If you are interested in accountability and transparency in public decision-making, this book is for you. If you are interested in ways and means of avoiding capture by vested interests when making public policy, this book is for you. If you are interested in a sustainable and efficient agri-food system which meets the needs of consumers, producers and society, this book is for you.Agriculture remains an important industry in many economies. It is also a key sector with an important role (...) to play in determining nations’, societies’ and households’ nutritional and environmental performance and outcomes. Unfortunately, the agri-food sector in many countries suffers from excessive and poorly focused levels and types of intervention, constrained growth, and unsustainable practices.In his book, Developing Successful Agriculture, Professor Zhang-Yue Zhou provides us with a comprehensive and compelling account of how Australia’s agri-food sector has become so successful even though it receive .. (shrink)

In this exploratory study, higher education faculty perceptions regarding acceptability of social media use for out-of-class student engagement are identified. Hypotheses are developed and tested using a survey to address the impact of factors such as awareness, faculty/student relationship status, gender, academic discipline, and rank on faculty attitudes toward out-of-class social media use for student engagement. Findings indicate that faculty members are aware of social media, but use varies. Overall, they do not view social media as an important part of (...) out-of-class engagement, but it is viewed as more acceptable for engagement with former students. In addition, faculty from Marketing and Communications disciplines and Associate/Full Professors perceive social media use to be more acceptable for student engagement when compared with their colleagues from other disciplines and lower ranks. Implications and conclusions are discussed for development of university social media usage policies and directions for future research. (shrink)

This article aims to deconstruct the concept of dignity in a way that is meaningful, in particular to nurses and other health workers who seek to promote the dignity of children in their care. Despite the emphasis in a variety of codes and policies to promote dignity, there is a lack of a clear definition of dignity in the literature. In particular there is little reference to dignity, theoretically or empirically, as it relates to children. Without clarity it is not (...) possible to act in an ethical way on behalf of children whose dignity could otherwise be compromised. The theoretical position taken has evolved from the medico-nursing and philosophical discourse concerning the nature of human dignity and more recent sociological texts that discuss the social construction of the child and childhood. The article is further influenced by additional insights derived from an ethnographic pilot study at a large district general hospital. This study was undertaken in an attempt to appreciate the subjective experience of dignity by children, and to begin to address the empirical gap in the literature and promote discussion. The concept of a macro and a micro dignity is discussed, together with the role of the nurse in articulating the relationship between the two. The importance of control and witnesses in the experience of dignity is discussed and, finally, also the ethical implications when seeking to promote the dignity of children. (shrink)

What determines whether an action is right or wrong? Morality, Rules, and Consequences: A Critical Reader explores for students and researchers the relationship between consequentialist theory and moral rules. Most of the chapters focus on rule consequentialism or on the distinction between act and rule versions of consequentialism. Contributors, among them the leading philosophers in the discipline, suggest ways of assessing whether rule consequentialism could be a satisfactory moral theory. These essays, all of which are previously unpublished, provide students in (...) moral philosophy with essential material and ask key questions on just what the criteria for an adequate moral theory might be. (shrink)

Religion and spirituality are important aspects of the lives of most psychotherapy clients. Unfortunately, many psychotherapists lack the training to effectively and ethically address these issues with their clients. At times, religious or spiritual concerns may be relevant to the reasons clients seek treatment, either as areas of conflict or distress for clients or as sources of strength and support that the psychotherapist may access to enhance the benefit of psychotherapy. This article reviews persistent ethical issues and dilemmas relevant to (...) providing psychotherapy to clients for whom issues of religion and spirituality are clinically relevant. Ethical considerations include assessment, advertising and public statements, informed consent, competence, boundary issues and multiple relationships, cooperation with other professionals, and how to effectively integrate religious and spiritual interventions into ongoing psychotherapy. A decision-making process is presented to guide psychotherapists in their clinical work with clients for whom religious and spiritual issues are salient or clearly linked to their presenting problems. (shrink)

Patterned after Strunk and White's classic The Elements of Style , this handy reference concisely summarizes the substantial existing research on the delicate balance of professional ethics. Johnson and Ridley reduce the wealth of published material on the topic to the seventy-five most important and pithy truths for supervisors in all fields. These explore questions of integrity, loyalty, justice, respect, and delivering one's best in the business environment. Succinct and comprehensive, this is a must-have for any professional or business leader (...) striving to create an ethical workplace. (shrink)

Is it ethical to treat a death row inmate only to stabilize him or her for eventual execution? What happens when a military provider receives highly sensitive intelligence from a client?

Is it ethical to treat a death row inmate only to stabilize him or her for eventual execution? What happens when a military provider receives highly sensitive intelligence from a client? How can clinicians refuse costly gifts from clients without damaging the therapeutic relationship? Should a therapist disclose a client's suicidal intent to the authorities? In Ethical Conundrums, Quandaries and Predicaments in Mental Health Practice, these and other real-life scenarios constitute a comprehensive and definitive ethics casebook for mental health professionals. (...) Inspired by the many difficult situations they themselves have faced, an eminent group of accomplished mental health clinicians provide first-hand accounts of ethical problems that defy boilerplate solutions. Each chapter begins with a compelling and ethically complex case followed by an illustrative yet succinct analysis of the key ethical issues present and a personal reflection on the case itself, along with the process of ethical reasoning used to arrive at a final decision. Every case concludes with key recommendations for promoting ethical practice within an often challenging work setting. Highlighting the human aspect of ethics in mental health practice through the use of mesmerizing narratives while also provoking the reader to reflect upon what is the "right" thing to do, Ethical Conundrums, Quandaries and Predicaments in Mental Health Practice offers trainees and seasoned professionals alike invaluable informative models for dealing with ethical dilemmas, as well as the inspiration to confront seemingly insurmountable clinical problems. (shrink)

Although advertisements for jobs in academe increasingly suggest that mentoring students is a job requirement, and although academic institutions are increasingly prone to consider a faculty member's performance as a mentor at promotion and tenure junctures, there is currently no common approach to conceptualizing or evaluating mentor competence. This article proposes the triangular model of mentor competence as a preliminary framework for conceptualizing specific components of faculty competence in the mentor role. The triangular model includes mentor character virtues and intellectual/emotional (...) abilities, as well as knowledge and skills (competencies) that are seen as expressions of training and experience. The article concludes with discussion of the implications of this model for faculty hiring, training, and evaluation. (shrink)

Clinical trials for acute conditions such as myocardial infarction and stroke pose challenges related to informed consent due to time limitations, stress, and severe illness. Consent processes shou...

Recent work in viral genomics has shown that bacteriophages exhibit a high degree of mosaicism, which is most likely due to a long history of prolific horizontal gene transfer (HGT). Given these findings, we argue that each of the most plausible attempts to properly classify bacteriophages into distinct species fail. Mayr's biological species concept fails because there is no useful viral analog to sexual reproduction. Phenetic species concepts fail because they obscure the mosaicism and the rich reticulated viral histories. Phylogenetic (...) species concepts, even when extended to take into account reticulation, fail because there is no non-arbitrary distinction between recombination events that create a new viral species and those that do not. There is good reason to think that bacteriophages, arguably the Earth's most abundant biological agent, evolve without forming species.1. Introduction2. The Biology of Viruses2.1. Bacteriophage life cycles2.2. Mechanisms of HGT3. The Species Problem and Species Concepts3.1. Phenetic species concepts3.2. The biological species concept3.3. Phylogenetic species concepts3.4. The ecological species concept3.5. Homeostatic property cluster species4. Viruses and Species Taxonomy5. Reticular Phylogenies6. Conclusion. (shrink)

The lateralized ERP N2pc component has been shown to be an effective marker of attentional object selection when elicited in a visual search task, specifically reflecting the selection of a target item among distractors. Moreover, when targets are known in advance, the visual search process is guided by representations of target features held in working memory at the time of search, thus guiding attention to objects with target-matching features. Previous studies have shown that manipulating working memory availability via concurrent tasks (...) or within task manipulations influences visual search performance and the N2pc. Other studies have indicated that visual vs. spatial working memory manipulations have differential contributions to visual search. To investigate this the current study assesses participants' visual and spatial working memory ability independent of the visual search task to determine whether such individual differences in working memory affect task performance and the N2pc. Participants completed a visual search task to elicit the N2pc and separate visual working memory and spatial working memory assessments. Greater SPWM, but not VWM, ability is correlated with and predicts higher visual search accuracy and greater N2pc amplitudes. Neither VWM nor SPWM was related to N2pc latency. These results provide additional support to prior behavioral and neural visual search findings that spatial WM availability, whether as an ability of the participant's processing system or based on task demands, plays an important role in efficient visual search. (shrink)

College of Medicine, University of South Alabama Mobile, AL 36688-0002, USA wbp501{at}jaguar1.usouthal.edu ' + u + '@' + d + ' '//--> Abstract Recent work in viral genomics has shown that bacteriophages exhibit a high degree of mosaicism, which is most likely due to a long history of prolific horizontal gene transfer (HGT). Given these findings, we argue that each of the most plausible attempts to properly classify bacteriophages into distinct species fail. Mayr's biological species concept fails because there is (...) no useful viral analog to sexual reproduction. Phenetic species concepts fail because they obscure the mosaicism and the rich reticulated viral histories. Phylogenetic species concepts, even when extended to take into account reticulation, fail because there is no non-arbitrary distinction between recombination events that create a new viral species and those that do not. There is good reason to think that bacteriophages, arguably the Earth's most abundant biological agent, evolve without forming species. Introduction The Biology of Viruses 2.1 Bacteriophage life cycles 2.2 Mechanisms of HGT The Species Problem and Species Concepts 3.1 Phenetic species concepts 3.2 The biological species concept 3.3 Phylogenetic species concepts 3.4 The ecological species concept 3.5 Homeostatic property cluster species Viruses and Species Taxonomy Reticular Phylogenies Conclusion CiteULike Connotea Del.icio.us What's this? (shrink)

A number of language evolution researchers have argued that while language as we now know it is a predominately vocal affair, early language plausibly made extensive use of gesture. Relatedly, these same researchers often claim that while modern language in general uses arbitrary symbols, it is very likely that early language made extensive use of iconicity. Anyone accepting an account of early language along these lines must therefore explain how language shifted over time from a heavily gestural and iconic communication (...) system to a predominately vocal and highly arbitrary one. This article looks at an intriguing theory advanced by Woll as to how this shift was made. We find the spirit of the theory plausible but take issue with its details. Specifically, we identify a serious tension at the core of the theory. We then go on to explore how that tension might be plausibly resolved. The result is a blueprint for a much-improved version of the theory, in our view. (shrink)

The Emerging Church is one of the more interesting new movements in the religious landscape of the United States today. The Emerging Church has come out of US Evangelicalism, which has found itself in crisis, with a diminishing number of young people remaining in the church and a general popular impression of being intolerant, judgmental, and right-wing. Many in the Emerging Church are attempting to construct a vision of Christianity that addresses these problems. However, the Emerging Church is not a (...) monolith; it includes a variety of perspectives and positions. What I will argue in this article is that there is, among several different perspectives within the movement, a critique of the US political and economic system that provides an interesting and new way of thinking about the relationship between Christianity, politics, economics, and identity that may serve to create a challenge to the hegemonic system of the United States. For the purposes of this article I use three examples to illustrate my point: Shane Claibourne’s “New Monasticism”/”red Letter Christians” movement; Brian McLaren’s recent work, Why did Jesus, Moses, the Buddha and Mohammed Cross The Road; and Peter Rollins as a self-proclaimed inheritor of the radical tradition. I will show that the Emerging Church thinkers, by challenging the theological constructions of US Evangelicalism, are likewise providing fodder, to varying degrees, for a critique of the US political and economic system. Whether this will coalesce into a real significant challenge or will ultimately be reabsorbed by the status quo and/or marginalized remains to be seen. (shrink)

Volume 20, Issue 8, August 2020, Page W12-W13.

It is widely recognized that conceptual and theoretical innovations and the employment of new instruments and experimental techniques are important factors in explaining the growth of scientific knowledge in chemistry. This study examines another dimension of research in chemistry, collaboration and co-authorship. I focus specifically on Theodore Richards’ career and publications. During the period in which Richards worked, co-authorship was beginning to become more common than it had been previously. Richards was the first American chemist to be awarded a Nobel (...) Prize and he was at the forefront in this new trend in chemistry. He collaborated more than was typical for his time, with many scientists, in different sized groups, and he often had persistent collaborative relationships, extending over a number of years. Further, it appears that these collaborations benefited Richards, his collaborators, and the field of chemistry as a whole. (shrink)

This volume contains essays that examine infinity in early modern philosophy. The essays not only consider the ways that key figures viewed the concept. They also detail how these different beliefs about infinity influenced major philosophical systems throughout the era. These domains include mathematics, metaphysics, epistemology, ethics, science, and theology. Coverage begins with an introduction that outlines the overall importance of infinity to early modern philosophy. It then moves from a general background of infinity up through Kant. Readers will learn (...) about the place of infinity in the writings of key early modern thinkers. The contributors profile the work of Descartes, Spinoza, Leibniz, and Kant. Debates over infinity significantly influenced philosophical discussion regarding the human condition and the extent and limits of human knowledge. Questions about the infinity of space, for instance, helped lead to the introduction of a heliocentric solar system as well as the discovery of calculus. This volume offers readers an insightful look into all this and more. It provides a broad perspective that will help advance the present state of knowledge on this important but often overlooked topic. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 36.3 (2003) 223-248 [Access article in PDF] Probabilities, Signs, Necessary Signs, Idia, and Topoi:The Confusing Discussion of Materials for Enthymemes in the Rhetoric Brad McAdon This essay examines three groups of "sources" or "materials" of enthymemes in Aristotle's Rhetoric. According to the text of the Rhetoric, enthymemes are derived from, among other things, probabilities, signs, and necessary signs, and/or from the topics, and/or from idia as (...) the following table indicates.1The Rhetoric does not explain any relationships that may exist between these different sources (or materials) from which enthymemes are said. This problem, as I am framing it, is two-fold: First, these different conceptions of materials from which enthymemes are said are never reconciled into a coherent account (or theory) in the Rhetoric. Rather, each conception of materials for the enthymeme is presented in a way that obscures, rather than facilitates, our understanding of the materials of enthymemes in the Rhetoric. Moreover, when Rhetoric 2.22-23 and its textual contexts are compared to 1.2 and its textual contexts, several differences will emerge [End Page 223] in respect to the nature of the materials of enthymemes and the distinctions in enthymemes that further cloud our understanding of the text. Second, many contemporary commentators place more emphasis on the dialectical aspects of rhetoric than the demonstrative. For while rhetoric is said to be closely related to dialectic in important ways in the early portions of the Rhetoric (especially 1.1-2), there are, arguably, more similarities between the materials of enthymemes in the Prior and Posterior Analytics (and thus demonstrative argument) than in the Topics (and dialectical argument). This suggests that the discussion of the materials of enthymemes in the Rhetoric is more demonstrative in nature (or at least in emphasis) than dialectical, and I hope to demonstrate that this is the case.As far as I can tell, Grimaldi's discussions of the "Eikota and semeia" (1972, 104-15) and "The topoi" (115-35) are the only contemporary attempts to explicitly address the relationship between probabilities and signs and the topoi in the Rhetoric. 2 Grimaldi's account is confusing in many respects. For example, in addition to understanding the idia as topoi, he claims that "[w]hen Aristotle has presented us with the sources of the enthymeme, eikota and semeia, and told us that they are the premises of enthymematic reasoning (A3, 59a7-10) the question which immediately arises is where does the rhetor turn for the material which will provide him with such eikota and semeia. The answer is: the topics" (115). Yet, a little further down the same page, he claims that "the topics are sources, or loci, both particular and general, to which one must have recourse in constructing probable argumentation by enthymeme in an effort to effect pistis" (115). So, in effect, Grimaldi claims that probabilities and signs are the sources of enthymemes and then that the topics are the sources of probabilities and signs, 3 but, as demonstrated above, the text of the Rhetoric clearly claims that the topoi are the sources of enthymemes just as probabilities, signs, and necessary signs are sources of enthymemes. Grimaldi fails to address or even acknowledge this. Rather, in his attempt to maintain the unity of the text of the Rhetoric, he has advanced this working relationship between eikota and se-meiaand the topoi in what he claims is a consistent theory in the Rhetoric concerning the relationship of eikota and se-meia (and tekme-ria)to the topoi that, I will argue, is not supported by the text as Grimaldi suggests. More recently, Robin Smith (1989 and 1997) provides carefully informed commentary on some of these terms—topos, idia, eikos, se-meia, and tekme-ria—but, and this is not his purpose, he does not provide a discussion that explicitly examines how (or if) these different terms relate to one another as sources of enthymemes. Thus, this essay is an attempt to explore and succinctly articulate the problems with the... (shrink)

Aboriginal Australians have an intrinsic relationship to Country, kinship and community. The processes related to colonisation have decimated traditional lifestyles, ecology and even families. The challenge for energy engineers lies in the ability to reconcile the profession of engineering with the contemporary and traditional cultural and physical needs of Aboriginal people. A discussion around Aboriginal peoples’ most deeply held values will be linked to both global and professional ethical canons. This discussion has implications for Aboriginal and Indigenous peoples globally. A (...) fictitious case study—the ‘Warrigal Downs Energy Hub’—provides us with a hypothetical project to which we can link both examples and frameworks. Our team of Aboriginal and non-Aboriginal educators and engineers provides us with a right, wrong and even better way to work sensitively, meaningfully and reciprocally with Aboriginal people in Australia and, indeed, globally. (shrink)

Response Content Type Journal Article DOI 10.1007/s11673-010-9253-3 Authors Brad Partridge, Program in Professionalism and Bioethics, Mayo Clinic, 200 First Street S.W., Rochester, MN 55905, USA Journal Journal of Bioethical Inquiry Online ISSN 1872-4353 Print ISSN 1176-7529.

Coastal ecosystems are increasingly dominated by humans. Consequently, the human dimensions of sustainability science have become an integral part of emerging coastal governance and management practices. But if we are to avoid the harsh lessons of land management, coastal decision makers must recognize that humans are one of the more coastally dependent species in the biosphere. Management responses must therefore confront both the temporal urgency and the very real compromises and sacrifices that will be necessary to achieve a sustainable coastal (...) ecosystem, one that is economically feasible, socially just, and ecologically sound. (shrink)

PHOTO ID 121339257© Designer491| Dreamstime.com ABSTRACT When physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be apparent conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters future physicians’ commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. We use an ethical dilemma that was presented to a group of third-year medical students to examine how ethics education might be causing (...) them to give undue deference to autonomy, thereby undermining their commitment to beneficence. INTRODUCTION The right of patients to choose which treatments they prefer is rooted in today’s social mores and taught as a principle of medical ethics as respect for autonomy. Yet, when physicians use their clinical knowledge and skills to advance the well-being of their patients, there may be a conflict between patient autonomy and physician beneficence. We are skeptical that today’s medical ethics education adequately fosters a commitment to beneficence, which is both rationally defensible and fundamentally consistent with patient autonomy. I. An Ethical Dilemma The impetus for this paper arose when students who were completing their third clinical year discussed a real-life ethical dilemma. A middle-aged man developed a pulmonary hemorrhage while on blood thinners for a recently placed coronary stent. The bleeding was felt to be reversible, but the patient needed immediate intubation or he would die. The cardiologist was told that the patient previously expressed to other physicians that he never wanted to be intubated. However, the cardiologist made the decision to intubate the patient anyway, and the patient eventually recovered.[1] Students were asked if they believed that the cardiologist had acted ethically. Their overwhelming response was, “No, the patient should have been allowed to die.” We looked into how students applied ethical reasoning to conclude that this outcome was ethically preferred. To explore how the third-year clinical experience might have formed the students’ judgment, we presented the same case to students who were just beginning their third year. Their responses were essentially uniform in recommending intubation. While there is likely more than one reasonable view in this case, we agree with the physician and the younger medical students that intubation was the ethically appropriate decision and will present an argument for it. But first, we explain the reasoning behind the more advanced medical students’ decision to choose patient autonomy at the expense of beneficence. II. Medical Ethics Education and the Priority of Autonomy Beauchamp and Childress’s Principles of Biomedical Ethics, first published in 1979 and now in its 8th edition, is a significant part of the formal ethics education in medical school.[2] Students learn an ethical decision-making approach based on respect for four ethical principles: autonomy, beneficence, nonmaleficence, and justice. While Beauchamp and Childress officially afford no prima facie superiority to any principle, the importance of respect for patient autonomy has increased through the editions of their book. For example, early editions of their book opposed the legalization of physician-assisted death compared to recent editions that defended it.[3] As another example, Beauchamp and Childress make paternalism harder to justify by adding an autonomy-protecting condition to the list of conditions for acceptable paternalism.[4] Authority, they contend, need not conflict with autonomy—provided the authority is autonomously chosen.[5] “The main requirement,” they write, “is to respect a particular patient’s or subject’s autonomous choices, whatever they may be.[6] In the principlism of Beauchamp and Childress, autonomy now seems to have a kind of default priority.[7] However, the bioethics discourse has strong counternarratives, noting some movement to elevate the role of beneficence and to respect the input of stakeholders, including the family and the healthcare team. Ethics education achieves particular relevance in the third clinical year when students become embedded in the care of patients and learn from what has been called the informal curriculum. They observe how attending physicians approach day-to-day ethical problems at the patient’s bedside. In this context, students observe the importance of informed consent for serious treatments or invasive procedures, a practice that highlights the principle of patient autonomy. In both the formal and informal curriculum, medical students observe how, in the words of Paul Wolpe, “patient autonomy has become the central and most powerful principle in ethical decision-making in American medicine.”[8] In short, students appear to learn a deference for patient autonomy. This curricular shift in favor of autonomy coincides with legal developments that protect patients’ rights and decision-making with respect to their healthcare choices. The priority of autonomy in medicine benefits patients by reflecting their choices and, in some cases, their fundamental liberty. III. The Practice of Medicine and the Commitment to Beneficence There are many critiques of the dominant place that autonomy has in biomedical ethics,[9] especially considering that autonomy seems to be biased toward individualistic, Western, and somewhat American culture-driven values.[10] In addition, many bioethical dilemmas are cast as a conflict between autonomy and beneficence. Our point is that medical students bring to their study of medicine a commitment to beneficence that seems to be suppressed by practical ethics education. We think this commitment is rationally defensible and should be nurtured. It is striking that young medical students have a pre-reflective commitment to beneficence at all. For, as we mentioned, it is not just medicine but Western culture generally that prioritizes autonomy in settling ethical dilemmas. In wanting to act for the good of others (rather than simply agreeing to what others want), physicians are already swimming somewhat against the cultural tide.[11] However, doing so makes sense, given the nature of medicine and the profession of healing. When prospective medical students are asked why they wish to become physicians, the usual answer is some variation on caring for the sick and preventing disease. It is unlikely that a reason to become a physician is to respect a patient’s autonomy. It would be easy to dismiss medical students’ commitment to beneficence as a mere intuition and contrary to a more reasoned and deliberative approach. Beauchamp and Childress seem to minimize the value of physician intuition, stating that justifications for certain procedures are “…supported by good reasons. They need not rest merely in intuition or feeling.”[12] Henry Richardson writes that “situational or perceptive intuition…leaves the reasons for decision unarticulated.”[13] We think this is a crude and rather thin way of understanding intuition. Some bioethicists have defended intuition as essential to the practice of medicine and not something opposed to reason.[14] In the case we describe, we believe the ethical justifications s for the patient’s intubation are fundamentally sound: the patient did not have a “do not intubate” order written in the chart, the emergency intubation had not been foreseen, so the patient did not have the opportunity to consent to or reject intubation; the patient had consented to the treatment for his cardiac disease so his consent for intubation could have been assumed;[15] and the consequences of respecting his autonomy did not justify allowing him to die.[16] While it is possible to have more than one reasonable view on this case, we think the case for beneficence is strong and certainly should not be dismissed out of hand. We do not deny that if a patient makes a clearly documented, well-informed decision to forgo intubation that this decision ought to be respected by the physician (even if the physician disagrees with the patient’s decision). But, in this situation, as in many others in the practice of medicine, the patient’s real wishes and preferences are not well-articulated in advance. There are many cases where a physician acts based on what she believes the patient, or the surrogate, would want, sometimes in situations that do not allow much time for reflection. An example might be resuscitation of a newborn at the borderline of viability. In their ethics education, beneficence would mean acting first to save a life. If the patient or surrogate makes an informed decision to the contrary, a beneficent physician respects that autonomous decision. In the case presented, the patient expressed gratitude to the cardiologist when extubated. But what if he had expressed anger at the physician for violating his autonomy? There are those who could argue that not only was intubation ethically wrong but that the cardiologist put himself in legal jeopardy by his actions (especially if there had been a written refusal applicable to the specific situation). In the example we use, we point out that the cardiologist may not have escaped a lawsuit if the patient had died without intubation. His family, when hearing the circumstances, may have sued for failure to act and dereliction of the cardiologist’s duty to save him. Beyond a potential legal challenge for either action or inaction, there is an overriding ethical question the cardiologist had to address: what course would be most satisfying to his conscience? Would he rather allow a patient to die for fear of recrimination, or act to save his life, regardless of the personal consequences? In the absence of real knowledge about the patient’s considered wishes, it is most reasonable to err on the side of promoting patient well-being. A physician’s commitment to beneficence is not necessarily a way of undermining a patient’s autonomy. In acting for the patient's good, physicians are also acting on what it is reasonable to believe a patient (or most patients, perhaps) would want, which is obviously connected to what a patient does want. Pellegrino and Thomasma argue that beneficence includes respect for a patient’s autonomy since “the best interests of the patient are intimately linked with their preferences.”[17] Instead of conceptualizing ethical dilemmas in medicine as conflicts between autonomy and beneficence, it is possible that medical schools could teach students that truly practicing beneficence is a way of valuing patient autonomy, especially when the patient’s wishes are not specific to the situation and are not clearly expressed. CONCLUSION It is important for students and practicing physicians to understand the principle of respect for patient autonomy in a pluralistic society that demands personal self-determination. However, the role of the physician as a beneficent healer should not be diminished by this respect for autonomy. Respecting a patient’s autonomy is grounded in and manifested by physician beneficence.[18] That is, seeking what is good for the patient can only be good if it respects their personhood and dignity. We propose that a commitment to beneficence, incipient in young medical students, should be developed over time with their other clinical reasoning skills. Such a commitment need not be sacrificed on the altar of patient autonomy. Beneficence needs greater relative moral weight with students as they proceed in their ethics education. - [1] S. Jauhar, “When Doctors Need to Lie,” New York Times, February 22, 2014, https://www.nytimes.com/2014/02/23/opinion/sunday/when-doctors-need-to-lie.html. [2] T. L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019). [3] Louise A. Mitchell, “Major Changes in Principles of Biomedical Ethics,” The National Catholic Bioethics Quarterly 14, no. 3 (2014): 459–75, https://doi.org/10.5840/ncbq20141438. [4] Tom L. Beauchamp and James F. Childress, Principles of Biomedical Ethics, 8th ed. (New York, NY: Oxford University Press, 2019), 238. [5] Beauchamp and Childress, 103. [6] Beauchamp and Childress, p. 108. [7] For other accounts that prioritize autonomy, see e.g. Allen E. Buchanan and Dan W. Brock, Deciding for Others: The Ethics of Surrogate Decision Making (Cambridge University Press, 1989), 38–39; R Gillon, “Ethics Needs Principles—Four Can Encompass the Rest—and Respect for Autonomy Should Be ‘First among Equals,’” Journal of Medical Ethics 29, no. 5 (October 2003): 307–12, https://doi.org/10.1136/jme.29.5.307. For examples of critiques of these accounts, see footnote 9. [8] P. R. Wolpe, “The Triumph of Autonomy in American Bioethics: A Sociological View,” in Bioethics and Society: Constructing the Ethical Enterprise, p. 43. [9] V. A. Entwistle et al., “Supporting Patient Autonomy: The Importance of Clinician-Patient Relationships,” Journal of General Internal Medicine 25, no. 7 (July 2010): 741–45; C. Foster, Choosing Life, Choosing Death: The Tyranny of Autonomy in Medical Ethics and Law, 1st ed. (Oxford ; Hart Publishing, 2009); O. O’Neill, Autonomy and Trust in Bioethics, The Gifford Lectures, University of Edinburgh 2001 (Cambridge, UK: Cambridge University Press, 2002). [10] P. Marshall and B. Koenig, “Accounting for Culture in a Globalized Bioethics,” The Journal of Law, Medicine & Ethics: A Journal of the American Society of Law, Medicine & Ethics 32, no. 2 (2004): 252–66; R. Fan, “Self-Determination vs. Family-Determination: Two Incommensurable Principles of Autonomy,” Bioethics 11, no. 3–4 (1997): 309–22. [11] Arguments stressing the importance of beneficence, as ours does here, certainly approach paternalistic arguments. We set aside the complex issue of paternalism for purposes of this paper and simply note that the principle of beneficence as such does not say anything specifically about acting against the patient’s will. In the case study that focuses this paper, we do not believe the patient’s will or wishes were clearly indicated. [12] Beauchamp and Childress, Principles of Biomedical Ethics, p. 20, see note 2 above. [13] H. S. Richardson, “Specifying, Balancing, and Interpreting Bioethical Principles,” The Journal of Medicine and Philosophy: A Forum for Bioethics and Philosophy of Medicine 25, no. 3 (January 1, 2000): 285–307, p. 287. [14] H. D. Braude, Intuition in Medicine a Philosophical Defense of Clinical Reasoning (Chicago ; University of Chicago Press, 2012). [15] R. Kukla, “Conscientious Autonomy: Displacing Decisions in Health Care,” The Hastings Center Report 35, no. 2 (2005): 34–44. [16] M. Schermer, The Different Faces of Autonomy: Patient Autonomy in Ethical Theory and Hospital Practice, vol. 13, Library of Ethics and Applied Philosophy (Dordrecht: Springer Netherlands, 2002). [17] E. D. Pellegrino and D. C. Thomasma, For the Patient’s Good - the Restoration of Beneficence in Health Care (New York, NY: Oxford University Press, 1988), p. 29. [18] Pellegrino and Thomasma, For the Patient’s Good. 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To build an argument--and particularly an argument presented as a monologue--a writer must assemble and marshal a battery of supports for a claim. Some of those supports will be arranged in convergent structures, some as linked; some will be expressed, some will be left implicit; sometimes a support will need further support of its own--and sometimes, not. This paper explores the factors which lead a writer to make particular choices, the interactions between those factors, and the constraints on a w (...) riter's freedom in exercising her power, drawing on recent findings in computational modelling of the generation process. (shrink)

The first passage quoted above is the only certain evidence we have about Tacitus' early career, until we come to his tenure of the praetorship in A.D. 88. His career before that date has been the subject of much speculation, so it is surprising that no notice has been taken of the second passage. Syme does not even mention it, and C.W. Mendell merely describes it as ‘curious’. The reason for its dismissal is presumably that the post of a bibliothecis (...) was equestrian, while Tacitus was a senator. Yet in view of our lack of other evidence about his early career, it seems at least worth considering how Pastrengo came to make his statement, even if we conclude he was wrong. (shrink)

Many reasons have been put forward to explain why Aeneas and the Sibyl should depart through the gate of ivory, which lets out ‘false dreams’. The two views which have perhaps been found the least unsatisfactory are those of W. Everett and the one most recently championed by Brooks Otis. Everett suggested that it was a common belief in antiquity that false dreams occur before midnight, and true dreams after midnight; he went on to suggest that Aeneas left Hades before (...) midnight, when only the ivory gate would be open. That there was such a common belief has been disputed by, among others, H. R. Steiner. (shrink)