The ethical principle of respect for autonomy has come into its own In American medicine since World War II as equal in importance to the traditional medicomoral principles of nonmaleficence and beneficence. Respect for autonomy provides the ethical underpinning for the patient's right to exercise an informed choice – whether to consent to or to refuse recommended medical treatment. However, an informed choice demands a certain level of competence. Typical criteria for patient competence to accept or to refuse medical treatments (...) Include ability to make a choice and ability to comprehend the nature of the treatment, as well as the risks and benefits of accepting or refusing the treatment. (shrink)
It is not the outpatient setting, per se, that is presenting new challenges and opportunities to ethics consultants and ethics committees. Rather, it is the underlying reason for shifting more and more patient care from the inpatient to the outpatient setting-namely, calculations of cost-effectiveness.
There is good news, and there is bad news. The good news is that in my experience, younger physicians generally are much more concerned about the cost of clinical tests and treatments, and about justly distributing finite medical resources, than were those who practiced medicine in the fee-for-service era. The bad news has at least three components. First, with respect to medically nonbeneficial treatment in the ICU, managed care has not yet given evidence of wanting to put the brakes on (...) unrealistic family demands for aggressive medical interventions. Second, managed care is frustrating many healthcare professionals as well as patients. And third, managed care has no apparent interest in addressing, and may even have contributed to, the problem of medical indigence. Let me develop these propositions more fully. (shrink)
As Part of the Omnibus Budget Reconciliation Act of 1990, the Patient Self Determination Act legislates new responsibilites for healthcare facilities. The authors served as members of the California Consortium on Patient Self-Determination, and the materials produced by this group offer healthcare facilities a valuable guide for implementing the PSDA. The ACt follows a historical trend led by doctrines of informed consent and increasing patient autonomy regarding rights to accept or refuse medical treatment and to execute advance directives. The requirements (...) of the Act will influence healthcare facilities and how they communicate with patients about advance directives. Although the Act seeks to increase awareness of advance directices among all participants in healthcare interactions, it could pose major stumbling blocks to providing sensitive and humane care if certain concerns are nor addressed adequatley. The benefits of the Act could be far reaching and substantial for patients and healthcare facilities alike. (shrink)
In brief compass, I will touch on three of the central ethical and public policy issues that divide those who are opposed to physician-assisted dying from those who are supportive of this practice. These are: the moral distinction between actively hastening death and passively allowing to die; how to interpret the Hippocratic tradition in medicine with respect to physician-assisted death; and whether physician-assisted suicide can be effectively regulated. I shall summarize the arguments pro and con with respect to each issue, (...) and also indicate my own position. (shrink)
Spiritual/religious coping has proven to be a fertile ground for investigating health-related spirituality in action. Ken Pargament and his colleagues have successfully demonstrated that spiritual/religious coping differs significantly from previously identified coping strategies. While much has been accomplished to date, there are undeveloped theoretical and methodological avenues that appear to provide important promise for understanding the complexities of this critical domain of coping. Some scholars have failed to conceptualize and research spiritual/religious coping as a contextual, temporally bounded process. This paper (...) explores the theoretical and methodological advantages of adopting a contextually embedded, process-oriented epistemology—contextual action theory. We propose that doing so will not only address some of the inadequacies of the extant literature but also aid researchers in exploring novel dimensions of spiritual/religious coping. From a contextual action-theory perspective, spiritual/religious coping is viewed as intentional, goal-directed behaviour that is embedded in a social and relational context. This teleonomic reconceptualization enables researchers to understand the constitution and development of intentions involved in the process of spiritual/religious coping over time. Further, a contextual action theory perspective transcends the narrow, individualistic lens of coping and explores joint and collective coping processes that emerge as people draw upon spiritual/religious practices to cope with distress. Thus, spiritual/religious coping is embedded in social and relational context and as part of personal, intentional goal-directed processes over time. The novel contributions of a contextual theoretical perspective to spiritual/religious coping research and theory are illustrated through a case example. (shrink)
Das »Richtige und das Gute« (1930), das ethische Hauptwerk W. D. Ross’, enthält eine Vielzahl wichtiger moralphilosophischer Thesen und Argumente, die bis in die Gegenwart kontrovers diskutiert werden. Im Mittelpunkt steht seine pluralistische Deontologie, der zufolge sich die richtige Handlung aus einer Abwägung der in der jeweiligen Situation relevanten und unableitbaren Prima-facie-Pflichten ergibt, von denen nur ein Teil auf die Optimierung der Handlungsfolgen bezogen ist. Diese Deontologie wurde zu einem modernen Klassiker unter den normativen ethischen Theorien. Darüber hinaus stellt Ross’ (...) These, dass moralische Intuitionen eine Quelle selbstevidenten Wissens sein können, einen wichtigen Referenzpunkt in Debatten um den erkenntnistheoretischen Fundamentalismus dar. Auch für die Handlungstheorie liefert Ross einflussreiche Argumente, wenn er die Ansicht vertritt, dass Pflichten nie ein bestimmtes Motiv des Handelnden zum Gegenstand haben können. Eine zentrale Stellung nimmt für Ross die Güterlehre ein, in welcher er von vier Grundgütern, Tugend, Wissen, Lust und Gerechtigkeit, ausgeht. Wurde Ross in den ersten Jahrzehnten des 20. Jahrhunderts im damaligen Großbritannien als ein herausragender Ethiker – einer der bedeutendsten des Jahrhunderts, auf Augenhöhe mit G.E. Moore – angesehen, wandelte sich das Meinungsbild in den folgenden Jahrzehnten unter dem Einfluss besonders des Logischen Positivismus und der Philosophie Wittgensteins. In den letzten Jahrzehnten ist jedoch wieder ein wachsendes Interesse an Ross’ Ethik festzustellen. Dabei wird »Das Richtige und das Gute« bisweilen sogar mit der »Nikomachischen Ethik«, Kants »Grundlegung« und Humes »Untersuchung über die Prinzipien der Moral« verglichen. (shrink)
In these seven letters, practising psychiatrist Vincenzo Di Nicola offers wisdom to a young therapist from 25 years of experience conducting relational therapy. Ranging from what to read and how to begin therapy, the letters cover therapeutic temperaments and technique, how to create a relational dialogue, the myths of individual psychology and the need for relational psychology, the evolution of therapy in the past century and when therapy is over-all the while looking forward to the relational practices of the (...) coming community. This book complements Di Nicola's model of working with families presented in A Stranger in the Family: Culture, Families, and Therapy (New York and London: W.W. Norton). -/- Awarded the prestigious Prix Camille-Laurin of the Association des médecins psychiatres du Québec - the Camille Laurin Prize of the Quebec Psychiatric Association. -/- From the Foreword: -/- "It's a beautiful idea, this project of turning to young people... The relational dialogue offers an important new direction of study to discover the deep basis of the therapeutic alliance, in order to understand the still too-little known phenomenon of 'change'... This is what you have brought together in your book: the search for the whole regarding the person and, at the same time, the network of primary affective relationships that we call the family and of social relationships ..." --from the Foreword by Maurizio Andolfi, M.D. Director of the Academy of Family Psychotherapy Professor of Psychology, University of Rome -/- Advance Review: -/- "Di Nicola is a true master of constructive inquiry, synthesis, and brilliant creativity. Memorable aphorisms leap from every page of this very wise, thoughtful, and beautifully written book in which the healing process of discovering and making meaning to help reorder the lives of troubled persons is clarified. I highly recommend this book for all who are or would be therapists!" --Armando Favazza, M.D., M.P.H. Emeritus Professor of Psychiatry University of Missouri-Columbia Author of Bodies Under Siege. (shrink)
When the Muséum d’histoire naturelle in Paris learned in 1836 that it had the chance to buy a live, young orangutan, it was excited by the prospect. Specimens were the focus of the Museum’s activities, and this particular specimen seemed especially promising, not only because the Museum had very few orangutan specimens in its collection, but also because of what was perceived to be the orangutan’s unique place in the natural order of things, namely, at the very boundary between (...) the animal kingdom and humans. Frédéric Cuvier, the superintendent of the Museum’s menagerie, urged that studying the orangutan’s mental faculties would help resolve fundamental questions regarding the similarities and differences between animals and humans. Archival and printed sources allow one to reconstruct the orangutan’s capture, acquisition, and subsequent career at the menagerie in greater detail than has generally been possible for animals of nineteenth-century zoos. Scientists, artists, the public, the press, and even musicians sought to engage with the orangutan, seeing in it not just another ape or monkey but a special creature unto itself at the animal/human boundary. Key to their fascination with the orangutan was the question of proximity—just how close was the orangutan to humans? The orangutan’s story illuminates not only how the animal-human boundary was conceived at the time but also the problematic status of the zoo as a site for scientific research and the roles of scientific and non-scientific actors alike in constructing how the orangutan was understood. (shrink)
This study is an unusual contribution to the philosophy of mind in that it argues for the sometimes unfashionable view of dualism: that mind and matter are distinct and separate entities as Descartes believed. The author takes as his point of departure the imaginative hypothesis of disembodiment, which establishes the possibility of the mind's being a quite non-material thing. There are clear casual correlations between what is physical and what is mental, and the most serious issue confronting dualism since Descartes (...) has been how such an interaction is possible. Dr Hart sets out to answer this question by showing that the issue is as much about the nature of causation as it is about the natures of mind and matter. (shrink)
What connexion is there between factual statements concerning God or man and moral judgments? That is the question which occasions this paper. Not long ago moral philosophers were wont to say that there is a logical gap between the two sorts of utterance to which I have just referred: that nothing follows in terms of moral value from a statement of fact, no ‘ought’ from any ‘is’. They recognised only one restriction on what may be said in terms of ‘ought’ (...) by what has been said in terms of ‘is’, namely that ‘ought’ implies ‘can’. It is manifest nonsense to say that anyone ought to do what he cannot do. But, this apart, they thought it possible without contradiction or anomaly to hold any conceivable factual belief and at the same time subscribe to any conceivable moral judgment. They would have held that it makes perfectly good sense to say, for example, ‘This is God’s will but it ought not to be done’ or ‘Men are not pigs but a good man will live like a pig’. Bizarre such judgments may be, they would have said, but nonsensical they are not. They conceived it to be their main business, as moral philosophers, to erect warning notices along the edge of the is-ought gap so that contemporary moralists would not fall headlong into it as so many of their predecessors, in less enlightened ages, had done. (shrink)
The primary aim of this study was to investigate the relation between self-perceived executive functions and the school achievement of young adolescents, while controlling for parental education and sex. We specifically focused on executive aspects of daily life behavior and the higher-order EFs, as measured with self-report, rather than on the more basic EFs which have been the primary focus of prior investigations. In two independent samples of sixth graders, students evaluated their EFs on a self-report questionnaire, the Amsterdam (...) Executive Functioning Inventory. School achievement in the domains of mathematics and reading comprehension were evaluated with nationally used, norm-based achievement tests. Results revealed that the self-perceived EFs of young adolescents were significantly correlated with their school achievement in both study samples. School achievement was also correlated with the level of parental education, but the factor sex did not have such influence. In study 1, self-perceived EFs explained additional variance in school achievement, while controlling for parental education and sex. In study 2, this was only the case for the most robust measure of school achievement, i.e., the end-of-primary-school final achievement test. Furthermore, besides the relation with achievement tests, we also found a relation between self-perceived EFs and teacher ratings behavioral problems in the classroom. Together, our findings imply that young students can properly reflect on the effectiveness and appropriateness of their EFs in a way that is relevant to their academic achievement and classroom behavior. The findings underscore the importance of considering the development of EFs and parental education in the evaluation of academic achievements in early adolescence. (shrink)
At the beginning of his book, Principles of Christian Theology, John Macquarrie says that theology ‘implicitly claims to have its place in the total intellectual endeavour of mankind’. The question I want to discuss is this: in what terms, if any, can that claim be justified?
I want to put forward a certain view of the logical foundation of religious belief. It is, in a sentence, the view that religious belief is constituted by the concept of god. This view will be discussed under three headings. First, I shall explain as clearly as I can what I mean by it. Secondly, I shall indicate what seem to me to be interesting parallels, both with regard to universes of discourse in general and to religious belief in particular, (...) between my idea of a constitutive concept and Wittgenstein's ideas of a fundamental proposition and a religious ‘picture’. Thirdly, I shall try to substantiate the view I take of the logical foundation of religious belief by rebutting three conceivable objections to it: namely, that it rests on an illegitimate craving for generality, that it is at variance with common usage, and that it consigns religious belief to an intellectual ghetto. (shrink)
It is sometimes suggested that the logic of religious language differs from other kinds of language. Or it is said that each ‘language-game’ has its own ‘logic’ and that, whatever usual language-games are played in the context of religion, there is something that could be called the ‘religious language-game’ which does not correspond to any other and, therefore, has its own peculiar logic. In either case, religious people are urged to make clear what this logic is, so that their utterances (...) may be understood and evaluated. (shrink)
W.D. Ross was the most important opponent of utilitarianism and consequentialism in British moral philosophy between 1861 and 1939. In Rossian Ethics, David Phillips offers the first monograph devoted exclusively to Ross's seminal contribution to moral philosophy. The book has two connected aims. The first is to interpret and evaluate Ross's moral theory. The second is to articulate a distinctive view intermediate between consequentialism and absolutist deontology, which Phillips calls "classical deontology.".