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)

I have Crohn's disease. This essay is about how my experiences with this disease have shaped my perceptions of boundaries in medicine, particularly around the issue of self‐disclosure. I became a pediatrician first, then a parent, and now a patient, and with each new role, I have become increasingly confused on where boundaries regarding self‐disclosures in medicine lie. I'd like to make the case for more of a reframing and a blurring of personal and professional boundaries regarding physicians’ disclosures about (...) their own health. Although historically thought of as a way to strengthen the physician‐patient relationship and therefore encouraged, physician disclosure has recently become more controversial, and boundary discussions that include it seem to increasingly begin from the edict, “Don't do it.” But why not capitalize on the shared experience of physicians and patients? It offers an opportunity to deepen our therapeutic relationship with our patients, to build trust, to help understanding, and maybe even to improve patient outcomes. (shrink)

The notion of a Sasaki projectionon an orthomodular lattice is generalized to a mapping Φ: E × E → E, where E is an effect algebra. If E is lattice ordered and Φ is symmetric, then E is called a Φ-symmetric effect algebra.This paper launches a study of such effect algebras. In particular, it is shown that every interval effect algebra with a lattice-ordered ambient group is Φ-symmetric, and its group is the one constructed by Ravindran in his proof that (...) every effect algebra that has the Riesz decomposition property is an interval algebra. It is shown that the doubling construction introduced in the paper is connected to the conditional event algebrasof Goodman, Nguyen, and Walker. (shrink)

Environmental concerns and the complex issues and dilemmas raised by animal rights pose fundamental questions for philosophers. The essays in this welcome collection put environmental thinking into the broader context of philosophical thought. Distinguished contributions from key thinkers, including Mary Midgley, Stephen Clark, J.Baird Callicott, Holmes Rolston, Dale Jamieson and John Haldane, focus on our attitudes to animals and the environment as critically determined by deeper philosophical concerns. Timothy Chappell's useful introduction provides a guide to the issues and dilemmas and (...) links the diverse arguments and themes. Examining whaling, animal captivity, and specicism amongst other topics, this book adds substantially to the contemporary debate in environmental philosophy. (shrink)

In the present state of philosophy in the English-speaking world, to choose to talk about sense data may seem perverse. What could be more boring for one's audience than to attempt variations on so threadbare a theme? And worse, what could be more unfashionable in the aftermath of Wittgenstein and Austin? My reasons for selecting this unpromising topic are twofold. First, the general theme of this series of lectures is empiricism. And whatever meanings we put upon that ambiguous word, it (...) is clear that as a matter of history the problems of perception have been important problems for nearly all those philosophers who would consider themselves to be empiricists. And however unsatisfactory sense datum theories of perception may now be held to be, such theories have been central to the empiricist tradition. Secondly, it is important not to be too much impressed by the fact that a particular philosophical opinion is fashionable or unfashionable. The former certainly does not guarantee its truth nor the latter its falsity. It has often been remarked that philosophical opinions are very rarely refuted. Instead they fall out of vogue only to return some years later in another guise. It is perhaps time to take another look at the notion of sense data. The most ingenious and persistent attacks on analyses of perception in terms of sense data have been at best indecisive, as Professor Ayer showed in his reply to Austin's Sense and Sensibilia. (shrink)

This book is a collection of critical essays that examine a radical shift in focus and orientation. In the challenge to the hermeneutics of suspicion, the adoption of alternative reading strategies, and the investigation of well-being, this collection is an analogue of a new discourse that has immensely enriched literary studies in the last decade.

Pleidooi voor een metafysische visie op hedendaagse sociale en economische problemen.

John Henry Newman is widely acknowledged to be an important theologian. However Newman commentators suggest that his work has received little recognition by philosophers. The general consensus has been that until the latter part of the twentieth century Newman has been an isolated philosophical figure. This essay offers an historical re-evaluation of Newman's philosophical reception in order to explore whether or not his significance has been underestimated. The historical method is used in the analysis and assessment of this question. The (...) study therefore probes the general philosophical reaction to Newman's work in the nineteenth and early twentieth century. In doing so the essay offers an historical investigation and re-evaluation of the claims of Newman having a negligible philosophical legacy. (shrink)

We assume that a statute permitting physician assisted death has been passed. We note that the rationale for the passage of such a statute would be respect for individual autonomy, the avoidance of suffering and the possibility of death with dignity. We deal with two moral issues that will arise once such a law is passed. First, we argue that the rationale for passing an assistance in dying law in the first place provides a justification for assisting patients to die (...) who are motivated by altruistic reasons as well as patients who are motivated by reasons of self-interest. Second, we argue that the reasons for passing a physician assisted death law in the first place justify extending the law to cover some nonterminal patients as well as terminal patients. (shrink)