Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

This paper argues that, while there is a difference between personal and sub‐personal explanation, claims of autonomy should be treated with scepticism. It distinguishes between horizontal and vertical explanatory relations that might hold between facts at the personal and farts at the sub‐personal level. Noting that many philosophers are prepared to accept vertical explanatory relations between the two levels, I argue for the stronger claim that, in the case of at least three central personal level phenomena, the demands of explanatory (...) adequacy require postulating horizontal explanatory relations. (shrink)

The infinitesimal methods commonly used in the 17th and 18th centuries to solve analytical problems had a great deal of elegance and intuitive appeal. But the notion of infinitesimal itself was flawed by contradictions. These arose as a result of attempting to representchange in terms ofstatic conceptions. Now, one may regard infinitesimals as the residual traces of change after the process of change has been terminated. The difficulty was that these residual traces could not logically coexist with the static quantities (...) traditionally employed by mathematics. The solution to this difficulty, as it turns out, is to regard these quantities asalso being subject to (a form of) change, for then they will have the same nature as the infinitesimals representing the residual traces of change, and will become,ipso facto, compatible with these latter.In fact, the category-theoretic models which realize the Principle of Infinitesimal Linearity may themselves be regarded as representations of a general concept of variation (cf. Bell (1986)). While the static set-theoretical models represent change or motion by making a detour through the actual (but static) infinite, the varying category-theoretic models enable such change to be representeddirectly, thus permitting the introduction of geometric infinitesimals and, as we have attempted to demonstrate in this paper, the virtually complete incorporation of the methods of the early calculus.It is surely a remarkable — even an ironic — fact that the contradiction between the flux of the objective world and the stasis of mathematical entities has found its resolution in category theory, a branch of mathematics commonly, and, as one now sees, mistakenly, regarded as the summit of gratuitous abstraction. (shrink)

In this paper the need for valid evidence of the cost-effectiveness of treatments that have not been properly evaluated, yet are already available, albeit in short supply, are examined. Such treatments cannot be withdrawn, pending proper evaluation, nor can they be made more widely available until they have been shown to be cost-effective. As a solution to this impasse the argument put forward recently by Toroyan et al is discussed. They say that randomised controlled trials of such resources could be (...) done but only if resources are randomly allocated independently of a research context. Relevant outcome data could then be collected for research, given this opportunity. We agree. We disagree with Toroyan et al on a number of points. First, they claim that no ethical issue relating to equipoise arises. We disagree and this disagreement depends on our showing that equipoise should be maintained in a relationship that they do not consider. Secondly, they say that consent to data collection is always needed. Again we disagree. Thirdly, they claim that the previous two issues are the only possible ethical issues that could arise. We argue, instead, that there is a further conflict of interests that has ethical import. (shrink)

Physical arguments stemming from the theory of black-hole thermodynamics are used to put constraints on the dynamics of closed-string tachyon condensation in Scherk–Schwarz compactifications. A geometrical interpretation of the tachyon condensation involves an effective capping of a noncontractible cycle, thus removing the very topology that supports the tachyons. A semiclassical regime is identified in which the matching between the tachyon condensation and the black-hole instability flow is possible. We formulate a generalized correspondence principle and illustrate it in several different circumstances: (...) an Euclidean interpretation of the transition from strings to black holes across the Hagedorn temperature and instabilities in the brane-antibrane system. (shrink)

Continuous as the stars that shine And twinkle on the milky way, They stretched in never-ending line Along the margin of a bay: Ten thousand saw I at a glance, Tossing their heads in sprightly dance.

In this paper we construct the ortholattices arising in quantum logic starting from the phenomenologically plausible idea of a collection of ensembles subject to passing or failing various “tests.” A collection of ensembles forms a certain kind of preordered set with extra structure called anorthospace; we show that complete ortholattices arise as canonical completions of orthospaces in much the same way as arbitrary complete lattices arise as canonical completions of partially ordered sets. We also show that the canonical completion of (...) an orthospace of ensembles is naturally identifiable as the complete lattice of properties of the ensembles, thereby revealing exactlywhy ortholattices arise in the analysis of “tests” or experimental propositions. Finally, we axiomatize the hitherto implicit concept of “test” and show how they may be correlated with properties of ensembles. (shrink)

This paper critically evaluates Jonathan Lowe's arguments for his non-Cartesian substance dualism. Sections 1 and 2 set out the principal claims of NCSD. The unity argument proposed in Lowe is discussed in Section 3. Throughout his career Lowe offered spirited attacks on reductionism about the self. Section 4 evaluates the anti-reductionist argument that Lowe offers in Subjects of Experience, an argument based on the individuation of mental events. Lowe offers an inventive proposal that the semantic distinction between direct and indirect (...) reference delineates the metaphysical boundary between self and world, and uses this as a further argument against reductionism about the self. This proposal is discussed in Sections 5 and 6. (shrink)