Many medical ethicists accept the thesis that there is no moral difference between withholding and withdrawing life-sustaining therapy. In this paper, we offer an interesting counterexample which shows that this thesis is not always true. Withholding is distinguished from withdrawing by the simple fact that therapy must have already been initiated in order to speak coherently about withdrawal. Provided that there is a genuine need and that therapy is biomedically effective, the historical fact that therapy has been initiated entails a (...) claim to continue therapy that cannot be attributed to patients who have not yet received therapy. This intrinsic difference between withholding and withdrawing therapy is of moral importance. In many instances, patients will waive this claim. But when one considers withdrawing therapy from one patient to help another in a setting of scarce resources, this intrinsic moral difference comes into sharp focus. In an era of shrinking medical resources, this difference cannot be ignored. (shrink)

Recent studies in semantics of modal and superintuitionistic predicate logics provided many examples of incompleteness, especially for Kripke semantics. So there is a problem: to find an appropriate possible- world semantics which is equivalent to Kripke semantics at the propositional level and which is strong enough to prove general completeness results. The present paper introduces a new semantics of Kripke metaframes' generalizing some earlier notions. The main innovation is in considering "n"-tuples of individuals as abstract "n"-dimensional vectors', together with some (...) transformations of these vectors. Soundness of the semantics is proved to be equivalent to some non- logical properties of metaframes; and thus we describe the maximal semantics of Kripke- type. (shrink)

OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and principles, withdrawing life support, informed consent, and justice. Identical content was offered simultaneously (...) at the largest affiliated community hospital. SETTING: A multi-hospital university training programme from July, 1992 to June, 1994. PARTICIPANTS: Thirty-nine HOs responded in 92. Thirty HOs from the same cohort responded in 94 (response rates = 83% v 71%; P = 0.19). RESULTS: The curriculum was well received, with 96% of HOs finding the sessions stimulating. Previously validated scales of knowledge and confidence were administered at baseline and at follow-up. The average knowledge score improved 14% (P < 0.001). Confidence also improved, rising from 3.3 to 3.8 on a 5-point Likert scale (P < 0.001). These findings were independent of age, gender, religion, and prior education. The only attitudinal change was an increase in the proportion of residents who thought that ethics should be a required part of residency training (57% v 80%, P = 0.05). CONCLUSION: This curriculum appears practical, popular, and effective. It should be readily transferable to other institutions. (shrink)

This is an intellectual biography of Benjamin Kidd, a leading Social Darwinist in the years before World War I, and a social prophet in the tradition of Comte and Spencer. His first book Social Evolution, published in 1894, was an immediate and enormous success around the world. In it, Kidd developed a collectivist form of Social Darwinism in tune with the values of Progressivism in America and the 'new liberalism' in Britain. By many it was regarded as the basis for (...) a properly scientific sociology, and the combination of its claims to scientific methodology, with an emphasis on non-rational forces as the agents of progress accurately caught the temper of its times. Launched on his career as a writer, Kidd's subsequent books and journalism continued to exercise extraordinary influence. His 'social imperialism', linking a bio-political defence of empire with a programme of social reform, won currency in the Anglo-American world at a time of expansionary fervour. (shrink)

We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series, 25 per cent received lectures and case conferences, with an ethicist in attendance, and 50 per cent served as controls. A post-intervention questionnaire was administered. Knowledge scores did (...) not differ among the groups. Confidence regarding ethical issues was significantly greater in the aggregate intervention group compared to the control group. Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls. Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile. We conclude that ethics education can have an impact on house officers' confidence and their responses to a simulated case, and that the EI was more effective than the LI. Such results have implications regarding the implementation of ethics education during residency. (shrink)

Assessments of the acceptability of new transplantation practices require a pinpointing of not only the meaning of death, but also the timing of death. They typically perceive elective ventilation as occurring just prior to death and non-heart-beating donor protocols as operative just after death. However, such practices in fact highlight the general vagueness and ambiguity surrounding these issues in both law and ethics. Supply-side dilemmas in transplantation lend real urgency to this "life or death" debate.

In 1885, during initial discussions of J. C. Maxwell's celebrated thermodynamic demon, Whiting (1) observed that the demon-like velocity selection of molecules can occur in a gravitationally bound gas. Recently, a gravitational Maxwell demon has been proposed which makes use of this observation [D. P. Sheehan, J. Glick, and J. D. Means, Found. Phys. 30, 1227 (2000)]. Here we report on numerical simulations that detail its microscopic phase space structure. Results verify the previously hypothesized mechanism of its paradoxical behavior. This (...) system appears to be the only example of a fully classical mechanical Maxwell demon that has not been resolved in favor of the second law of thermodynamics. (shrink)

In any competition for monuments of wasted labour the collection of accidental acrostics in Latin poets published by I. Hilberg would stand a good chance of a prize. But amongst his examples of ‘neckische Spiele des Zufalls’ is one I am gullible enough to believe may be more significant. In Aeneid 7. 601–15 Vergil describes the custom of opening the gates of war in a long anacoluthic sentence, the first four lines of which run: Mos erat Hesperio in Latio, quern (...) protinus urbes Albanae coluere sacrum, nunc maxima rerum Roma colit, cum prima movent in proelia Mortem, Sive Getis inferre manu lacrimabile bellum…. (shrink)

A laboratory-testable, solid-state Maxwell demon is proposed that utilizes the electric field energy of an open-gap p-n junction. Numerical results from a commercial semiconductor device simulator (Silvaco International–Atlas) verify primary results from a 1-D analytic model. Present day fabrication techniques appear adequate for laboratory tests of principle.

This study represents an improvement in the ethics scales inventory published in a 1988 Journal of Business Ethics article. The article presents the distillation and validation process whereby the original 33 item inventory was reduced to eight items. These eight items comprise the following ethical dimensions: a moral equity dimension, a relativism dimension, and a contractualism dimension. The multidimensional ethics scale demonstrates significant predictive ability.

I will take David Hall and Roger Ames’s idea of “field and focus”—each unique individual is a unique focus in the communal field—as a central theme of the East Asian way of dealing with the relationship between the community and its constituent members. The pairing of these two concepts suggests the essential mutuality of the communal involvement of every person and the “insistent particularity” of each person. The worth of each individual becomes manifest only if the “egocentered” self yields to (...) the “selfless” self. An East Asian sense of justice thereby acquires the sense of attention to each unique focus (particular individual) in the field (community). Liberty and human rights are thus ineluctably bound up with a sense of communal responsibility. (shrink)