Cet article propose une spéculation à l’échelle géopolitique de la « réconciliation » entre les Premières nations et l’État colonial canadien, demandant à quoi pourrait bien ressembler une justice qui ne reproduirait pas le monde dont elle cherche à réparer les violences? Il suggère que les conceptions héritées de la justice du côté de l’Occident colonisateur ne sont pas assez bizarres, que les solutions proposées pour faire face à la violence n’ont pas assez d’humour, d’étrangeté, d’instabilité, pour proposer des bascules (...) significatives. C’est du côté de la rencontre avec les « inappropriées » que se jouent de telles bascules, capables de transformer nos rapports à la notion de justice. (shrink)

The integrative approach to punishment appears more adequate than the utilitarian and retributive theories. It does not only engender restitution, retribution, and deterrence but it also reconciles the physical and nonphysical realms of existence. The goal of punishment is to maintain social balance or order. Content analysis is employed. The integrative notion of punishment is associated with the principle of proportionality within a vigorous collective conscience. This paper seeks to contribute to the criminal justice system by going beyond the discussion (...) of the utilitarian- retributive punishment framework. (shrink)

1. What if I don't want to be saved? -- 2. We didn't vote for gods -- 3. Stop teaching the Bible to school children -- 4. Of criticism and higher criticism -- 5. Time to start to create or own miracles in Africa -- 6. Time to embrace science -- 7. Where are our scientists? -- 8. Miracles, magic, superstitions, delusions and Emmanuel Television -- 9. Of god curses and Ghana economy -- 10. Absurdities in the Bible -- 11. (...) Atrocities in the Bible 12. Indecencies in the Bible -- 13. Contradictions in the Bible -- 14. Why not a national day of science and technology? -- 15. While we slumber and pray -- 16. On prayer and good planning -- 17. Battling ignorance and superstition -- 18. Than men may think -- 19. Exploration of mars, moon and the crash-landing of wizards. (shrink)

Background: The magnitude of bullying and harassment among psychiatrists is reportedly high, yet no peer-review published studies addressing this issue could be found. Therefore, it was decided to conduct a pilot study to assess the degree of the problem, the types of bullying/harassment and to provide some insights into the situation.Methods and Principal Findings: Following multiple focus group meetings, a yes/no response type questionnaire was developed to assess the degree and type of bullying and harassment experienced by psychiatrists. Over a (...) 3-month period the questionnaire was administered to a random sample of 60 psychiatrists. 57 out of the 60 psychiatrists reported harassment and bullying. Frequencies of the following response variables are presented in descending order: rumours 40% ; defamation 20% ; passing remarks 20% ; false accusations 15% ; threats 13.3% ; verbal abuse 13.3% ; unjustified complaints 13.3% ; promotion blocked 13.3% ; humiliation 13% ; bad reference given 10% ; credentials questioned 8.3% ; physical attacks 5% ; termination 5% ; derogatory remarks 1.7% and 1.7% were subjected to personal work. As a result of being subjected to harassment, 66.7% of the psychiatrists did not take any action, whereas 33.3% confronted the person they believed responsible. Asked whether the bullying and harassment caused distress, 18.3% of the psychiatrists did not report any effect, 30% reported mild distress, 40% moderate distress and severe distress was reported by 11.7%.Conclusions: It was concluded that the magnitude of bullying and harassment among psychiatrists may be quite high, as evidenced by this pilot study. There is a need for extensive systematic studies on this subject and to establish strategies to prevent and address this issue at a national and regulatory level. (shrink)

Background: There is a shortage of reports on what potential recipients of implantable cardioverter–defibrillators need to be informed about and what role they can and want to play in the decision-making process when it comes to whether or not to implant an ICD.Aims: To explore how patients with heart failure and previous episodes of malignant arrhythmia experience and view their role in the decision to initiate ICD treatment.Patients and methods: A qualitative content analysis of semistructured interviews was used. The study (...) population consisted of 31 outpatients with moderate heart failure at the time of their first ICD implantation.Setting: The study was performed at Sahlgrenska University Hospital, Göteborg, Sweden.Results: None of the respondents had discussed the alternative option of receiving treatment with anti-arrhythmic drugs, the estimated risk of a fatal arrhythmia, or the expected time of survival from heart failure in itself. Even so, very little criticism was directed at the lack of information or the lack of participation in the decision-making process. The respondents felt that they had to rely on the doctors’ recommendation when it comes to such a complex and important decision. None of them regretted implantation of the ICD.Conclusions: The respondents were confronted by a matter of fact. They needed an ICD and were given an offer they could not refuse, simply because life was precious to them. Being able to give well-informed consent seemed to be a matter of less importance for them. (shrink)

Objective: To explore the relationship between the presentation of suffering and support for euthanasia in the British news media.Method: Data was retrieved by searching the British newspaper database LexisNexis from 1996 to 2000. Twenty-nine articles covering three cases of family assisted suicide were found. Presentations of suffering were analysed employing Heidegger’s distinction between technological ordering and poetic revealing.Findings: With few exceptions, the press constructed the complex terrain of FAS as an orderly or orderable performance. This was enabled by containing the (...) contradictions of FAS through a number of journalistic strategies: treating degenerative dying as an aberrant condition, smoothing over botched attempts, locating the object of ethical evaluation in persons, not contexts, abbreviating the decision making process, constructing community consensus and marginalising opposing views.Conclusion: The findings of this study support the view that news reporting of FAS is not neutral or inconsequential. In particular, those reports presenting FAS as an orderly, rational performance were biased in favor of technical solutions by way of the legalisation of euthanasia and/or the involvement of medical professionals. In contrast, while news reports sensitive to contradiction did not necessarily oppose euthanasia, they were less inclined to overtly support technical solutions, recognising the importance of a trial to address the complexity of FAS. (shrink)

Background: Only data of published study results are available to the scientific community for further use such as informing future research and synthesis of available evidence. If study results are reported selectively, reporting bias and distortion of summarised estimates of effect or harm of treatments can occur. The publication and citation of results of clinical research conducted in Germany was studied.Methods: The protocols of clinical research projects submitted to the research ethics committee of the University of Freiburg in 2000 were (...) analysed. Published full articles in several databases were searched and investigators contacted. Data on study and publication characteristics were extracted from protocols and corresponding publications.Results: 299 study protocols were included. The most frequent study design was randomised controlled trial , followed by uncontrolled studies , laboratory studies and non-randomised studies . 182 were multicentre studies including 97 international collaborations. 152 of 299 had commercial funding and 46 non-commercial funding. 109 of the 225 completed protocols corresponded to at least one full publication ; the publication rate was 48%. 168 of 210 identified publications were cited in articles indexed in the ISI Web of Science. The median was 11 citations per publication .Conclusions: Results of German clinical research projects conducted are largely underreported. Barriers to successful publication need to be identified and appropriate measures taken. Close monitoring of projects until publication and adequate support provided to investigators may help remedy the prevailing underreporting of research. (shrink)

Background: Increasing collaboration between industrialised and developing countries in human research studies has led to concerns regarding the potential exploitation of resource deprived countries. This study, commissioned by the former National Bioethics Advisory Commission of the United States, surveyed developing country researchers about their concerns and opinions regarding ethical review processes and the performance of developing country and US international review boards .Methods: Contact lists from four international organisations were used to identify and survey 670 health researchers in developing countries. (...) A questionnaire with 169 questions explored issues of IRB review, informed consent, and recommendations.Results: The majority of the developing country researchers were middle aged males who were physicians and were employed by educational institutions, carrying out research on part time basis. Forty four percent of the respondents reported that their studies were not reviewed by a developing country IRB or Ministry of Health and one third of these studies were funded by the US. During the review process issues such as the need for local language consent forms and letters for approval, and confidentiality protection of participants were raised by US IRBs in significantly higher proportions than by host country IRBs.Conclusion: This survey indicates the need for the ethical review of collaborative research in both US and host countries. It also reflects a desire for focused capacity development in supporting ethical review of research. (shrink)

In the past thirty years, two fundamental issues have emerged in the philosophy of science. One concerns the appropriate attitude we should take towards scientific theories--whether we should regard them as true or merely empirically adequate, for example. The other concerns the nature of scientific theories and models and how these might best be represented. In this ambitious book, da Costa and French bring these two issues together by arguing that theories and models should be regarded as partially rather than (...) wholly true. They adopt a framework that sheds new light on issues to do with belief, theory acceptance, and the realism-antirealism debate. The new machinery of "partial structures" that they develop offers a new perspective from which to view the nature of scientific models and their heuristic development. Their conclusions will be of wide interest to philosophers and historians of science. (shrink)

Objective: To explore the experiences of people with a “terminal illness”, focusing on the patients’ perspective of euthanasia and assisted suicide.Method: A qualitative study using narrative interviews was conducted throughout the UK. The views of the 18 people who discussed euthanasia and assisted suicide were explored. These were drawn from a maximum variation sample, who said that they had a “terminal” illness, malignant or non-malignant.Results: That UK law should be changed to allow assisted suicide or voluntary euthanasia was felt strongly (...) by most people. Those who had seen others die were particularly convinced that this should be a right. Some had multiple reasons, including pain and anticipated pain, fear of indignity, loss of control and cognitive impairment. Those who did not want to be a burden also had other reasons for wanting euthanasia. Suicide was contemplated by a few, who would have preferred a change in the law to allow them to end their lives with medical help and in the company of family or friends. The few who opposed a change in UK law, or who felt ambivalent, focused on involuntary euthanasia, cited religious reasons or worried that new legislation might be open to abuse.Conclusion: Qualitative research conducted on people who know they are nearing death is an important addition to the international debate on euthanasia and assisted suicide. Those who had seen others die were particularly convinced that the law should be changed to allow assisted death. (shrink)

1. The “puzzle” Physical objects are coloured: roses are red, violets are blue, and so forth. In particular, physical objects have fine-grained shades of colour: a certain chip, we can suppose, is true blue (unique, or pure blue). The following sort of scenario is commonplace. The chip looks true blue to John; in the same (ordinary) viewing conditions it looks (slightly) greenish-blue to Jane. Both John and Jane are “normal” perceivers. Now, nothing can be both true blue and greenish-blue; since (...) the chip is true blue, it is not greenish-blue. Hence Jane, unlike John, is misperceiving the chip. Generalizing, the conclusion is that there is widespread misperception of fine-grained shades. According to Tye (2006), and Cohen, Hardin, and McLaughlin (2006), the previous paragraph amounts to a paradox: an apparently unacceptable conclusion has been drawn from apparently acceptable premises via apparently acceptable reasoning. (See also Hawthorne and Kovakovich 2006, 180-1.) Tye swallows the conclusion, aided by a dose of evolutionary speculation. Hardin (1988), on the other hand, rejects the first premise, and denies that physical objects are coloured. Cohen (2004) and McLaughlin (2003) claim that both Jane and John have the colour of the chip right. Our opening paragraph concealed a crucial parameter. In fact, the chip looks greenish-blue-relative-to- circumstances-C to Jane, and true-blue-relative-to-circumstances-C* to John, and the chip has both these relativized colours.1 All this ingenious philosophizing would be in vain, of course, if the conclusion of the opening paragraph were not puzzling or problematic. So, why is it supposed to be? According to Tye, the conclusion is puzzling because John and Jane are both “normal perceivers” (xx). He seems to think that it is (prima facie) plausible to assume.. (shrink)

OBJECTIVES: To compare the practices of local research ethics committees and the time they take to obtain ethical approval for a multi-centre study. DESIGN: A retrospective analysis of outcome of applications for a multi-centre study to local research ethics committees. SETTING: Thirty-six local research ethics committees covering 38 district health authorities in England. MAIN MEASURES: Response of chairmen and women, the time required to obtain approval, and questions asked in application forms. RESULTS: We received replies from all 36 chairmen contacted: (...) four (11%) granted their approval, and 32 (89%) required our proposal to be considered by their local research ethics committee. Three committees asked us to attend their meetings. The application was approved by all 36 local research ethics committees but the time to obtain ethical approval varied between six to 208 days. One third of the committees did not approve the project within three months, and three took longer than six months. There was considerable variation in the issues raised by local research ethics committees and none conformed exactly to the Royal College of Physicians' guidelines. CONCLUSION: Obtaining ethical approval for a multi-centre study is time-consuming. There is much diversity in the practice of local research ethics committees. Our data support the recommendation for a central or regional review body of multi-centre studies which will be acceptable to all local research ethics committees. (shrink)

Background: Older, frail patients with multimorbidity are at an especially high risk for disease severity and death from COVID-19. The social restrictions proved challenging for the residents, their relatives, and the care staff. While these restrictions clearly impacted daily life in Norwegian nursing homes, knowledge about how the pandemic influenced nursing practice is sparse. Aim: The aim of the study was to illuminate ethical difficult situations experienced by Norwegian nurses working in nursing homes during the COVID-19 pandemic. Research design and (...) participants: The research design involved semistructured individual interviews conducted with 15 nurses working in 8 nursing homes in 3 health regions in Norway, within both urban and rural areas. Ethical considerations: Oral and written information about the study was provided before the participants gave their written consent. The transcribed interviews were de-identified. The study was approved by the Norwegian Centre for Research Data. Findings: Four ethical difficult situations were identified: (a) turning the nursing home into a prison; (b) using medication to maintain peace and order; (c) being left alone with the responsibility; and (d) s. impact on decision-making. Conclusions: The nurses’ ethical challenges were intertwined with external factors, such as national and local guidelines, and the nurses’ own internalized factors, which were connected to their subjective professionality. This duality inflicted emotional distress and gave nurses few opportunities to perform nursing in a professionally sound and safe manner. (shrink)

How is it possible to think new thoughts? What is creativity and can science explain it? And just how did Coleridge dream up the creatures of The Ancient Mariner? When The Creative Mind: Myths and Mechanisms was first published, Margaret A. Boden's bold and provocative exploration of creativity broke new ground. Boden uses examples such as jazz improvisation, chess, story writing, physics, and the music of Mozart, together with computing models from the field of artificial intelligence to uncover the nature (...) of human creativity in the arts. The second edition of The Creative Mind has been updated to include recent developments in artificial intelligence, with a new preface, introduction and conclusion by the author. It is an essential work for anyone interested in the creativity of the human mind. (shrink)

[Edited from Conclusion section:] We have looked at various challenging issues to do with getting connectionism to cope with high-level cognitive activities such a reasoning and natural language understanding. The issues are to do with various facets of generalization that are not commonly noted. We have been concerned in particular with the special forms these issues take in the arena of propositional attitude processing. The main problems we have looked at are: (1) The need to construct explicit representations of (...) generalizations, not just generalize correctly to individual cases; (2) The need to be able to match two or more complex short-term information structures, to enable rapid generalization from recent examples rather than from long-term memories; (3) The need to represent and reason with anomalous combinations of concepts; (4) The need to perform embedded reasoning. This presents special problems for systems using non-concatenative representations (as in mainstream connectionist approaches). We also touched on vague quantification in attitude report complements. Neither this topic nor that of analogies between short-term structures (point 2) has been adequately addressed in the symbolic framework, let alone in connectionism. -/- The opportunities and problems covered are put forward as things worth being optimistic about or pessimistic about, respectively. They are not put forward as decisive arguments for or against connectionism. The hope is that this chapter contributes to a greater understanding of the connectionist/symbolist gap by presenting some unusual issues and by throwing new light on some well known ones. (shrink)

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

Background: Legislation on physician-assisted suicide is being considered in a number of states since the passage of the Oregon Death With Dignity Act in 1994. Opinion assessment surveys have historically assessed particular subsets of physicians.Objective: To determine variables predictive of physicians’ opinions on PAS in a rural state, Vermont, USA.Design: Cross-sectional mailing survey.Participants: 1052 physicians licensed by the state of Vermont.Results: Of the respondents, 38.2% believed PAS should be legalised, 16.0% believed it should be prohibited and 26.0% believed it should (...) not be legislated. 15.7% were undecided. Males were more likely than females to favour legalisation . Physicians who did not care for patients through the end of life were significantly more likely to favour legalisation of PAS than physicians who do care for patients with terminal illness . 30% of the respondents had experienced a request for assistance with suicide.Conclusions: Vermont physicians’ opinions on the legalisation of PAS is sharply polarised. Patient autonomy was a factor strongly associated with opinions in favour of legalisation, whereas the sanctity of the doctor–patient relationship was strongly associated with opinions in favour of not legislating PAS. Those in favour of making PAS illegal overwhelmingly cited moral and ethical beliefs as factors in their opinion. Although opinions on legalisation appear to be based on firmly held beliefs, approximately half of Vermont physicians who responded to the survey agree that there is a need for more education in palliative care and pain management. (shrink)

Objectives: to assess physicians’ and patients’ views in Saudi Arabia towards involving the patient versus the family in the process of diagnosis disclosure and decision-making, and to compare them with views from the USA and Japan.Design: A self-completion questionnaire was translated to Arabic and validated.Participants: Physicians from different specialties and ranks and patients in a hospital or attending outpatient clinics from 6 different regions in KSA.Results: In the case of a patient with incurable cancer, 67% of doctors and 51% of (...) patients indicated that they would inform the patient in preference to the family of the diagnosis . Assuming the family already knew, 56% of doctors and 49% of patients would tell the patient even if family objected . However, in the case of HIV infection, 59% of physicians and 81% of patients would inform the family about HIV status without the patient’s consent . With regards to withholding ventilatory support, about 50% of doctors and over 60% of patients supported the use of mechanical ventilation in a patient with advanced cancer, regardless of the wishes of the patient or the family. Finally, the majority of doctors and patients were against assisted suicide.Conclusions: Although there was more recognition for a patient’s autonomy amongst physicians, most patients preferred a family centred model of care. Views towards information disclosure were midway between those of the USA and Japan. Distinctively, however, decisions regarding life prolonging therapy and assisted suicide were not influenced to a great extent by wishes of the patient or family, but more likely by religious beliefs. (shrink)

Anna J Dare,1 Anthony RJ Phillips,1–3 Michael Chu,1 Anthony JR Hickey,2 Adam SJR Bartlett1–31Department of Surgery, 2Maurice Wilkins Centre for Biodiscovery, University of Auckland, Auckland, New Zealand; 3New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New ZealandBackground: Hepatic steatosis is increasingly encountered among organ donors. Currently, there is no consensus guideline as to the type or degree of donor steatosis considered acceptable for liver transplantation, and little is known about local practices in this area. The aim of this survey (...) was to evaluate current clinical practices amongst liver transplant surgeons in Australia and New Zealand in the evaluation and use of steatotic donor livers in LT.Methods: An anonymous online twelve-question survey was emailed to all practicing LT surgeons in ANZ in January 2010.Results: The response rate was 83%. Estimated prevalence of steatosis in donor livers was between 40% and 60%. In determining suitability for LT, 90% of respondents reported rejecting organs with "severe" steatosis based on visual and palpation grounds alone. A total of 68% sought further histological assessment if the donor liver looked bad and there were risk factors for steatosis. The majority of respondents performed only one biopsy of the liver, using hematoxylin and eosin staining for fat assessment. There was wide variation in the upper limit of steatosis considered to be acceptable for LT. A total of 21% of respondents still considered microvesicular steatosis a risk factor for primary graft nonfunction.Conclusion: This survey highlights the significant variation in the appraisal and use of steatotic grafts by LT surgeons in ANZ. Accurate evaluation and judicious use of mild and moderately steatotic grafts is required if we are to utilize the available donor pool best.Keywords: liver transplantation, steatosis, fatty liver, organ donors. (shrink)

The purpose of the article is to reveal the anthropologization of Dasein-psyche’s being by methods of neurophilosophy. The anthropologization of Dasein-psyche’s being by methods of neurophilosophy allows considering the noogenesis from the perspective of philosophical traditions, which is much richer in comparison with the history of scientific knowledge about the psychology of meanings. The being of Dasein-psyche in the meaning of "philosopher’s soul" was firstly mentioned by Plato in "Phaedo". The anthropologization of Dasein-psyche’s being reveals the ontological orientation and limits (...) of the being of Dasein-psyche within the being of Dasein-the-One, as well as the intellect, knowledge and techne, as the arete existentials. Theoretical basis of the study is built on Heidegger’s fundamental ontology and methods of neurophilosophy. Originality lies in exploring Dasein-psyche through the neurophilosophical approach. In the context, Dasein-psyche is revealed as a part of the whole or the image, created from Dasein-Y-Matter as a paradigm. It is formed by the factors and causes of complication, as well as by the experience of being of the previous states of matter. Conclusions. In conclusion, the anthropologization of Dasein-psyche’s being by methods of neurophilosophy allows considering the noogenesis from the perspective of philosophical traditions. The essence of a person is revealed as the arete existentials, which require further rethinking and clarification. (shrink)

Objectives: To study knowledge and attitudes of hospital ethics committee members at the first workshop for ethics committees in Croatia.Design: Before/after cross-sectional study using a self administered questionnaire.Setting: Educational workshop for members of hospital ethics committees, Zagreb, 2003.Main outcome measurements: Knowledge and attitudes of participants before and after the workshop; everyday functioning of hospital ethics committees.Results: The majority of the respondents came from committees with at least five members. The majority of ethics committees were appointed by the governing bodies of (...) their hospitals. Most committees were founded after the implementation of the law on health protection in 1997. Membership structure and functions were established on the basis of that law. Analysis of research protocols was the main part of their work. Other important functions—education, case analysis, guidelines formation—were neglected. Members’ level of knowledge was not sufficient for the complicated tasks they were supposed to perform. However, it was significantly higher after the workshop. Most respondents felt their knowledge should be improved by additional education. Their views on certain issues and bioethical dilemmas displayed a high level of paternalism and over protectiveness, which did not change after the workshop.Conclusions: The committees developed according to bureaucratic requirements. Furthermore, there are concerns about members’ knowledge levels. More efforts need to be made to use education to improve the quality of the work. Additional research is necessary to explore ethics committees’ work in Croatia especially in the hospital setting. (shrink)

Background: Priority setting is necessary in current healthcare services. Discussion of fair process has highlighted the value of developing reasons for allocation decisions on the basis of experience gained from real cases.Aim: To identify the reasons that those with experience of real decision-making concerning resource allocation think relevant in deciding on the priority of a new but expensive drug treatment.Methods: Semistructured interviews with members of committees with responsibility for making resource allocation decisions at a local level in the British National (...) Health Service, analysed using modified grounded theory.Results: 22 interviews were carried out. 14 reasons were identified. Four reasons were almost universally considered most important: cost effectiveness; clinical effectiveness; equality and gross cost. No one reason was considered dominant. Some considerations, such as political directives and fear of litigation, were thought by many participants to distort decision-making. There was a substantial lack of agreement over the relevance of some reasons, such as the absence of alternative treatment for the condition.Conclusions: There is a clear consensus on the importance and role of a limited number of reasons in allocation decisions among participants. A focus on the process of decision-making, however, does not obviate the need for those involved in the process to engage with problematical ethical issues, nor for the importance of further ethical analysis. (shrink)

Madeleine Simms begins her article by saying that it will attempt to `redress the balance' of views on the conflicting rights of handicapped children and their parents. I, on the other hand, will argue that no semblance of a balance has yet been achieved, and that her questions and conclusions merely serve to tip the scales further away from a genuine rights-based theory to a pragmatic utilitarian assessment of individual `worth'.

ABSTRACT Broome and others have argued that it makes no sense, or at least that it cannot be true, to say that it is better for a given person that he or she exist than not. That argument can be understood to suggest that, likewise, it makes no sense, or at least that it cannot be true, to say that it is worse for a given person that he or she exist than that he or she never have existed at (...) all. This argument is of critical importance to the question of whether consequentialist theory should take a traditional, aggregative form or a less conventional, person‐affecting, or person‐based, form. I believe that, potentially, the argument represents a far more serious threat to the person‐based approach than does, for example, Parfit's two medical programmes example. Parfit's example nicely illustrates the distinction between aggregative and person‐based approaches and raises important questions. But the example — though not, I think, by Parfit — is sometimes pressed into service as a full‐fledged counterexample against the person‐based approach. As such, I argue, the example is not persuasive. In contrast, the Broomeian argument, if correct, is definitive. For that argument relies on certain metaphysical assumptions and various uncontroversial normative claims — and hence nicely avoids putting into play the controversial normative claims that lie at the very heart of the debate. The purpose of the present paper, then, is to evaluate the Broomeian argument. I argue that this potentially definitive challenge to a person‐based approach does not in fact succeed. (shrink)

Quantum frameworks for modeling competitive ecological systems and self-organizing structures have been investigated under multiple perspectives yielded by quantum mechanics. These comprise the description of the phase-space prey–predator competition dynamics in the framework of the Weyl–Wigner quantum mechanics. In this case, from the classical dynamics described by the Lotka–Volterra (LV) Hamiltonian, quantum states convoluted by statistical gaussian ensembles can be analytically evaluated. Quantum modifications on the patterns of equilibrium and stability of the prey–predator dynamics can then be identified. These include (...) quantum distortions over the equilibrium point drivers of the LV dynamics which are quantified through the Wigner current fluxes obtained from an onset Hamiltonian background. In addition, for gaussian ensembles highly localized around the equilibrium point, stability properties are shown to be affected by emergent topological quantum domains which, in some cases, could lead either to extinction and revival scenarios or to the perpetual coexistence of both prey and predator agents identified as quantum observables in microscopic systems. Conclusively, quantum and gaussian statistical driving parameters are shown to affect the stability criteria and the time evolution pattern for such microbiological-like communities. (shrink)

Modern physics asks: how do the objects exist? This kind of question inevitably touches upon philosophy; to be precise, it involves metaphysics that traditionally deals with these problems. There are grounds to assume that a quantum object in a certain sense does not exist until it is registered. Thus, one of the conclusions says, “Photon is a photon if it is a registered photon”. This is a paraphrase of well-known Wheeler’s words about the essence of quantum phenomenon. These effects cannot (...) be understood if we come from the assumption that all existing (‘real’) and quantum objects in particular, is only being of the actual. To explain quantum mechanics phenomena we need to realize that there exists another modus of being. Quantum mechanics refers to some sort oftranscendence. Such conclusion is based not only on the analysis of the testing of Aspeckt’s experiments. The whole structure of quantum mechanics confirms it. The revision of the New European paradigm leads to the return of such conception of existence that brings us to the traditional metaphysical understanding of the being and implies its study on several levels of existence. The conclusion of this kind leads to a serious correction of the philosophical model of the world built by modern natural science. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 36.3 (2003) 177-188 [Access article in PDF] Chaïm Perelman's "First Philosophies and Regressive Philosophy":Commentary and Translation David A. Frank Michelle K. Bolduc Chaïm Perelman's 1949 article, "First Philosophies and Regressive Philosophy," has remained unavailable to readers unable to read French. Our commentary and translation is intended to provide English readers access to the context, influences, and themes that make the article an extraordinarily important work in (...) the history of twentieth-century rhetoric. In this article, Perelman offers a powerful critique of first philosophies and anticipates the problems of radical postmodernity. "First Philosophies" remains a strikingly elegant attempt to foil what Foucault (1984, 41-42) has called the "Enlightenment blackmail of reason," the assumption held by logical positivists and radical skeptics that if reason does not yield absolute and eternal Enlightenment knowledge, there can be no knowledge.Perelman and Lucie Olbrechts-Tyteca's New Rhetoric project avoids Enlightenment blackmail by charting a third way between logical positivism and radical relativism, and "First Philosophies" sets forth the project's philosophical blueprint. Commencing in 1947 and culminating in 1958 with the publication of Traité de l'argumentation: La nouvelle rhétorique, Perelman and Olbrechts-Tyteca sought, discovered, and developed a philosophical system designed as a rapprochement between dialectic (reason and logic) and rhetoric (the art of adapting arguments to audiences). Historians of rhetoric judge the work a "grand revolution" (Meyer 1999, 259), believing it marks a rhetorical renaissance in Europe, and suggest nothing like it will appear for another 100 years after its publication (Johnstone 1971). The New Rhetoric project influenced Gadamer and a host of post-war European and American thinkers (Mootz 1998). Michael Leff calls the 1970 English translation of Traité a "bombshell" (1994, 510). Beyond its historical importance, Crosswhite suggests that the New Rhetoric project is "the single most important event in contemporary rhetorical theory" (1996, 35)and "First Philosophies" marks Perelman's turn from logical [End Page 177] positivism to rhetoric, offering prescient answers to the post-World War II crises of reason, and the ideas in the article provide the Traité'sphilosophical glue (see in particular the English translation, 62).Perelman joined many post-war theorists, including Horkheimer and Adorno (1972), in the resistance to the reign of a disembodied Enlightenment rationality. However, Perelman identified what Habermas (1987, 119) would later call the "performative contradiction" in the conclusion that radical skepticism was the only alternative to Enlightenment rationality. In "First Philosophies," Perelman responds directly to Sartre's 1943 Being and Nothingness (198; see translation below) by exposing the failure of radical skeptics to see that they had been held hostage by Enlightenment blackmail in accepting the Enlightenment criterion for truth, rejecting it, and then making skepticism an absolute. Indeed, "First Philosophies" navigates from this performative contradiction to chart a third way between Enlightenment rationality and radical skepticism with an approach that he labels regressive philosophy. Regressive philosophy, Perelman argues, provides the human community with a mode of philosophical reasoning located between the extremes of Enlightenment rationality and radical skepticism. In this space between extremes, Perelman identifies contingent truths and values dependent on a rhetorical mode of reasoning, one making moral judgments possible.To best understand "First Philosophies," we recognize the importance of historical context in the development of social theories of knowledge (see Delacampagne 1999; Kennedy 1999). The intellectual networks in which philosophers operate also influence the development of philosophical systems, as Randall Collins has aptly documented. In addition to historical context and intellectual networks, Frederick Beiser has recently noted: "[t] he best introduction to any philosophy is the biography of the person who created it" (1999, 5). He argues that textual analysis alone cannot illuminate the motivation or meaning of a philosophy. A sense of Perelman's biography and the cultural influences that gave rise to "First Philosophies" are necessary for a proper understanding of its themes. For Perelman, the primary intellectual exigencies of the post-war period were the interrelated crises of justice, philosophical reasoning, and responsibility to which "First Philosophies" is a... (shrink)

The eclectic problem solving methodology used by the British Medical Association is described in this paper. It has grown from the daily need to respond to doctors’ practical queries and incorporates reference to law, traditional professional codes, and established BMA policies—all of which must be regularly assessed against the benchmark of contemporary societal expectations. The two Jehovah’s Witness scenarios are analysed, using this methodology and in both cases the four principles solution is found to concur with that of the BMA’s (...) approach. The author’s overall conclusion is that although the BMA resorts to a lengthier list of thins to consider, the solutions that emerge are often likely to coincide with the four principles approach. (shrink)

Background: Depression (major depressive disorder) is a common and serious medical illness that negatively affects how you feel, the way you think and how you act. Fortunately, it is also treatable. Depression causes feelings of sadness and/or a loss of interest in activities once enjoyed. It can lead to a variety of emotional and physical problems and can decrease a person’s ability to function at work and at home. Depression affects an estimated one in 15 adults (6.7%) in any given (...) year. And one in six people (16.6%) will experience depression at some time in their life. Depression can strike at any time, but on average, first appears during the late teens to mid-20s. Women are more likely than men to experience depression. Some studies show that one-third of women will experience a major depressive episode in their lifetime. Objectives: The main goal of this expert system is to get the appropriate diagnosis of disease and the correct treatment and give the appropriate method of treatment through several tips that concern the disease and how to treat it and we will see it through the application on the expert system. Methods: in this paper the design of the proposed Expert System which was produced to help Psychologist in diagnosing depression disease through its symptoms such as: a loss of energy, a change in appetite, sleeping more or less, anxiety, reduced concentration, indecisiveness, restlessness, feelings of worthlessness, guilt or hopelessness and thoughts of self-harm or suicide. The proposed expert system presents an overview about depression disease is given, the cause of diseases is outlined and the treatment of disease whenever possible is given out. SL5 Object Expert System language was used for designing and implementing the proposed expert system. Results: The proposed depression disease diagnosis expert system was evaluated by psychologist students and they were satisfied with its performance. Conclusions: The Proposed expert system is very useful for psychologist, patients with depression and newly graduated psychologist. (shrink)

Background: Informed consent in the modern era is a common and important topic both for the well-informed patient and to prevent unnecessary litigation. However, the effectiveness of informed consent in trauma patients is an under-researched area. This paper aims to assess the differences in patient recall of the consent process and desire for information by performing a comparative analysis between orthopaedic trauma and elective patients. Methods: Information from 41 consecutive elective operations and 40 consecutive trauma operations was collected on the (...) first post-operative day. Results: 100% of elective patients and 90% of trauma patients knew what operation they had received (p = 0.06). Overall recall of complications was poor, but was significantly lower in trauma patients compared with elective patients (62% vs 22%, p<0.001). 30% of trauma patients desired more information about their operation compared to 12% of elective patients (p = 0.049), although only 35% of trauma patients wanted written as well as verbal explanations, compared to 85% of elective patients p<0.001). Overall 100% of elective and 90% of trauma patients were happy with the consent process (p = 0.06). Subset analysis of neck of femur compared to other trauma patients showed that the above factors were not significantly different between the two groups. Conclusions: Recall of complications in the trauma patients is significantly lower than in elective patients, although both groups scored poorly overall. Repeated verbal explanations should be reinforced with the option of additional information leaflets for trauma operations. Further research into the usefulness of DVDs for commonly performed operations is warranted, although official internet resources may be more cost-effective. (shrink)

Objectives—During recent decades, rabbis in Israel have been playing an increasing role in the consultation of patients or their families on medical issues. The study was performed to determine the attitude of physicians to rabbinical consultation by parents of sick children for purposes of basic medical decision making.Design and setting–A questionnaire was prepared which contained questions regarding physicians' reactions to specific medical situations as well as their demographic data. The study participants included all the available physicians who were employed in (...) the study period at one tertiary medical centre in Israel, which is not associated with any religious organisation. The questionnaire was presented personally to all of the physicians who were available for the study.Results–Between 63% and 77% of the respondents were accepting of rabbinical consultation in regard to medical decisions. Nevertheless, in cases of divergence from accepted medical practice and in emergencies, almost all stated they would take measures to resist the rabbi's advice. This attitude did not correlate with the physician's age, religious status or experience in medicine.Conclusions–Israeli physicians respect rabbis' suggestions in the area of medical decision making, though they would not let a rabbi's advice interfere with their decisions if they believed the rabbi's opinion went against medical need. In order to prevent an untoward effect of the rabbinical involvement in medicine, rules should be set to establish norms for rabbi-physician collaboration. (shrink)

Would you want to be operated on by a surgeon trained at a medical school that did not evaluate its students? Would you want to fly in a plane designed by people convinced that the laws of physics are socially constructed? Would you want to be tried by a legal system indifferent to the distinction between fact and fiction? These questions may seem absurd, but these are theories being seriously advanced by radical multiculturalists that force us to ask them. These (...) scholars assert that such concepts as truth and merit are inextricably racist and sexist, that reason and objectivity are merely sophisticated masks for ideological bias, and that reality itself is nothing more than a socially constructed mechanism for preserving the power of the ruling elite. In Beyond All Reason, liberal legal scholars Daniel A. Farber and Suzanna Sherry mount the first systematic critique of radical multiculturalism as a form of legal scholarship. Beginning with an incisive overview of the origins and basic tenets of radical multiculturalism, the authors critically examine the work of Derrick Bell, Catherine MacKinnon, Patricia Williams, and Richard Delgado, and explore the alarming implications of their theories. Farber and Sherry push these theories to their logical conclusions and show that radical multiculturalism is destructive of the very goals it wishes to affirm. If, for example, the concept of advancement based on merit is fraudulent, as the multiculturalists claim, the disproportionate success of Jews and Asians in our culture becomes difficult to explain without opening the door to age-old anti-Semitic and racist stereotypes. If historical and scientific truths are entirely relative social constructs, then Holocaust denial becomes merely a matter of perspective, and Creationism has as much "validity" as evolution. The authors go on to show that rather than promoting more dialogue, the radical multiculturalist preferences for legal storytelling and identity politics over reasoned argument produces an insular set of positions that resist open debate. Indeed, radical multiculturalists cannot critically examine each others' ideas without incurring vehement accusations of racism and sexism, much less engage in fruitful discussion with a mainstream that does not share their assumptions. Here again, Farber and Sherry show that the end result of such thinking is not freedom but a kind of totalitarianism where dissent cannot be tolerated and only the naked will to power remains to settle differences. Sharply written and brilliantly argued, this book is itself a model of the kind of clarity, civility, and dispassionate critical thinking which the authors seek to preserve from the attacks of the radical multiculturalists. With far-reaching implications for such issues as government control of hate speech and pornography, affirmative action, legal reform, and the fate of all minorities, Beyond All Reason is a provocative contribution to one of the most important controversies of our time. (shrink)

In the present article, the author deals with the role of the middle term in the four figures of conjunctive syllogism. In this regard, he refers to the views of logicians such as Ibn Sina, Fakhr al-Din Razi, Muhaqqiq Tusi, Urmawi, Athir al-Din Abhari as well as Mulla Sadra. The author is of the view that many difficulties in syllogisms arise out of linguistic deficiencies.By resorting to Mulla Sadra's view, the author concludes that we are not compelled to divide the (...) syllogism to its traditional four forms, for on the basis of the Sadrian view, the only condition for the productivity of all forms of syllogism is the repetition of the middle term. Therefore, with regard to the mechanical deduction of the conclusion of premises, it seems unneccessary for us to distinguish the figures of a syllogism from each other. (shrink)

1. Transmission Jim’s teacher has just given him his marked maths exam. Jim knows that his mark is 7.25 out of 22. He also knows that the pass mark is 35%. Does Jim know he has failed? No, he doesn’t. Not yet. As you would expect from his mark, Jim is not very good with numbers. He’ll need a few minutes with pencil and paper to work out that 7.25 is less than 35% of 22. Only then will he know (...) that he has failed. This case exemplifies a common and important phenomenon: someone recognises the validity of an inference from a set of premises that he knows, and in so doing he acquires knowledge of the conclusion. Jim knows that his mark is 7.25 out of 22 and that the passmark is 35%. Then, by virtue of his calculation, he comes to recognise the validity of the inference from these premises to the conclusion that he has failed, thereby coming to know the sad truth. It is undeniable that there are many cases, like Jim’s, in which recognising the validity of an inference from known premises brings about knowledge of the conclusion, as this is the most natural characterisation of what goes on when we acquire knowledge by deductive inference. But can knowledge always be acquired in this way? Does recognition of the validity of an inference from known premises always bring about knowledge of the conclusion? (shrink)

The “new natural lawyers” (NNLs) are a prolific group of philosophers, theologians, and political theorists that includes John Finnis, Robert George, Patrick Lee, Gerard Bradley, and Germain Grisez, among others. These thinkers have devoted themselves to developing and defending a traditional sexual ethic according to which homosexual sexual acts are immoral per se and marriage ought to remain an exclusively heterosexual institution. The sterility objection holds that the NNLs are guilty of making an arbitrary and irrational distinction between same-sex couples (...) and sterile heterosexual couples. The NNLs believe that it is a necessary condition for two people’s being morally and legally entitled to get married that they be able to perform sexual acts that are “suited to procreating.” But sterile heterosexual couples are incapable of performing such acts. Therefore, it should follow from the NNLs’ own premises that sterile heterosexual couples are not entitled to marry. But the NNLs do not draw this conclusion. Instead, they maintain that sterile heterosexuals can marry while denying that the same is true of same-sex couples. The sterility objection claims the NNLs are being inconsistent in treating the two kinds of couples differently. Although the sterility objection has been endorsed by recent critics, I don’t think it has yet been adequately defended. The NNLs have responded by arguing that there is a sense in which the sex acts of sterile heterosexual couples are as suited to reproduction as those of fertile heterosexuals. Thus they maintain that the distinction they draw between the two kinds of couple has a rational basis. A successful defense of the sterility objection must show that this response on the part of the NNLs fails. Such is the task I undertake in this paper. I argue that the NNLs’ response fails because acts of penile-vaginal intercourse between sterile heterosexuals lack the actual causal power to produce conception that sexual acts need to be considered truly reproductive, and because their assumption that penile-vaginal intercourse always functions reproductively is bad biology. (shrink)

The most important question under this heading is the question whether states are subject to the moral law. That they are has sometimes been denied even in theory, and there are no doubt still countries in which it would be highly desirable to publish an article combating this denial. But, thank goodness, England is not one of these countries, and it will suffice to say briefly that I can find no even plausible argument for the contrary view. This view has (...) often been associated with the doctrine that the State is a sort of super-person over and above the individual citizens, to whom the latter can appropriately be sacrificed as beings of little worth, as we sacrifice to our own welfare, if we can, without any compunction the myriad germs inhabiting our bodies. I cannot see any reason whatever for holding this view either, but I should have thought that, if it were adopted, the analogy of the individual thus applied to the State would suggest the contrary conclusion that the State should find its true good not in its own unscrupulous aggrandizement but in co-operation with other States. We have been taught the analogous doctrine in regard to the individual from the beginning of the Christian era or earlier, and we can look on it as generally accepted in regard to the individual by reflective people in theory, although not, of course, by any means always in practice. If we regard the State as just a group of individuals, there is still less excuse for making it out to be subject to no moral law. In that case actions of the State will always be actions by individual persons, differing only from other such actions because they are performed on behalf of certain groups of persons. (shrink)

Why is it that despite having many of the same concerns on how ethics may be included in undergraduate medical curriculums, I write to state my concerns on Cowley’s formulation and conclusions.1I think my main problem is with an argument that starts from a position of criticising “universalising”, but offers as a substitute the idealising of another universality—“their own healthy intuitions and vocabulary”. What is it that can help in promoting an appreciation of what may be a “healthy”, as opposed (...) to an “unhealthy”, intuition? At the risk of immediately undermining my argument by indulging in psychoanalytical …. (shrink)

The most closely argued and widely discussed case against abortion in the philosophical literature today is Don Marquis’s “future like ours” argument. The argument moves from an analysis of why there is a serious presumption against killing someone “like us” to the conclusion that most abortions are seriously wrong for the same reason: they deprive “an individual” of a future of valuable experiences and activities, a “future like ours”. Julian Savulescu has objected that “preventing” such a future could not (...) be as seriously presumptively wrong as Marquis contends for if it were, even contraception and failure to engage in reproductive cloning would be seriously presumptively wrong. Savulescu maintains that there is only a modest presumption against preventing a “future of value like ours” and that in the case of human embryonic stem cell research, it is clearly outweighed by “the enormous potential to save people’s lives and to improve their quality of life”. Marquis defends his strong anti-abortion stance against Savulescu’s “contraception” and “failure to clone” objections but surprisingly says nothing about the implications of the “future like ours” argument for the controversy surrounding human embryonic stem cell research. I argue that key features of Marquis’s response actually support the view that embryos used in stem cell research are not included within the protective scope of the “future like ours” argument. It is significant that the most philosophically rigorous anti-abortion case thus far presented does not entail that human embryonic stem cell research is even presumptively wrong. (shrink)

What ethical principles should autonomous machines follow? How do we implement these principles, and how do we evaluate these implementations? These are some of the critical questions Vivek Nallur asks in his essay “Landscape of Machine Implemented Ethics (2020).” He provides a broad, insightful survey of answers to these questions, especially focused on the implementation question. In this commentary, I will first critically summarize the main themes and conclusions of Nallur’s essay and then expand upon the landscape that Nallur presents (...) by suggesting additional approaches to machine ethics. The approaches I discuss reflect normative ethical theories and need not be applied only to machines, although machine ethics is the focus here. The overall goal is to open up further questions and research possibilities as society searches for the best approach to machine ethics. (Due to an unfortunate miscommunication with the copy editor an important reference was omitted from this article. The reference that should be included is: Nallur, V. (2020). Landscape of Machine Implemented Ethics. Science and Engineering Ethics 26 (5):2381-2399.). (shrink)

BackgroundAs moral case deliberations (MCDs) have increasingly been implemented in health care institutions as a form of ethics support, it is relevant to know whether and how MCDs actually contribute to positive changes in care. Insight is needed on what actually happens in daily care practice following MCD sessions. This study aimed at investigating the impact of MCD and exploring how ‘impact of MCD’ should be conceptualized for future research.MethodsA multiple-case study was conducted in a care organization for people with (...) intellectual disabilities and/or acquired brain injury, by observing MCD sessions as ‘cases’, followed by interviews with health care professionals concerning the follow-up to these cases, and a focus group with involved MCD facilitators. A conceptual scheme concerning the possible impact formed the basis for analysis: (1) individual moral awareness; (2) the actions of health care professionals; (3) collaboration among health care professionals; (4) the concrete situation of the client; (5) the client’s quality of care and life; (6) the organizational and policy level.ResultsAccording to interviewees, their moral awareness and their collaboration, both among colleagues and with clients’ relatives, improved after MCD. Perceived impact on client situation, quality of care/life and the organizational level varied among interviewees or was difficult to define or link to MCD. Three aspects were added to the conceptual scheme concerning the impact of MCD: (a) preparations and expectations prior to the MCD session; (b) a translational step between the conclusions of the MCD session and practical events in the following period, and (c) collaboration with clients’ relatives. A negative impact of MCD was also found on misunderstandings among participants and disappointment about lack of follow-up.ConclusionsConcretizing and conceptualizing the ‘impact’ of MCD is complicated as many factors play a role either before or during the transition from MCD to practice. It is important to consider ‘impact’ in a broad sense and to relate it to the goals and context of the MCD in question. Future studies in this field should pay additional attention to the preparations, content and process involved in ethics support, including clients’ and relatives’ experiences. (shrink)

Forty years after the end of the Second Vatican Council, contrasting opinions dispute the range of its reception and its real effects as the Catholic Church struggles in a changing world of secularization and pluralism. The present paper tries to throw new light on the historical significance of that event, mobilizing different methods and applying some new ‘hermeneutical lenses’. Four topics will serve for this task: the ‘neo‐Enlightened’ mood that affected a fair amount of its reception; the evolutive process of (...) variations and selections associated with it; the forms of ‘rationalization’ and ‘expansion’, which the Council promoted; and the theological challenge of discerning the ‘signs of the time’. In conclusion, the historical judgment on the Council should keep in mind the complexity of the entire process of modernization it assumed. (shrink)

The main article is devoted to the historical and philosophical reconstruction of controversy between Vladimir Solovyov and the authors of the “Faith and Reason” - a magazine of the Kharkov Theological Seminary. This controversy took its place in the “theological and journalistic” or the “theocratic” period of Solovyov’s works. Particular attention is paid to the disputes of Solovyov and T. Stoyanov, A.P. Shost'in and the French Orthodox priest Fr. Vladimir Gette on the theory of dogmatic development in the church. In (...) the context of this controversy, the arguments for the “defense” of Solovyov's position, cited in the magazine “Orthodox Review” by a theologian and Konstantin Leontyev's follower Ivan Kristi are also analyzed. The reception of Solovyov's theocratic ideas and reaction to his ecclesiastical views in both the Catholic and Orthodox circles of Russian and Western society is shown. Especially it concerns the criticism of Solovyov’s ideas in the pages of the French magazines “L’Univers”, “L'Union Chrétienne”, “Revue d’Eglise greque-unie”, etc. The evolution of Solovyov's views on the problem of the union of Eastern and Western churches, the renewal of church communication between Orthodoxy and Catholicism, the main result of which was his fundamental but unfinished work “The History and Future of the Theocracy” was demonstrated. A conclusion about the “superficiality” of the judgments of the majority of Vladimir Solovyov's ideological opponents, as well as later interpreters of his legacy, following the French Jesuit Michel d'Erbigny, who tried to present him as a “Russian Newman” who converted from Orthodoxy into the Catholic faith is drawn. It is shown that Solovyov’s projects of the “religion of the Holy Spirit” and the “Universal Church”, created on its basis, should be considered primarily in the context of his own philosophical quest, and not in connection with the confessional and ideological divergences of his time. (shrink)

The search for 'ecological insights' in venerable Asian traditions of thought prompts questions about how such traditions understood humans in relation to nature. Answers which focus on philosophical and religious ideas may overlook culturally important understandings of people and places articulated within scientific and medical thinking. The paper tentatively explores the prospects for gleaning a form of ethics of place from the study of traditional Hindu and Chinese medical sources. Although there are serious problems with the idea that any unadulterated (...) assimilation from other traditions can take place, these sources can be thought of as incorporating a place-centred ethic. By looking closely at Francis Zimmerman's study of Hindu medicine, it is argued that a poetics of place can be ascribed to Ayurvedic discourses on health and disease. It may be possible to associate a similar poetics with classical Chinese medical worldviews, these being reconcilable with-though not the same as-contemporary ecological understandings of humans in relation to the world. Although no pristine reconstruction of Asian traditions of medical thought can be made, the conclusion of the present paper is that it would be wrong to dismiss these traditions as 'antienvironmental', based purely on the study of philosophical and religious texts. (shrink)

The paper asks under what conditions deductive reasoning transmits justification from its premises to its conclusion. It argues that both standard externalist and standard internalist accounts of this phenomenon fail. The nature of this failure is taken to indicate the way forward: basic forms of deductive reasoning must justify by being instances of 'blind but blameless' reasoning. Finally, the paper explores the suggestion that an inferentialist account of the logical constants can help explain how such reasoning is possible.

Introduction Tourette Syndrome is a childhood onset disorder characterized by vocal and motor tics and often remits spontaneously during adolescence. For treatment refractory patients, Deep Brain Stimulation may be considered. Methods and Results We discuss ethical problems encountered in two adolescent TS patients treated with DBS and systematically review the literature on the topic. Following surgery one patient experienced side effects without sufficient therapeutic effects and the stimulator was turned off. After a second series of behavioural treatment, he experienced a (...) tic reduction of more than 50%. The second patient went through a period of behavioural disturbances that interfered with optimal programming, but eventually experienced a 70% tic reduction. Sixteen DBS surgeries in adolescent TS patients have been reported, none of which pays attention to ethical aspects. Discussion Specific ethical issues arise in adolescent TS patients undergoing DBS relating both to clinical practice as well as to research. Attention should be paid to selecting patients fairly, thorough examination and weighing of risks and benefits, protecting the health of children and adolescents receiving DBS, special issues concerning patient’s autonomy, and the normative impact of quality of life. In research, registration of all TS cases in a central database covering a range of standardized information will facilitate further development of DBS for this indication. Conclusion Clinical practice should be accompanied by ongoing ethical reflection, preferably covering not only theoretical thought but providing also insights in the views and perspectives of those concerned, that is patients, family members and professionals. (shrink)

Objectives To evaluate whether the requirement of “minimal risk and burden” for paediatric research without direct benefit to the subjects compromises the ability to obtain data necessary for improving paediatric care. To provide evidence-based reflections on the EU recommendation that allows for a higher level of risk. Design and setting Systematic analysis of the approval/rejection decisions made by the Dutch Central Committee on Research involving Human Subjects (CCMO). Review methods The analysis included 165 proposals for paediatric research without direct benefit (...) that were reviewed by the CCMO between January, 2000, and July, 2007. A separate, in-depth analysis of all drug studies included 18 early phase drug studies and nine other drug studies without direct benefit. Results 11 out of 165 studies were definitively rejected because the CCMO did not regard the risk and/or burden to be minimal. In three of these 11 cases (including two early phase drug studies) the requirement of minimal risk and burden was cited as the only reason for rejection. Four other early phase drug studies also involved risks and/or burdens that were not regarded to be minimal but were nevertheless approved. Conclusions The requirement of minimal risk and burden, aiming to protect research subjects, occasionally leads to rejection of protocols. Early phase drug studies relatively often do not comply with the requirement. Committees may find ways to approve important studies that formally should be rejected, but that is not a desirable solution. The regulatory framework should be revised to make such occasional exceptions to the requirement legitimate and transparent. (shrink)

As its subtitle indicates, Democracy’s Discontent is a study of the political philosophies that have guided America’s public life. The “search” Michael Sandel describes has, in his view, temporarily come to a disappointing resolution in America’s acceptance of a liberal “public philosophy” that “cannot secure the liberty it promises” and has left Americans “discontented” with their “loss of self-government and the erosion of community”. This theme is unlikely to surprise readers familiar with Sandel’s earlier work. What may surprise them is (...) how little of Sandel’s second book is devoted to his critique of liberal theory or to his defense of his favored “republican” alternative. Far less than 10 percent of the book is devoted to characterizing liberal and republican political philosophy and to argument concerning their relative theoretical virtues. The body of Democracy’s Discontent is a history of American Constitutional law and political/economic debate, from pre-Revolutionary times to the Clinton presidency, all designed to show that the republican vision that has animated so much of that history has been recently abandoned to our detriment, replaced by a liberal public philosophy whose dramatic failure in practice “recapitulates” its “poverty in theory”. Sandel’s history is lively and engaging, and many of his analyses are insightful and persuasive. But the looseness in his treatment of theory regularly infects the conclusions he draws from this history and undermines his efforts to show that American political practice indicts liberal political philosophy. (shrink)

My title is deliberately provocative. What could be less humanitarian than the Melian Dialogue? For most readers of Thucydides it is the paradigm of imperial brutality, ranking with the braggadocio of Sennacherib's Rabshakeh in its insistence upon the coercive force of temporal power. The Melians are assured that the rule of law is not applicable to them. As the weaker party they can only accept the demands of the stronger and be content that they are not more extreme. Appeals to (...) moral or religious norms are quite irrelevant, for in their position the Melians simply cannot afford them—as little as Mr. Doolittle could afford middle-class morality. The message is a hard one, and it has elicited outrage over the centuries from the majority of scholars who tend to prefer the καλὰ ὀνόματα of propaganda to the harsh underlying realities of imperial expansion. Dionysius of Halicarnassus, writing shortly after a war to protect western values had resulted in a new world order, finds it inconceivable that Athenian generals could discount divinely-inspired hope and insist on the imperative of force or that the Melians, that tiny state, would prefer the nobler to the safer course. In this he is echoed by George Grote, writing in the expansionist days of the early nineteenth century: ‘a civilized conqueror is bound by received international morality to furnish some justification—a good plea, if he can—a false plea or a sham plea if he has not better’. Instead, says Grote, the Athenian envoy ‘disdains the conventional arts of civilized diplomacy’; and the inevitable conclusion for him, as it had been for Dionysius, is that the Dialogue is fundamentally bogus, a composition of Thucydides ‘to bring out the sentiments of a disdainful and confident conqueror in dramatic antithesis’. (shrink)

Purpose Prescription stimulant use as “cognitive enhancers” has been described among undergraduate college students. However, the use of prescription stimulants among future health care professionals is not well characterized. This study was designed to determine the prevalence of prescription stimulant misuse among students at an academic health sciences center. -/- Method Electronic surveys were e-mailed to 621 medical, pharmacy, and respiratory therapy students at East Tennessee State University for four consecutive weeks in fall 2011. Completing the survey was voluntary and (...) anonymous. Surveys asked about reasons for, frequency of, and side effects of nonprescription misuse of prescription stimulants. Given the sensitive material, an opportunity to win one of ten $50 gift cards was used as an incentive. -/- Results Three hundred seventy-two (59.9%) students completed the survey from three disciplines (47.6% medical, 70.5% pharmacy, and 57.6% respiratory therapy). Overall, 11.3% of responders admitted to misusing prescription stimulants. There was more misuse by respiratory therapy students, although this was not statistically significant (10.9% medicine, 9.7% pharmacy, 26.3% respiratory therapy; P = .087). Reasons for prescription stimulant misuse included to enhance alertness/ energy (65.9%), to improve academic performance (56.7%), to experiment (18.2%), and to use recreationally/get high (4.5%). -/- Conclusions Prescription stimulant misuse was prevalent among participating students, but further research is needed to describe prevalence among future health care workers more generally. The implications and consequences of such misuse require further study across professions with emphasis on investigating issues of academic dishonesty (e.g., “cognitive enhancement”), educational quality, and patient safety or health care quality. (shrink)