Formalised knowledge systems, including universities and research institutes, are important for contemporary societies. They are, however, also arguably failing humanity when their impact is measured against the level of progress being made in stimulating the societal changes needed to address challenges like climate change. In this research we used a novel futures-oriented and participatory approach that asked what future envisioned knowledge systems might need to look like and how we might get there. Findings suggest that envisioned future systems will need (...) to be much more collaborative, open, diverse, egalitarian, and able to work with values and systemic issues. They will also need to go beyond producing knowledge about our world to generating wisdom about how to act within it. To get to envisioned systems we will need to rapidly scale methodological innovations, connect innovators, and creatively accelerate learning about working with intractable challenges. We will also need to create new funding schemes, a global knowledge commons, and challenge deeply held assumptions. To genuinely be a creative force in supporting longevity of human and non-human life on our planet, the shift in knowledge systems will probably need to be at the scale of the enlightenment and speed of the scientific and technological revolution accompanying the second World War. This will require bold and strategic action from governments, scientists, civic society and sustained transformational intent. (shrink)
Clinical decision making is a challenging task that requires practical wisdom—the practised ability to help patients choose wisely among available diagnostic and treatment options. But practical wisdom is not a concept one typically hears mentioned in medical training and practice. Instead, emphasis is placed on clinical judgement. The author draws from Aristotle and Aquinas to describe the virtue of practical wisdom and compare it with clinical judgement. From this comparison, the author suggests that a more complete understanding of clinical judgement (...) requires its explicit integration with goals of care and ethical values. Although clinicians may be justified in assuming that goals of care and ethical values are implicit in routine decision making, it remains important for training purposes to encourage habits of clinical judgement that are consciously goal-directed and ethically informed. By connecting clinical judgement to patients' goals and values, clinical decisions are more likely to stay focused on the particular interests of individual patients. To cultivate wise clinical judgement among trainees, educational efforts should aim at the integration of clinical judgement, communication with patients about goals of care, and ethical reasoning. But ultimately, training in wise clinical judgement will take years of practice in the company of experienced clinicians who are able to demonstrate practical wisdom by example. By helping trainees develop clinical judgement that incorporates patients' goals of care and ethical reasoning, we may help lessen the risk that ‘clinical judgement’ will merely express ‘the clinician's judgement.’. (shrink)
This article explores egg freezing experiences of women in Turkey. Since 2014, it has been legal in Turkey to use egg freezing technology for ageing women, while it was previously allowed only for disease-related purposes. In cooperation with a private fertility clinic in Istanbul, the authors conducted 21 interviews with older, single women who held either professional or managerial positions and who were undergoing or had undergone the procedure. Drawing on a qualitative analysis of these interviews, the authors explore the (...) social context in which women postpone motherhood and decide to freeze their eggs. The study also looks at the women’s emotional responses to ageing that were triggered by the experience of egg freezing and their narratives of empowerment as a result of the procedure. (shrink)
We review the equivalence of the two-flavor Skyrme-Witten model and the two-flavor large-N c quark model. The claimed equivalence for three flavorsbetween these two models is shown to be incorrectly given in the literature, and the properly equivalent extended three-flavor large-N c quark model is constructed and discussed.
Objective: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide , and explore characteristics of internists who support terminal sedation but not assisted suicide.Design: A statewide, anonymous postal survey.Setting: Connecticut, USA.Participants: 677 Connecticut members of the American College of Physicians.Measurements: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics.Results: 78% of respondents believed that if (...) a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation . Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients and attending religious services more frequently .Conclusions: Support for terminal sedation was widespread in this population of physicians, and most who agreed with terminal sedation did not support PAS. Most internists who support aggressive palliation appear likely to draw an ethical line between terminal sedation and assisted suicide. (shrink)
Background and objective: Code status discussions may fail to address patients’ treatment-related goals and their knowledge of cardiopulmonary resuscitation (CPR). This study aimed to investigate patients’ resuscitation preferences, knowledge of CPR and goals of care. Design, setting, patients and measurements: 135 adults were interviewed within 48 h of admission to a general medical service in an academic medical centre, querying code status preferences, knowledge about CPR and its outcome probabilities and goals of care. Medical records were reviewed for clinical information (...) and code status documentation. Results: 41 (30.4%) patients had discussed CPR with their doctor, 116 (85.9%) patients preferred full code status and 11 (8.1%) patients expressed code status preferences different from the code status documented in their medical record. When queried about seven possible goals of care, patients affirmed an average of 4.9 goals; their single most important goals were broadly distributed, ranging from being cured (n = 36; 26.7%) to being comfortable (n = 8; 5.9%). Patients’ mean estimate of survival to discharge after CPR was 60.4%. Most patients believed it was helpful to discuss goals of care (n = 95; 70.4%) and the chances of surviving inhospital CPR (n = 112; 83.0%). Some patients expressed a desire to change their code status after receiving information about survival following inhospital CPR (n = 11; 8.1%) or after discussing goals of care (n = 2; 1.5%). Conclusions: Doctors need to address patients’ knowledge about CPR and take steps to avoid discrepancies between treatment orders and patients’ preferences. Addressing CPR outcome probabilities and goals of care during code status discussions may improve patients’ knowledge and influence their preferences. (shrink)
Success in sport can provide a source of national pride for a society, and vast financial and personal rewards for an individual athlete. It is therefore not surprising that many athletes will go to great lengths in pursuit of success. The provision of healthcare for elite sports people has the potential to create many ethical issues for sports doctors; however there has been little discussion of them to date. This study highlights these issues. Respondents to a questionnaire identified many ethical (...) matters, common to other areas of medicine. However they also raised problems unique to sports medicine. Some of these ethical difficulties arise out of the place of the sports doctor within the hierarchy of sport. Yet others arise out of the special relationship between sports doctors and individual players/athletes. This study raises some important questions regarding the governance of healthcare in sport, and what support and guidance is available to sports doctors. As medical and scientific intervention in sport escalates, there is a risk that demands for enhanced performance may compromise the health of the athlete, and the role the sports doctor plays remains a critical question. (shrink)
Science, which is guided by reason and not pure intuition, is to be regarded as justifiable opinion. Bunge's sketch of philosophical intuition from Aristotle to Heidegger will probably be of interest primarily to the general reader.--G. L. C.
We present a quantum-mechanical analysis of Szilard's famous single-molecule engine, showing that it is analogous to the double-slit experiment. We further show that the energy derived from the engine's operation is provided by the act of observing the molecule's location. The engine can be operated with no increase in physical entropy, and the second law of thermodynamics does not compel us to relate physical entropy to informational entropy. We conclude that information per seis a subjective, idealized, concept separated from the (...) physical realm. Physical entropy depends on physical objects and physical interactions, and any entropy change owing to observations is entirely a result of the entropy created in the physical apparatus by the process of observation. (shrink)
Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)
Althusius is significant as an early and rigorous contract theorist who explored the concepts of confederation and social symbiosis. This work is the first English translation of a large part of the Politics. In most cases the translation is clear and readable. Both a preface by Carl J. Friedrich and an introduction by the editor provide short surveys of the general Althusian theory.—L. C.
As the title indicates, this most recent of Hartshorne's works blends doctrinal exposition with analyses of methodological issues. Each of the sixteen chapters can be read as an independent essay, although the entire work is intended as "an essay in systematic metaphysics." The paradox is resolved once we realize that Hartshorne does not separate substantive discussion and the examination of methodological principles--the text exemplifies the principles latent in "creative synthesis" as he understands it. Each chapter takes shape out of a (...) position-matrix in terms of which a number of possible positions on problems of relations, modality, and temporality are exhibited and finally sifted in order to determine the most viable for future philosophic inquiry. Portions of six of the chapters had previously been published, one as early as 1958; the remaining ten appear for the first time in this volume. Although much of the doctrinal content will be familiar to those who have read Hartshorne's earlier works, the clarity and coherence of these essays make it an especially valuable work for students of metaphysics, whether they accept the neoclassical position or not. In the first chapter, "A Philosophy of Shared Creative Experience," Hartshorne presents his case for the inclusive priority of "becoming" over "being"; in the next three chapters, he turns to a more detailed analysis of technical problems in metaphysics--the specification of the domain of metaphysical inquiry, the viability of the notion of inclusive contrast as the heart of "relativity", and the ultimate coincidence of modal and temporal categories as the summit of the analyses of "abstractions". Each of these chapters is an excellent example of Hartshorne's working through "position-matrices"; but for those who are unfamiliar with Hartshorne's work, or for those who desire a less 'naïve' approach to metaphysical inquiry it might be advisable to turn to Chapters V and VI immediately after Chapter I. In these two essays, Hartshorne presents a general exposition of the structure of his system, exposing and defending the conception of relativity which lies at the heart of his system: the triadicity [[sic]] of creative synthesis must be construed relatively, the contrast of relative and absolute being included within the relative member of the contrast. In the succeeding chapters, the difficulties which such a conception must face are explored in detail. Among the difficulties which Hartshorne focuses upon are the possibility of "non-restrictive or necessary existential truths", the psychological reeducation which a conception of the priority of events necessitates, the explanatory power of directed or asymmetrical relations as opposed to non-directed, symmetrical ones, and the critique of the notion of ens realissimum and its substitution by the universal forms of dependence and independence. It is interesting that at various places in this work Hartshorne indicates that the importance of the problem of the relations among contemporaries must be relegated to secondary status in the philosophy of shared creative experience. It becomes increasingly evident that were the author to stress its importance, he should have to turn to a conception of eternal objects functioning relationally or affirm interaction between God and any other individual in strictly simultaneous states. Either move would necessitate a major shift in his methodological principles and substantive doctrines. That he has struggled with the problem of the relations among contemporaries for so long shows his willingness to confront the possibility of such a shift. This is one of the major criteria for evaluating metaphysicians, as Hartshorne notes; in the light of this criterion, Hartshorne's newest work will be judged a significant contribution to metaphysical inquiry.--R. L. C. (shrink)
The author covers the history of logic and mathematics from pre-Hellenic theory forward to Gödel's theorem and metamathematics. A special effort is made to show the co-ordinate development of mathematics and logic, and the grounds for their identification in recent years. The critique of the parallel postulate, and the development of non-Euclidean geometries are dealt with in detail. A good index and an extensive bibliography are provided.—L. C.
A distinguished group of linguists examine the present state of theoretic linguistics by looking to the past to see what has been accomplished, and to the future for requirements needed to frame a workable theory of language. The universals of language are taken from phonology, grammar, semantics and psycho-linguists. Uriel Weinreich's paper, "On the Semantic Structure of Language," should be of special interest to philosophers.--G. L. C.
In his Lindley Lecture, Professor Chisholm argues that neither determinism, "hard or soft," nor indeterminism is compatible with the fact of human responsibility. He proposes a theory of agency similar to those advanced by C. A. Campbell and R. Taylor, and defends it as being more consistent with responsibility, and as being respectable in its own right.—L. C.
Employing the premiss that "fundamental religious doctrines are arguable," the author considers the traditional arguments for the existence of God and gods, in addition to arguments for and against His existence from authority, particular experience, pragmatism, and the phenomenon of evil. His conclusion is that there exist no reasonable grounds for such belief, and that it doesn't matter much, in general, whether God exists or not, since God's proper function is as an ideal. The work provides an interesting and easy-to-read (...) introduction to the problem, and the chapters on the traditional arguments for God's existence are particularly stimulating.—L. C. (shrink)