BackgroundSelf-prescribing and prescribing to personal contacts is explicitly discouraged by General Medical Council guidelines.AimsThis study examines how widespread the practice of self-prescribing and prescribing to personal contacts is.MethodsA 16-item questionnaire was distributed via an online forum comprising 4445 young medical doctors, which asked respondents about previous prescribing to themselves, their families, friends and colleagues, including the class of medication prescribed. Demographic details were collected including medical grade and specialty.ResultsA total of 729 responses were obtained, the majority of which were from (...) young non-consultant hospital doctors from a range of specialties. Two-thirds of respondents had self-prescribed, over 70% had prescribed to family, and nearly 60% had prescribed to a friend or colleague. Older doctors were more likely to self-prescribe. Interns being less likely to self-prescribe was not unexpected, while general practitioners and paediatricians were more likely to self-prescribe. GPs, paediatricians and hospital medicine specialties were more likely to prescribe to family and surgeons were more likely to prescribe to friends. Some 3% to 7% who had self-prescribed had prescribed an opiate, benzodiazepine or psychotropic medication. Male doctors, anaesthetists and surgeons were more likely to self-prescribe opioids, while those in hospital medicine were more likely to self-prescribe psychotropic medications.ConclusionPrescribing outside the traditional doctor-patient relationship is widespread despite clear professional guidance advising against it. (shrink)

Parents in Iran, China and the United States were asked 1) about their potential influence on their children’s religious and scientific views and 2) to consider a situation in which their children expressed dissent. Iranian and US parents endorsed their influence on the children’s beliefs in the two domains. By contrast, Chinese parents claimed more influence in the domain of science than religion. Most parents spoke of influencing their children via Parent-only mechanisms in each domain, although US parents did spontaneously (...) note Multiple sources for the transmission of religious views. Parents proposed a similar stance towards children’s dissenting religious and scientific views. Chinese and US parents were more likely to express Supportive approaches and Iranian parents were more likely to express a Directive approach by comparison. The present research informs our understanding of the cultural transmission of views about science and religion. (shrink)

Five‐ to 11‐year‐old U.S. children, from either a religious or secular background, judged whether story events could really happen. There were four different types of stories: magical stories violating ordinary causal regularities; religious stories also violating ordinary causal regularities but via a divine agent; unusual stories not violating ordinary causal regularities but with an improbable event; and realistic stories not violating ordinary causal regularities and with no improbable event. Overall, children were less likely to judge that religious and magical stories (...) could really happen than unusual and realistic stories although religious children were more likely than secular children to judge that religious stories could really happen. Irrespective of background, children frequently invoked causal regularities in justifying their judgments. Thus, in justifying their conclusion that a story could really happen, children often invoked a causal regularity, whereas in justifying their conclusion that a story could not really happen, they often pointed to the violation of causal regularity. Overall, the findings show that children appraise the likelihood of story events actually happening in light of their beliefs about causal regularities. A religious upbringing does not impact the frequency with which children invoke causal regularities in judging what can happen, even if it does impact the type of causal factors that children endorse. (shrink)

What is the role of phenomenal consciousness in grounding epistemic justification? This paper explores the prospects for a global version of phenomenal conservatism inspired by the work of Michael Huemer, according to which all epistemic justification is grounded in phenomenal seemings. I’m interested in this view because of its global ambitions: it seeks to explain all epistemic justification in terms of a single epistemic principle, which says that you have epistemic justification to believe whatever seems to you strongly enough on (...) balance to be true. One of the attractions of phenomenal conservatism is that it offers such a simple and unified framework for explaining the epistemic role of phenomenal consciousness. I will argue, however, that the simplicity of phenomenal conservatism is not a theoretical virtue, but a theoretical vice, since it distorts the epistemological phenomena it is supposed to explain. In effect, phenomenal conservatism seeks to explain all epistemic justification on the same model as perception. But this has the predictable effect of distorting the epistemology of other domains, including introspection, inference, and a priori justification. (shrink)

Is God's foreknowledge compatible with human freedom? One of the most attractive attempts to reconcile the two is the Ockhamistic view, which subscribes not only to human freedom and divine omniscience, but retains our most fundamental intuitions concerning God and time: that the past is immutable, that God exists and acts in time, and that there is no backward causation. In order to achieve all that, Ockhamists distinguish ‘hard facts’ about the past which cannot possibly be altered from ‘soft facts’ (...) about the past which are alterable, and argue that God's prior beliefs about human actions are soft facts about the past. (shrink)

Plato's Timaeus contains a powerful and influential myth, of the construction of the universe by a divine craftsman. A god imposes reason on necessity, to bring order from a primeval 'receptacle' of disordered matter. There results the 'child' that is the cosmos - a copy of an eternally-existing perfect model. Here eight new essays from a distinguished international cast, explore aspects of this challenging work: the principles of the mythical narrative, how the world soul and human body are formed, implications (...) for illness - mental and physical, the importance of music and harmonious proportion. Later developments are also treated: Aristotle's theory of generation, the commentary of Proclus and elements of modern evolutionary theory. (shrink)

This is the first of two companion articles drawn from a larger project, provisionally entitled Undisciplining Moral Epistemology. The overall goal is to understand how moral claims may be rationally justified in a world characterized by cultural diversity and social inequality. To show why a new approach to moral justification is needed, it is argued that several currently influential philosophical accounts of moral justification lend themselves to rationalizing the moral claims of those with more social power. The present article explains (...) how discourse ethics is flawed just in this way. The article begins by identifying several conditions of adequacy for assessing reasoning practices designed to achieve moral justification and shows that, when used in contexts of cultural diversity and social inequality, discourse ethics fails these conditions. It goes on to argue that the failure of discourse ethics is rooted in its reliance on a broader conception of moral epistemology that is invidiously idealized. It concludes by pointing to the need to rethink both the mission and the method of moral epistemology. (shrink)

According to the standard analysis of degree questions, the logical form of a degree question contains a variable that ranges over individual degrees and is bound by the degree question operator how. In contrast with this, we claim that the variable bound by the degree question operator how does not range over individual degrees but over intervals of degrees, by analogy with Schwarzschild and Wilkinson's proposal regarding the semantics of comparative clauses. Not only does the interval-based semantics predict the existence (...) of certain readings that are not predicted under the standard view, it is also able, together with other natural assumptions, to account for the sensitivity of degree questions to negative islands, as well as for the fact, uncovered by Fox and Hackl, that negative islands can be obviated by some properly placed modals. Like Fox and Hackl, we characterize negative island effects as arising from the fact that the relevant question, due to its meaning alone, can never have a maximally informative answer. Contrary to Fox and Hackl, however, we do not need to assume that scales are universally dense, nor that the notion of maximal informativity responsible for negative islands is blind to contextual parameters. (shrink)

Ethics and the Clinical Encounter explores the moral dimensions of clinical medicine and the phenomenon of illness, to determine what ethics must be in order to be fully responsive to clinical encounters. Written in a lively and conversational style with minimal technical terminology, and enhanced by actual experience or real clinical situations, this volume lays out a clinical ethics methodology both in practical and theoretical terms. Here's what the experts had to say: Professor Zaner has provided us with a remarkably (...) lucid and trenchant discussion of the interface of philosophy and the field of medicine. He brings into play an extraordinary range of historial knowledge, extensive observations based on firsthand experience with medical practices, and an acute sense of philosophical argumentation. This is a work that will be an exemplary and indispensable text in the philosophy of medicine for years to come. -- Calvin Schrag... it is a highly original contribution usable in a number of fields.... It really has no competition.... The genius of Zaner's approach is to ground ethics from the 'bottom up' and to direct us to the concrete particulars of therapeutic encounters wherein lie moral and ethical matters... meaty, challenging, and ultimately rewarding.... -- Paul R. Dokecki Richard M. Zaner founded the Center for Clinical and Research Ethics at Vanderbilt University Medical Center. Having established Vanderbilt's first Hospital Ethics Committee (1985), he served as co-chair of VUMC's Ethics Committee since its inception in 1990. Zaner has published five original books, edited ten, and translated four more, and has published more than 100 sections of books and professional journals. (shrink)

Considerable methodological difficulties abound in neuroimaging, and several philosophers of science have recently called into question the potential of neuroimaging studies to contribute to our knowledge of human cognition. These skeptical accounts suggest that functional hypotheses are underdetermined by neuroimaging data. I apply Mayo’s error-statistical account to clarify the evidential import of neuroimaging data and the kinds of inferences it can reliably support. Thus, we can answer the question “What can we reliably learn from neuroimaging?” and make sense of how (...) this knowledge can contribute to novel construals of cognition. (shrink)

The use of platelet rich plasma as a novel treatment is discussed in the context of a qualitative research study comprising 38 interviews with sports medicine practitioners and other stakeholders working within the English Premier League during the 2013–16 seasons. Analysis of the data produced several overarching themes: conservatism versus experimentalism in medical attitudes; therapy perspectives divergence; conflicting versions of appropriate evidence; subcultures; community beliefs/practices; and negotiation of medical decision-making. The contested evidence base for the efficacy of PRP is presented (...) in the context of a broader professional shift towards evidence based medicine within sports medicine. Many of the participants while accepting this shift are still committed to casuistic practices where clinical judgment is flexible and does not recognize a context-free hierarchy of evidentiary standards to ethically justifiable practice. We also discuss a tendency in the data collected to consider the use of deceptive, placebo-like, practices among the clinician participants that challenge dominant understandings of informed consent in medical ethics. We conclude that the complex relation between evidence and ethics requires greater critical scrutiny for this emerging specialism within the medical community. (shrink)

Peckham claims that my "behavior" in dealing with the quotations in Natural Supernaturalism is the same, in methodology and validity, as the interpretative behavior of Booth's waiter. But the great bulk of the utterances in my quotations—and no less, of the utterances constituting Peckham's own essay—do not consist of orders, requests, or commands. Instead, they consist of assertions, descriptions, judgments, exclamations, approbations, condemnations, and many other kinds of speech-acts, the meanings of which are not related to my interpretative behavior, even (...) in the indirect way in which the meaning of Booth's order is related to the future behavior of his waiter. M. H. Abrams, author of Natural Supernaturalism and The Mirror and the Lamp and Class of 1916 Professor of English at Cornell University, responds in this essay to Morse Peckham's "The Infinitude of Pluralism" . Morse Peckham, in his Critical Response, was commenting on issues raised by the forum on "The Limits of Pluralism" , to which M. H. Abrams contributed. Previous contributions to Critical Inquiry are "Rationality and Imagination in Cultural History: A Reply to Wayne Booth" and "The Deconstructive Angel". (shrink)

In retrospect, I think I was right to compose Natural Supernaturalism by relying on taste, tact, and intuition rather than on a controlling method. A book of this kind, which deals with the history of human intellection, feeling, and imagination, employs special vocabularies, procedures, and modes of demonstration which, over many centuries of development, have shown their profitability when applied to matters of this sort. I agree with Booth that these procedures, when valid, are in a broad sense rational, and (...) subject to analysis and some degree of definition. But the rules underlying such a discourse are complex, elusive, unsystematic, and subject to innovative modification; they manifest themselves in the intuitive expertise of the historian; and the specification of these rules should not precede, but follow practice. . . . After the fact, nevertheless, a book like Natural Supernaturalism is subject to close critical inquiry about its methods and rationale. I am grateful to Booth for opening up such an inquiry, and for doing so in a way that is not only disarming, but seems to me to be the most promising of useful results. That is, instead of adopting a prosecutorial stance, demanding: "Justify the rationality and probative force of what you have done; it looks dammed suspicious to me," he has adopted the friendly tactic of saying: "Your book, in my experience of it, has yielded discoveries that I want to call knowledge, by methods, however deviant from standard rubrics of valid reasoning, that it seems irrational to call non-rational. Let's set out to clarify what these methods are, and to see what grounds we can find for the claim that they provide warranted knowledge." M.H. Abrams' contributions to Critical Inquiry are "The Deconstructive Angel" and "Behaviorism and Deconstruction: A Comment on Morse Peckham's 'The Infinitude of Pluralism'". (shrink)

Objectives The objective of this research was to develop ethics accreditation standards for hospitals. Research design Our research methods included a literature review, an expert focus group, the Delphi technique and a hospital survey. The entire process was separated into two stages: (1) the development of a draft of hospital ethics accreditation standards; and (2) conducting a nationwide hospital survey of the proposed standards. Results This study produced a tentative draft of hospital ethics accreditation standards comprised of six chapters and (...) 62 standards based on the expert focus group and Delphi technique. The six chapters are: Medical ethics policies, regulations and leadership; The establishment and operation of a medical ethics committee; The establishment and operation of research-related ethics committees; Medical ethics education; Organisational ethical climate; and Respect for patients' rights and establishment of good hospital-patient relationships. The hospital survey indicated that the concept of an organisational ethical climate was new to most hospital managers, most hospitals disliked the idea of having a separate hospital ethics accreditation system, and small hospitals were concerned about their ability to comply with all of the standards. Conclusions Regardless of whether hospital ethics accreditation can be a stand-alone accreditation or just part of existing hospital accreditation programmes, we hope this draft can serve as a good reference for future endeavours by hospital accreditation authorities. (shrink)

Throughout the history of aphasiology, researchers have identified important premorbid and stroke-related predictors of linguistic performance. Although Grodzinsky discusses some of these variables, exclusion of other variables could lead to unnecessary experimental error and erroneous conclusions. Aspects to consider include sources of experimental bias, premorbid differences, nonlinguistic roles of the frontal regions, and comparison of normal and aphasic performance.