deliberation (MCD) project in two elderly care organizations. The overview was inductively derived from all case descriptions (N = 202) provided by participants of seven mixed MCD groups, consisting of care providers from various professional backgrounds, from nursing assistant to physician. The MCD groups were part of a larger MCD project within two care institutions (residential homes and nursing homes). Care providers are (...) confronted with a wide variety of largely everyday ethical issues. We distinguished three main categories: ‘resident’s behavior’, ‘divergent perspectives on good care’ and ‘organizational context’. The overview can be used for agendasetting when institutions wish to stimulate reflection and deliberation. It is important that an agenda is constructed from the bottom-up and open to a variety of issues. In addition, organizing reflection and deliberation requires effort to identify moral questions in practice whilst at the same time maintaining the connection with the organizational context and existing communication structures. Once care providers are used to dealing with divergent perspectives, inviting different perspectives (e.g. family members) to take part in the deliberation, might help to identify and address ethical ‘blind spots’. (shrink)

Health workers and support staff at Malawi’s major referral hospital, the Queen Elizabeth Central Hospital, Blantyre, were on strike between 5th and 19th October 2001. The health workers’ grievances included: lack of risk allowances; poor professional allowances; low salaries; and low housing allowances. The strike resulted in almost total closure of the 1500-bed hospital; only the burns and orthopaedic wards continued to serve patients. Volunteer staff, comprising the Red Cross, and nursing and medical students provided services. Verbal and written threats (...) by the authorities had minimal effect on terminating the strike; rather, they encouraged the resolve to continue with the industrial action. We report aspects of the genesis, progress and resolution of the strike. Although not much seems to have been achieved, both the employer and the workers need to draw lessons from the experience. (shrink)

This study investigated the importance of socioeconomic factors such as education, income, religion, family structure and residence in explaining the increased risk of mortality among vulnerable populations aged less than 20 years in Rio de Janeiro, Brazil. Data used were from the 1991 Brazilian Demographic Census and comprised 121,060 women aged 15–49 residing in Rio de Janeiro. Two alternative statistical methods were used to calculate the risk of death: the widely used Brass method (an indirect estimate which assesses population (...) risks) and a case-control study (which assesses individual risks). The study also focused on the importance of indicators of human and social capital, the lack of which may explain the higher risk of death among children and adolescents. Lack of education was found to be a major determinant of mortality at young ages. Residence in a favela (shantytown), families in which mothers were the head of the family, and a lower median level of income were found to be significant determinants of mortality among vulnerable populations in Brazil. However, religion was not found to be as important a predictor of high mortality. (shrink)

Physician assistants (PAs), nurse practitioners (NPs), and medical residents constitute an increasingly significant part of the American health care workforce, yet patient assent to be seen by nonphysicians is only presumed and seldom sought. In order to assess the willingness of patients to receive medical care provided by nonphysicians, we administered provider preference surveys to a random sample of patients attending three emergency departments (EDs). Concurrently, a survey was sent to a random selection of ED residents and PAs. All respondents (...) were to assume the role of patient when presented with hypothetical clinical scenarios and standardized provider definitions. Despite presumptions to the contrary, ED patients are generally unwilling to be seen by PAs, NPs, and residents. While seldom asked in practice, 79.5% of patients fully expect to see a physician regardless of acuity or potential for cost savings by seeing another provider. Patients are more willing to see residents than nonphysicians. (shrink)

The habits of direct violence in U.S. society continue to pose dangerous and dehumanizing trends. As scholars and activists cultivate alternatives to the use ofviolence, a key need involves providing direct experience for U.S. residents to explore and see the power of unarmed civilian peacekeeping. In this paper I ask the following questions: How can the international unarmed civilian peacekeeping models influence the U.S. in the form of domestic peace teams? What are the accomplishments and the challenges for local peace (...) teams with an eye toward further development? First, I describe some broad trends in the international work of unarmed civilian peacekeeping. Second, I analyze the accomplishments and challenges for the Michigan Peace Team and Ceasefire in Chicago. Third, I integrate these insights to recommend key contributions from each program toward developing more domestic peace teams. I briefly provide a recent example and analysis of implementing these recommendations in the DC Peace Team. (shrink)

Background: Physicians sometimes are asked by co-workers for prescriptions to deal with their medical problems. These “hallway” requests typically occur outside a formal doctor-patient relationship. There are professional guidelines on serving as physician for family members and friends, but no guidelines address writing prescriptions for co-workers. The frequency of these requests and the factors physicians consider in responding to them have not been examined.Objectives: To obtain data on the frequency of these requests and physicians’ attitudes and practices in responding to (...) them, and to explore the ethical considerations in writing prescriptions for co-workers.Design: A survey was administered to all physician faculty and residents in an academic department of internal medicine. The questions included whether the respondent had ever been asked for a prescription by a co-worker and how often the respondent had received such requests and written such prescriptions in the previous three months. Respondents also were asked to rate how likely they would be to write such a prescription in 15 hypothetical scenarios.Results: Of the 113 respondents who completed surveys, 68 percent reported having been asked for a prescription by a co-worker. Among those who had ever been asked, 59 percent had been asked one or more times during the previous three months and 88 percent had ever written such a prescription. Also, 88 percent of all respondents stated they were “very likely” or “likely” to write the prescription in one or more of the hypothetical scenarios.Conclusions: Most physicians in our sample had been asked for prescriptions by co-workers, and most had written such prescriptions. Many respondents indicated a willingness to write such prescriptions in a variety of scenarios, despite the absence of a formal doctor-patient relationship. Further discussion of the ethical considerations in writing prescriptions for co-workers is needed. (shrink)

Decisions regarding life-sustaining medical treatments for young children with profound disabilities can be extremely challenging for families and clinicians. In this study, Brick and colleagues1 surveyed adult residents of the UK about their attitudes regarding withdrawal of treatment using a series of vignettes of infants with varying levels of intellectual and physical disability, based on real and hypothetical cases.1 This is an interesting study on an important topic. We first highlight the limitations of using these survey data to inform public (...) policy and then offer a different interpretation from the authors’ regarding their findings about the value the public appears to place on relational capacity. The authors asked members of the lay public to interpret a disabled child’s best interest in a series of vignettes. The respondents were 92% white; 59% were atheist or reported no religious affiliation. Though the authors note this lack of diversity as a limitation, we would add that this limitation is particularly problematic in this context. Minority views on this issue may differ significantly from the majority perspective. When the stakes are high, use of public opinion data to directly inform policy requires, at a minimum, a representative sample reflecting both the true diversity of views within the public and a method to justly account for the alternate views of the minority. Even if the sampled population were more …. (shrink)

The mechanism by which the mammalian kidney creates the osmotic gradient necessary for urine concentration remains an open question. We present a brief survey of the give-and-take between theory and experiment on this question over the last half century. We start with the introduction of the countercurrent multiplier paradigm in 1951. We finish with a description of a recent suggestion that the explanation for the enigmatic inner medullary osmotic gradient may reside in the very metabolism of the inner medullary cells, (...) which are required by the region's hypoxia to obtain their ATP largely from anaerobic glycolysis and which thus, by the same token, furnish net osmoles to the medullary interstitium by convering glucose to lactate. (shrink)

William James argued for a philosophy of democracy and pluralism that advocates individual and collective responsibility for our social arrangements, our morality, and our religion. In James' view, democracy resides first and foremost not in governmental institutions or in procedures such as voting, but rather in the characteristics of individuals, and in qualities of mind and conduct. It is a philosophy for social change, counselling action and hope despite the manifold challenges facing democratic politics, and these issues still resonate strongly (...) today. In this book, Stephen Bush explores how these themes connect to James' philosophy of religion, his moral thought, his epistemology, his psychology, and his metaphysics. His fresh and original study highlights the relevance of James' thought to modern debates, and will appeal to scholars and students of moral and political philosophy. (shrink)

BackgroundReducing the number of animals used in experiments has become a priority for the governments of many countries. For these reductions to occur, animal-free alternatives must be made more available and, crucially, must be embraced by researchers.MethodsWe conducted an international online survey for academics in the field of animal science (N = 367) to explore researchers’ attitudes towards the implementation of animal-free innovations. Through this survey, we address three key questions. The first question is whether scientists who use animals in (...) their research consider governmental goals for animal-free innovations achievable and whether they would support such goals. Secondly, responders were asked to rank the importance of ten roadblocks that could hamper the implementation of animal-free innovations. Finally, responders were asked whether they would migrate (either themselves or their research) if increased animal research regulations in their country of residence restricted their research.ResultsWhile nearly half (40%) of the responders support governmental goals, the majority (71%) of researchers did not consider such goals achievable in their field within the near future. In terms of roadblocks for implementation of animal-free methods, ~ 80% of the responders considered ‘reliability’ as important, making it the most highly ranked roadblock. However, all other roadblocks were reported by most responders as somewhat important, suggesting that they must also be considered when addressing animal-free innovations. Importantly, a majority reported that they would consider migration to another country in response to a restrictive animal research policy. Thus, governments must consider the risk of researchers migrating to other institutes, states or countries, leading to a ‘brain-drain’ if policies are too strict or suitable animal-free alternatives are not available.ConclusionOur findings suggest that development and implementation of animal-free innovations are hampered by multiple factors. We outline three pillars concerning education, governmental influence and data sharing, the implementation of which may help to overcome these roadblocks to animal-free innovations. (shrink)