Few residency training programmes explicitly require substantive exposure to issues in medical ethics and fewer still have a formal curriculum in this area. Traditional undergraduate medical ethics courses teach preclinical students to identify ethical issues and analyse them at a theoretical level. Residency training, however, is the ideal time to establish the critical behavioural link which makes ethics truly useful in clinical medicine. The General Internal Medicine Residency Training Program at Rhode Island Hospital has developed an integrated, three-year curriculum with (...) the goals of helping residents to perceive ethical issues in clinical practice, to utilise basic philosophical principles in resolving ethical dilemmas and to communicate these issues clearly and sensitively to patients. The curriculum has been well received by residents and has had a hospital-wide impact. We believe that training residents in medical ethics and communication skills is an effective approach to developing physicians' humane qualities. (shrink)

The Ethos of Medicine in Postmodern America is an analysis of medical care, medical education and medical professionalism with reference to the cultural touchstones of the postmodern era: consumerism, computerization, destruction of meta-narratives, and “stakeholder late capitalism.” The prism of postmodern thought provides a powerful heuristic to grasp the fundamental changes that have occurred and substantively changed the ethos of healthcare delivery, the patient-physician relationship, the physician-corporate entanglement, and the addition of more stakeholders in healthcare delivery.

The Ethos of Medicine in Postmodern America is an analysis of medical care, medical education, and medical professionalism with reference to the cultural touchstones of the postmodern era: consumerism, computerization, destruction of meta-narratives, and “stakeholder late capitalism.”.

Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how the 'medical (...) consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver. (shrink)

Formal training in clinical ethics must become a central part of residency curricula to prepare practitioners to manage the ethical dimensions of patient care. Residency educators must ground their teaching in an understanding of the conceptual, biomedical, and psychosocial aspects of the important ethical issues that arise in that field of practice. Four aspects of professional competence in clinical ethics provide a useful framework for curricular planning. The physician should learn to: (1) recognize ethical issues as they arise in clinical (...) care and identify hidden values and unacknowledged conflicts; (2) think clearly and critically about these issues in ways that lead to ethically justifiable courses of action; (3) apply those practical skills needed to implement an ethically justifiably course of action; and (4) judge when the management of a clinical situation requires consultation with individuals or institutional bodies with additional expertise or authority. We argue that these practical goals can be accomplished with a relatively modest emphasis on the theoretical aspects of medical ethics. (shrink)

Objective: To determine the usefulness of Q methodology to locate and describe shared subjective influences on clinical decision making among participant physicians using hypothetical cases containing common ethical issues. Design: Qualitative study using by-person factor analysis of subjective Q sort data matrix. Setting: University medical center. Participants: Convenience sample of internal medicine attending physicians and house staff (n = 35) at one midwestern academic health sciences center. Interventions: Presented with four hypothetical cases involving urgent decision making near the end of (...) life, participants selected one of three specific clinical actions offered for each case. Immediately afterward and while considering their decision, each respondent sorted twenty-five subjective self-referent items in terms of the influence of each statement on their decision-making process. By-person factor analysis, where participants are defined as variates, yielded information about the attitudinal background the physicians brought to their consideration of each hypothetical case. We performed a second-order factor analysis on all of the subjective viewpoints to determine if a smaller core of shared attitudes existed across some or all of the four case vignettes. Factor scores for each item and post-sort comments from interviews conducted individually with each respondent guided the interpretation of ethical perspective used by these respondents in making clinical decisions about the cases. Measurements and Main Results: Second-order factor analysis on seventeen viewpoints used by physicians in the four hypothetical urgent decision cases revealed three moderately correlated (r 2 < 40%) subjective core attitudinal guides used broadly among all the cases and among sixteen of the seventeen original factors. Across all the cases, our participants were guided in general by: (1) patient-focused beneficence, (2) a patient- and surrogate-focused perspective that includes risk avoidance, and (3) best interest of the patient guided by ethical values. Economic impact on the physician, expediency in resolution of the situation, and the expense of medical treatment were not found to be influential determinants in this study. Conclusions: Q sorting and by-person factor analysis are useful qualitative methodological tools to study the complex structure of subjective attitudes that influence physicians in making medical decisions. This study revealed the subjective viewpoints used by our physician participants as they made ethically challenging treatment decisions. The three second-order factors identified here are grounded in current bioethical values as well as the personal traits of physicians. The participants' decision methods appear to resemble casuistry more than principle-based decision making. Generalizability of results will require further studies. (shrink)

One approach to understanding how the human cognitive system stores and operates with quantifiers such as “some,” “many,” and “all” is to investigate their interaction with the cognitive mechanisms for estimating and comparing quantities from perceptual input (i.e., nonsymbolic quantities). While a potential link between quantifier processing and nonsymbolic quantity processing has been considered in the past, it has never been discussed extensively. Simultaneously, there is a long line of research within the field of numerical cognition on the relationship between (...) processing exact number symbols (such as “3” or “three”) and nonsymbolic quantity. This accumulated knowledge can potentially be harvested for research on quantifiers since quantifiers and number symbols are two different ways of referring to quantity information symbolically. The goal of the present review is to survey the research on the relationship between quantifiers and nonsymbolic quantity processing mechanisms and provide a set of research directions and specific questions for the investigation of quantifier processing. (shrink)

One of the traditional pragmatic approaches to vagueness suggests that there needs to be a significant gap between individuals or objects that can be described using a vague adjective like tall and those that cannot. In contrast, intuitively, an explicit comparative like taller does not require fulfillment of the gap requirement. Our starting point for this paper is the consideration that people cannot make precise measures under time pressure and their ability to discriminate approximate heights obeys Weber’s law. We formulate (...) and experimentally test three hypotheses relating to the difference between positive and comparative forms of the vague adjectives, gap requirement, and Weber’s law. In two experiments, participants judged appropriateness of usage of positive and comparative forms of vague adjectives in a sentence-picture verification task. Consequently, we review formal analysis of vagueness using weak orders and semi-orders and suggest adjustments based on the experimental results and properties of Weber’s law. (shrink)

This paper investigates provability and non-provability of well-foundedness of ordinal notations in weak theories of bounded arithmetic. We define a notion of well-foundedness on bounded domains. We show that T21 and S22 can prove the well-foundedness on bounded domains of the ordinal notations below 0 and Γ0. As a corollary, the class of polynomial local search problems, PLS, can be augmented with cost functions that take ordinal values below 0 and Γ0 without increasing the class PLS.

This paper proves exponential separations between depth d-LK and depth -LK for every utilizing the order induction principle. As a consequence, we obtain an exponential separation between depth d-LK and depth -LK for . We investigate the relationship between the sequence-size, tree-size and height of depth d-LK-derivations for , and describe transformations between them. We define a general method to lift principles requiring exponential tree-size -LK-refutations for to principles requiring exponential sequence-size d-LK-refutations, which will be described for the Ramsey principle (...) and d=0. From this we also deduce width lower bounds for resolution refutations of the Ramsey principle. (shrink)

To organise future behaviour, it is important to remember both the central and contextual aspects of a situation. We examined the impact of contextual threat or safety, learned through verbal instructions, on face identity recognition. In two studies (N = 140), 72 face–context compounds were presented each once within an encoding session, and an unexpected item/source recognition task was performed afterwards (including 24 new faces). Hierarchical multinomial processing tree modelling served to estimate individual parameters of item (face identity) and source (...) memory (threat or safety context) as well as guessing behaviour. Results show that language was highly effective in establishing threatening and safe context conditions. In Study 1, a fleeting picture stream (1 s per picture) led to poor item and source recognition. Prolonged presentation times (Study 2 with 6 s per picture) improved face memory but no contextual modulation was observed. Thus, incidental face learning was surprisingly poor and rapidly changing contextual settings might have interfered with the accurate encoding of face identity information and item–source binding. (shrink)

The complexity class of [Formula: see text]-polynomial local search problems is introduced and is used to give new witnessing theorems for fragments of bounded arithmetic. For 1 ≤ i ≤ k + 1, the [Formula: see text]-definable functions of [Formula: see text] are characterized in terms of [Formula: see text]-PLS problems. These [Formula: see text]-PLS problems can be defined in a weak base theory such as [Formula: see text], and proved to be total in [Formula: see text]. Furthermore, the [Formula: (...) see text]-PLS definitions can be skolemized with simple polynomial time functions, and the witnessing theorem itself can be formalized, and skolemized, in a weak base theory. We introduce a new [Formula: see text]-principle that is conjectured to separate [Formula: see text] and [Formula: see text]. (shrink)

This paper investigates provability and non-provability of well-foundedness of ordinal notations in weak theories of bounded arithmetic. We define a notion of well-foundedness on bounded domains. We show that T21 and S22 can prove the well-foundedness on bounded domains of the ordinal notations below 0 and Γ0. As a corollary, the class of polynomial local search problems, PLS, can be augmented with cost functions that take ordinal values below 0 and Γ0 without increasing the class PLS.

Confused terms appear to signify more than one entity. Carnap maintained that any putative name that is associated with more than one object in a relevant universe of discourse fails to be a genuine name. Although many philosophers have agreed with Carnap, they have not always agreed among themselves about the truth-values of atomic sentences containing such terms. Some hold that such atomic sentences are always false, and others claim they are always truth-valueless. Field maintained that confused terms can still (...) refer, albeit partially, and offered a supervaluational account of their semantic properties on which some atomic sentences with confused terms can be true. After outlining many of the most important theoretical considerations for and against various semantic theories for such terms, we report the results of a study designed to investigate which of these accounts best accords with the truth-value judgments of ordinary language users about sentences containing these terms. We found that naïve participants view confused names as capable of successfully referring to one or more objects. Thus, semantic theories that judge them to involve total reference failure do not comport well with patterns of ordinary usage. (shrink)

This essay focuses on the contemporary relevance of Hannah Arendt’s work insofar as it relates to US racism, imperialism, and migration. While Arendt denied that US migration policy and racism were linked or even similar to exercises of racialized sovereignty, totalitarian tactics, and mass displacement in Europe, I suggest that her analyses help us to understand important racialized dialectics between prison and camp, citizen and stateless, and external displacement and internal displacement. In effect, this essay suggests that many of Arendt’s (...) analyses of racism, migration, and camps are more relevant to US history and contemporary US reality than she did or would have admitted. Arendt’s work importantly suggested that the stateless were so rightless that they lacked even criminal rights. In many respects, the criminal-stateless binary accurately illustrates the rightlessness of refugees in contrast to the rights of US citizen-criminals. However, she partly fails to recognize how the dialectical opposition between foreigner and citizen-criminal could lead to less visible forms of overlap and convergence. Arendt’s binary also indicates an adherence to crypto-normativity, despite her professed antifoundational approach to political issues. Together, her theoretical strengths and certain failures illuminate our own (mis)understandings of a set of complex circumstances experienced today. (shrink)

Why Don't You Just Talk to Him? looks at the broad political contexts in which violence, specifically domestic violence, occurs. Kathleen Arnold argues that liberal and Enlightenment notions of the social contract, rationality and egalitarianism -- the ideas that constitute norms of good citizenship -- have an inextricable relationship to violence. According to this dynamic, targets of abuse are not rational, make bad choices, are unable to negotiate with their abusers, or otherwise violate norms of the social contract; they (...) are, thus, second-class citizens. In fact, as Arnold shows, drawing from Nietzsche and Foucault's theories of power and arguing against much of the standard policy literature on domestic violence, the very mechanisms that purportedly help targets of domestic abuse actually work to compound the problem by exacerbating the power differences between the abuser and the abused. The book argues that a key to understanding how to prevent domestic violence is seeing it as a political rather than a personal issue, with political consequences. It seeks to challenge Enlightenment ideas about intimacy that conceive of personal relationships as mutual, equal and contractual. Put another way, it challenges policy ideas that suggest that targets of abuse can simply choose to leave abusive relationships without other personal or economic consequences, or that there is a clear and consistent level of help once they make the choice to leave. Asking "Why Don't You Just Talk to Him?" is in reality a suggestion riven with contradictions and false choices. Arnold further explores these issues by looking at two key asylum cases that highlight contradictions within the government's treatment of foreigners and that of long-term residents. These cases expose problematic assumptions in the approach to domestic violence more generally. Exposing major injustices from the point of view of domestic violence targets, this book promises to generate further debate, if not consensus. (shrink)