Background: The traditional approach to resolving ethics concerns may not address underlying organisational issues involved in the evolution of these concerns. This represents a missed opportunity to improve quality of care “upstream”. The purpose of this study was to understand better which organisational issues may contribute to ethics concerns. Methods: Directed content analysis was used to review ethics consultation notes from an academic children’s hospital from 1996 to 2006 (N = 71). The analysis utilised 18 categories of organisational issues derived (...) and modified from published quality improvement protocols. Results: Organisational issues were identified in 68 of the 71 (96%) ethics consult notes across a range of patient settings and reasons for consultation. Thirteen of the 18 categories of organisational issues were identified and there was a median of two organisational issues per consult note. The most frequently identified organisational issues were informal organisational culture (eg, collective practices and approaches to situations with ethical dimensions that are not guided by policy), policies and procedures (eg, staff knows policy and/or procedural guidelines for an ethical concern but do not follow it) and communication (eg, communication about critical information, orders, or hand-offs repeatedly does not occur among services). Conclusions: Organisational issues contribute to ethical concerns that result in clinical ethics consults. Identifying and addressing organisational issues such as informal culture and communication may help decrease the recurrence of future similar ethics concerns. (shrink)

In Bester’s article (2018) challenging the use of the harm principle and advocating sole reliance on the use of a best interest standard (BIS) in pediatric decision-making, we believe that the auth...

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

There is a growing trend of refusal of blood transfusions from COVID-19 vaccinated donors. We highlight three cases where parents have refused blood transfusions from COVID-19 vaccinated donors on behalf of their children in the setting of congenital cardiac surgery. These families have also requested accommodations such as explicit identification of blood from COVID-19 vaccinated donors, directed donation from a COVID-19 unvaccinated family member, or use of a non-standard blood supplier. We address the ethical challenges posed by these issues. We (...) describe the current screening and safety processes for standard blood donation and explore the importance of donor anonymity and challenges with directed donation and non-standard blood suppliers. We present an ethical framework using the Best Interest Standard, the Zone of Parental Discretion, and the Harm Principle when considering these refusals. Finally, we provide recommendations for how to approach these requests as they potentially become more commonplace in pediatrics. (shrink)

Decisions regarding life-sustaining medical treatments for young children with profound disabilities can be extremely challenging for families and clinicians. In this study, Brick and colleagues1 surveyed adult residents of the UK about their attitudes regarding withdrawal of treatment using a series of vignettes of infants with varying levels of intellectual and physical disability, based on real and hypothetical cases.1 This is an interesting study on an important topic. We first highlight the limitations of using these survey data to inform public (...) policy and then offer a different interpretation from the authors’ regarding their findings about the value the public appears to place on relational capacity. The authors asked members of the lay public to interpret a disabled child’s best interest in a series of vignettes. The respondents were 92% white; 59% were atheist or reported no religious affiliation. Though the authors note this lack of diversity as a limitation, we would add that this limitation is particularly problematic in this context. Minority views on this issue may differ significantly from the majority perspective. When the stakes are high, use of public opinion data to directly inform policy requires, at a minimum, a representative sample reflecting both the true diversity of views within the public and a method to justly account for the alternate views of the minority. Even if the sampled population were more …. (shrink)

In this bold, challenging book, D. S. Clarke outlines reasons for accepting panpsychism and defends the doctrine against its critics.

This is an introduction to, and survey of, the constructive approaches to pure mathematics. The authors emphasise the viewpoint of Errett Bishop's school, but intuitionism. Russian constructivism and recursive analysis are also treated, with comparisons between the various approaches included where appropriate. Constructive mathematics is now enjoying a revival, with interest from not only logicans but also category theorists, recursive function theorists and theoretical computer scientists. This account for non-specialists in these and other disciplines.

This work has been selected by scholars as being culturally important, and is part of the knowledge base of civilization as we know it. This work is in the "public domain in the United States of America, and possibly other nations. Within the United States, you may freely copy and distribute this work, as no entity (individual or corporate) has a copyright on the body of the work. Scholars believe, and we concur, that this work is important enough to be (...) preserved, reproduced, and made generally available to the public. We appreciate your support of the preservation process, and thank you for being an important part of keeping this knowledge alive and relevant. (shrink)

An anthology of readings in panpsychism, spanning two millennia.

Almost traditionally, it seems, accounts of the development of the concepts of work and energy have tended to describe them within the classical framework of Newtonian mechanics. They are seen as the end products of the celebratedvis-vivadispute in the eighteenth century: the outcome of a debate within the confines of the science of rational mechanics. I would like to suggest that this may be to take too narrow a view of the case. It is to project backwards our present specialist (...) arrangement of scientific knowledge, our present divisions between the sciences, and to assume that past development was strictly guided by these divisions. And this is to make questionable historical and sociological assumptions. (shrink)

Authenticates approximately 500 lines of Aristotle's lost work the Protrepticus (Exhortation to Philosophy) contained in the circa third century AD work by Iamblichus of Chalcis entitled Protrepticus epi philosophian. Includes a complete English translation of the authenticated material.

Introduction What is the point of studying Aristotle's theory of moral virtue? In the first place, many interesting questions are raised, in metaphysics, ...

This article traces the career path and personality of a chancery official or secretary in the service of the Gonzaga, the ruling dynasty of Mantua, in the middle years of the fifteenth century. It relates Giovanni Arrivabene to the contemporary social, political and cultural context of this secondary northern Italian power or signoria but touches the wider Italian world at many points, particularly the papal court, whether in Rome or other locations, where Giovanni’s talented younger brother served first as the (...) secretary of Cardinal Francesco Gonzaga and later as an apostolic secretary. The comparison between the two brothers and their interdependence as property owners is a recurring theme. Giovanni emerges with evident limitations which hampered the succession to his father’s superior role in the chancery, where other privileged families also tended to prevail. Humanist educated and efficient, he seems to have been a bureaucrat of routine abilities, not quite astute enough to outpace certain departmental rivals or to avoid being tainted by association with some possibly corrupt practice which caused loss of favour. His later rehabilitation, first as a provincial magistrate concerned with criminal jurisdiction and later as an estate management official, illustrates that private relationships within the narrow world of a civic quasi despotic government were all important. (shrink)

This is a criticism of quine's treatment of mass terms such as "water", "gold", Etc. In word and object. Instead of becoming singular terms referring to a "scattered object", It is argued that they either become general terms as subjects of sentences or retain their unique status as ascribed to an indicated place.

This paper attempts to outline the logical structure of imperatives. It criticizes the prevailing view that this structure is isomorphic with that for indicatives. For "mixed" imperatives with constituents in both indicative and imperative moods (e.G., Conditional imperatives with indicative antecedents) there are features unique to imperatives. These features are specified, And consequences of them are traced. Finally, Formation rules for imperatives are stated.

Since the revolution in philosophic method that began about a century ago, the focus of philosophic attention has been on language as used both in daily conversation and in specialized institutional activities such as science, law, and the arts. But language is an extremely complex and varied means of communication, and the study of it has been increasingly incorporated into such empirical disciplines as linguistics, psycho linguistics, and cognitive psychology. It is becoming less clear what aspects of language remain as (...) proper subjects of philosophical study, what are to be "kicked upstairs" (J. L. Austin's phrase) to the sciences. This work is a study of those logical features of language that remain central to philosophy after completion of kicking up. It conducts this study by describing similarities and differences between signs at differing levels, starting with natural events as primitive signs in the environments of their interpreters, and proceeding to pre linguistic signaling systems, elementary forms of language, and finally to the forms of specialized discourse used within social institutions. The investiga tion of comparative features requires isolating basic mental capacities that are present in the most primitive forms of organisms capable of sign interpretation. The problem then becomes one of tracing the emergence from these capacities of such categories as substance, attribute or quality, and quantity that we apply to natural languages. The study of sign levels is thus the construction of a genealogy of logical categories marking the develop ment of natural languages. (shrink)