We argue that in contemporary business organizations, in which fundamental purpose is construed to be increased value—especially in ‘participative’ organizations, in which non–hierarchal interaction (for example, work teams) is the norm; and in ‘adaptive’ organizations, in which unpredictable change is the rule—a process of values covenanting will be much more valueable than just espoused values or even values covenants. We propose such a process model for organizational values covenanting and argue that such covenanting reflects an anthropomorphism of the human character (...) development process, validated in terms of the theory of viable systems. (shrink)

First ed. published in 1946 under title: Medical ethics for nurses.

Survival of the fittest in evolutionary biology has a counterpart in the evolution of research paradigms. It’s called survival of the funded, and there is a sense in which paradigms are even more adaptable than species. Whereas species may become extinct if their fitness declines below a critical threshold, paradigms can rise again, perhaps with a new name, following fiscal collapse, provided only that funding is once again made available.A current example is the born-again concept of comparative effectiveness research , (...) which achieved resurrection status with the passage of the Affordable Care Act of 2010. The ACA established a private, nonprofit entity to oversee publicly financed CER. According to .. (shrink)

We argue that in contemporary business organizations, in which fundamental purpose is construed to be increased value—especially in ‘participative’ organizations, in which non–hierarchal interaction (for example, work teams) is the norm; and in ‘adaptive’ organizations, in which unpredictable change is the rule—a process of values covenanting will be much more valueable than just espoused values or even values covenants. We propose such a process model for organizational values covenanting and argue that such covenanting reflects an anthropomorphism of the human character (...) development process, validated in terms of the theory of viable systems. (shrink)

David Sackett and Jack Wennberg have each introduced and developed ideas and methods that have had major impacts on how we think about and perform clinical research. Sackett is best known for his work in Evidence-Based Medicine (Sackett et al. 1997); Wennberg, upon noting wide geographic (and other) variations in best practices for the same conditions, stressed the importance of comparative effectiveness in clinical decision-making (Wennberg et al. 1993). When these two collaborated in an editorial about the current state of (...) the art and science of clinical research, it comes as no great surprise that they produced some truly memorable guidance. And, as is so often the case for inspired—and inspiring—advice, their .. (shrink)

In a recent paper in this journal, John Worrall (2008) used the example of a series of trials involving extracorporeal membrane oxygenation (ECMO), a technology for the treatment of respiratory failure in newborns, to illustrate the relationship between ethics and epistemology in medical research. One of the issues considered was whether or not it was ethical to perform a particular clinical trial at all, and he showed clearly that the answer was intimately related to epistemological judgments about the weight to (...) be given existing evidence concerning treatment effectiveness. In the case of ECMO, a trial was initiated at the University of Michigan (Bartlett et al. 1985), despite the fact that the researchers had .. (shrink)

This scarce antiquarian book is a facsimile reprint of the original. Due to its age, it may contain imperfections such as marks, notations, marginalia and flawed pages. Because we believe this work is culturally important, we have made it available as part of our commitment for protecting, preserving, and promoting the world's literature in affordable, high quality, modern editions that are true to the original work.

This book has been considered by academicians and scholars of great significance and value to literature. This forms a part of the knowledge base for future generations. So that the book is never forgotten we have represented this book in a print format as the same form as it was originally first published. Hence any marks or annotations seen are left intentionally to preserve its true nature.

We argue that in contemporary business organizations, in which fundamental purpose is construed to be increased value—especially in ‘participative’ organizations, in which non–hierarchal interaction (for example, work teams) is the norm; and in ‘adaptive’ organizations, in which unpredictable change is the rule—a process of values covenanting will be much more valueable than just espoused values or even values covenants. We propose such a process model for organizational values covenanting and argue that such covenanting reflects an anthropomorphism of the human character (...) development process, validated in terms of the theory of viable systems. (shrink)

Dramatization has been conceived by some Deleuze scholars as ‘dramatizing’ the mode of existence of a subject. This paper argues, on the contrary, dramatization involves the very creation of a viewpoint on the world. The ethical significance of dramatization is not the ability to ‘evaluate’ certain subjective modes of existence, but to produce ways of unfolding the world in which we do not ‘imprison’ others and in which multiple perspectives are allowed to unfold. Love is incapable of such a truly (...) ethical comportment, because the lover is always thrown back onto their own world, trapped within subjectivity, unable to see from two viewpoints at once. A world is most precisely a set of signs, a set of relationships between ‘things’ and ‘meanings’ ; therefore, in order to produce more ‘ethical’ worlds, worlds in which we do not ‘explicate’ or imprison ourselves and others too much, we must turn to art. Art is precisely a ‘unity’ in which multiple perspectives are allowed to unfold at their own rhythm. Language perfects this insofar as the creation of new modes of grammatical relation in writing is nothing more than the unification of a multiplicity of relationships between meaning and things. (shrink)

Commentators have claimed that the philosophies of Merleau-Ponty and Deleuze converge upon a spatial field of sensation which is prior to representation. This essay will contest these readings by showing that, for Deleuze, the pre-representational spatial field of intensity is fundamentally split from thought. This “gap” between sensation and thought is, for Deleuze, fundamentally temporal, in that thought is continually open and passive to being violated and transformed by the sensible and the sensible is continually being pushed beyond itself by (...) a certain kind of thought. This violent exchange across the gap between thought and sensibility is found, by Deleuze, in Kant's notion of the aesthetic idea. On the contrary, for Merleau-Ponty, Kant's aesthetics imply a non-conceptual “ground” shared by both thought and sensibility. By contrasting these two readings of Kant's aesthetics, this paper reveals the basic divergence between the philosophies of Deleuze and Merleau-Ponty. (shrink)

Transplantation continues to push the frontiers of medicine into domains that summon forth troublesome ethical questions. Looming on the frontier today is human facial transplantation. We develop criteria that, we maintain, must be satisfied in order to ethically undertake this as-yet-untried transplant procedure. We draw on the criteria advanced by Dr. Francis Moore in the late 1980s for introducing innovative procedures in transplant surgery. In addition to these we also insist that human face transplantation must meet all the ethical requirements (...) usually applied to health care research. We summarize the achievements of transplant surgery to date, focusing in particular on the safety and efficacy of immunosuppressive medications. We also emphasize the importance of risk/benefit assessments that take into account the physical, aesthetic, psychological, and social dimensions of facial disfiguration, reconstruction, and transplantation. Finally, we maintain that the time has come to move facial transplantation research into the clinical phase. (shrink)

This book is a first attempt to cover the whole area of aesthetics from the point of view of critical rationalism. It takes up and expands upon the more narrowly focused work of E. H. Gombrich, Sheldon Richmond, and Raphael Sassower and Louis Ciccotello. The authors integrate the arts into the scientific world view and acknowledge that there is an aesthetic aspect to anything whatsoever. They pay close attention to the social situatedness of the arts. Their aesthetics treats art as (...) emerging from craft in the form of luxurious and playful challenge to the audience. In developing it they place emphasis on the number of questions and claims that can be settled by appeal to empirical facts; on the historical character of aesthetic judgements; and on the connection of aesthetic truth to true love and true friendship, i.e. fidelity and integrity, not to informative truth. (shrink)

Main Response Topics ? Introduction ? Open display and public evaluation ? Publicity versus patient privacy ? Facial tissue donation ? Validity of Louisville Instrument for Risk Acceptance ? Patients' understanding of risk ? Face versus hand transplantation ? Rejection rates/risks ? Patient compliance ? Exit strategy ? Functional recovery ? Societietal implications ? Psychological implications ? Conclusion: Uncertainty likely to persist.

Bernard Smith’s canonical book, Australian Painting, 1788-1960, was shaped by the Cold War. This forced the emerging discipline of Australian art history onto a trajectory that would not be shaken for another two decades. More than art history determined Smith’s innovations. This article proceeds from that obvious but easily overlooked point, that Smith and his book were deeply conditioned by the intellectual climate of Cold War Australia. The appearance of Smith’s book and, henceforth, Australian art history’s concerns with postcoloniality and (...) anxiety about nationality derive from this. Smith’s particular Cold War has shaped Australian art history ever since. (shrink)

Informed consent in medical practice is essential and a global standard that should be sought at all the times doctors interact with patients. Its intensity would vary depending on the invasiveness and risks associated with the anticipated treatment. To our knowledge there has not been any systematic review of consent practices to document best practices and identify areas that need improvement in our setting. The objective of the study was to evaluate the informed consent practices of surgeons at University teaching (...) Hospitals in a low resource setting. (shrink)

Much has been written recently about both the urgency and efficacy of teaching business ethics. The results of our survey of AACSB member schools confirm prior reports of similar surveys: The teaching of business ethics is indiscriminate, unorganized, and undisciplined in most North American schools of business. If universities are to be taken seriously in their efforts to create more ethical awareness and better moral decision-making skills among their graduates, they must provide a rigorous and well-developed system in which students (...) can "live ethics" instead of merely learn ethics. A system must be devised to allow students to discover and refine their own values rather than simply learning ethical theories from an intellectual point of view. After reviewing the literature on business ethics in undergraduate curricula, we make a series of recommendations to deliver experiential ethical education for business students. The recommendations include student and faculty written codes of ethics, emphasis on ethical theory within the existing required legal environment course, applied ethics in the functional area capstones using alternative learning, a discussion of employee rights and responsibilities during the curriculum capstone course, and a public service requirement for graduation. These recommendations may be implemented without substantive additional cost or programming requirements. (shrink)

Embodied, embedded, enactive, and extended theorists do not typically focus on the ontological frameworks in which they develop their theories. One exception is 4E theories that embrace New Mechanism. In this paper, we endorse the New Mechanist’s general turn to ontology, but argue that their ontology is not the best on the market for 4E theories. Instead, we advocate for a different ontology: causal powers realism. Causal powers realism posits that psychological manifestations are the product of mental powers, and that (...) mental powers are empirically-discoverable features of individuals that account for the causal work those individuals do. We contend that causal powers realism provides a unifying framework for the central commitments of 4E theories, as well as additional resources for theorizing in a 4E framework. And while New Mechanism offers some of these resources as well, we argue that causal powers realism is ultimately the better of the two. (shrink)

Post-abortion care research is increasingly being conducted in low- and middle-income countries to help reduce the high burden of unsafe abortion. This study aims to help address the evidence gap about ethical challenges that researchers in LMICs face when carrying out PAC research with adolescents. Employing an explorative qualitative approach, the study identified several ethics challenges encountered by PAC researchers in Zambia, including those associated with seeking ethics and regulatory approvals at institutional and national levels. Persistent stigma around abortion and (...) community perceptions that PAC studies encourage adolescents to seek abortion affected adolescents’ right to exercise their autonomy and to make decisions as well as exposed adolescents to social stigmatization risks. Challenges with recruitment was reported to result in abandoning of studies, thereby undermining development of PAC services that are more responsive to adolescent needs. Training needs identified included knowledge of best practices for conducting and disseminating PAC research. Strategies for addressing the ethical challenges included trust building and using less value-laden terminology when seeking permission and consent. It is essential to the future of PAC research in Zambia and globally that these important challenges be addressed through the development of comprehensive ethics guidance. (shrink)

Cultural psychologists often describe the relationship between mind and culture as ‘dynamic.’ In light of this, we provide two desiderata that a theory about encultured minds ought to meet: the theory ought to reflect how cultural psychologists describe their own findings and it ought to be thoroughly naturalistic. We show that a realist theory of causal powers — which holds that powers are causally-efficacious and empirically-discoverable — fits the bill. After an introduction to the major concepts in cultural psychology and (...) describing causal power realism, we use a case study — the effects of pathogen prevalence on culture and cognition — to show the explanatory capacities of the powers framework. (shrink)

Double Effect Donation claims it is permissible for a person meeting brain death criteria to donate vital organs, even though such a person may be alive. The reason this act is permissible is that it does not aim at one’s own death but rather at saving the lives of others, and because saving the lives of others constitutes a proportionately serious reason for engaging in a behavior in which one foresees one’s death as the outcome. Double Effect Donation, we argue, (...) opens a novel position in debates surrounding brain death and organ donation, and does so without compromising the sacredness and fundamental equality of human life. (shrink)

"Les Dilemmes de la métaphysique pure" de Charles Renouvier. Philosophe français (1815-1903).

We discuss how academically-based interdisciplinary teams can address the extreme challenges of the world’s poorest by increasing access to the basic necessities of life. The essay’s first part illustrates the evolving commitment of research universities to develop ethical solutions for populations whose survival is at risk and whose quality of life is deeply impaired. The second part proposes a rationale for university responsibility to solve the problems of impoverished populations at a geographical remove. It also presents a framework for integrating (...) science, engineering and ethics in the efforts of multidisciplinary teams dedicated to this task. The essay’s third part illustrates the efforts of Howard University researchers to join forces with African university colleagues in fleshing out a model for sustainable and ethical global development. (shrink)

Recent magnetic resonance imaging and pathological studies have indicated that axonal loss is a major contributor to disease progression in multiple sclerosis. 1 H magnetic resonance spectroscopy, through measurement of N -acetyl aspartate, a neuronal marker, provides a unique tool to investigate this. Patients with primary progressive multiple sclerosis have few lesions on conventional MRI, suggesting that changes in normal appearing white matter, such as axonal loss, may be particularly relevant to disease progression in this group. To test this hypothesis (...) NAWM was studied with MRS, measuring the concentration of N -acetyl derived groups. Single-voxel MRS using a water-suppressed PRESS sequence was carried out in 24 patients with primary progressive multiple sclerosis and in 16 age-matched controls. Ratios of metabolite to creatine concentration were calculated in all subjects, and absolute concentrations were measured in 18 patients and all controls. NA/Cr was significantly lower in NAWM in patients than in controls, as was the absolute concentration of NA. There was no significant difference in the absolute concentration of creatine between the groups. This study supports the hypothesis that axonal loss occurs in NAWM in primary progressive multiple sclerosis and may well be a mechanism for disease progression in this group. (shrink)

OBJECTIVE: To describe the issues faced, and how they were addressed, by the University of Toronto Critical Care Medicine Program/Joint Centre for Bioethics Task Force on Appropriate Use of Life-Sustaining Treatment. The clinical problem addressed by the Task Force was dealing with requests by patients or substitute decision makers for life-sustaining treatment that their healthcare providers believe is inappropriate. DESIGN: Case study. SETTING: The University of Toronto Joint Centre for Bioethics/Critical Care Medicine Program Task Force on Appropriate Use of Life-Sustaining (...) Treatment. PARTICIPANTS: The 24-member Task Force included physician and nursing leaders from five critical care units, bioethicists, a legal scholar, a health administration expert, a social worker, and a hospital public relations professional. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: Our specific lessons learned include a) a policy focus on process; b) use of a negotiation and mediation model, rather than a hospital ethics committee model, for this process; and c) the policy development process is itself a negotiation, so we recommend equal involvement of interested groups including patients, families, and the public. CONCLUSIONS: This article describes the key issues faced by the Task Force while developing its policy. It will provide a useful starting point for other groups developing policy on appropriate use of life-sustaining treatment. (shrink)

BackgroundHIV prevention research in resource-limited countries is associated with a variety of ethical dilemmas. Key amongst these is the question of what constitutes an appropriate standard of health care (SoC) for participants in HIV prevention trials. This paper describes a community-focused approach to develop a locally-appropriate SoC in the context of a phase III vaginal microbicide trial in Mwanza City, northwest Tanzania.MethodsA mobile community-based sexual and reproductive health service for women working as informal food vendors or in traditional and modern (...) bars, restaurants, hotels and guesthouses has been established in 10 city wards. Wards were divided into geographical clusters and community representatives elected at cluster and ward level. A city-level Community Advisory Committee (CAC) with representatives from each ward has been established. Workshops and community meetings at ward and city-level have explored project-related concerns using tools adapted from participatory learning and action techniques e.g. chapati diagrams, pair-wise ranking. Secondary stakeholders representing local public-sector and non-governmental health and social care providers have formed a trial Stakeholders' Advisory Group (SAG), which includes two CAC representatives.ResultsKey recommendations from participatory community workshops, CAC and SAG meetings conducted in the first year of the trial relate to the quality and range of clinic services provided at study clinics as well as broader standard of care issues. Recommendations have included streamlining clinic services to reduce waiting times, expanding services to include the children and spouses of participants and providing care for common local conditions such as malaria. Participants, community representatives and stakeholders felt there was an ethical obligation to ensure effective access to antiretroviral drugs and to provide supportive community-based care for women identified as HIV positive during the trial. This obligation includes ensuring sustainable, post-trial access to these services. Post-trial access to an effective vaginal microbicide was also felt to be a moral imperative.ConclusionParticipatory methodologies enabled effective partnerships between researchers, participant representatives and community stakeholders to be developed and facilitated local dialogue and consensus on what constitutes a locally-appropriate standard of care in the context of a vaginal microbicide trial in this setting.Trial registrationCurrent Controlled Trials ISRCTN64716212. (shrink)

In this paper, we describe causal powers realism as a conjunction of four claims: causal powers are not reducible to counterfactuals; they are empirically-discoverable; they manifest effects in conjunction with partners; and their manifestations empower further manifestations. We describe four challenges to extended mind theory and for each show how an ontology of causal powers realism either avoids or dissolves the problem. We close by suggesting that causal powers realism isn’t a competitor with extended mind theory but rather a new (...) way to understand what it means for minds to be extended. (shrink)