The dilemma of whether and how to disclose a diagnosis of cancer or of any other terminal illness continues to be a subject of worldwide interest. We present the case of a 62-year-old Japanese woman afflicted with advanced gall bladder cancer who had previously expressed a preference not to be told a diagnosis of cancer. The treating physician revealed the diagnosis to the family first, and then told the patient: "You don't have any cancer yet, but if we don't treat (...) you, it will progress to a cancer". In our analysis, we examine the role of family consent, communication patterns (including ambiguous disclosure), and advance directives for cancer disclosure in Japan. Finally, we explore the implications for Edmund Pellegrino's proposal of "something close to autonomy" as a universal good. (shrink)

Drawing on ancient writers, from Aesop to Ovid, classicist and working farmer, Mark Usher compiles in this book an anthology of Greco-Roman passages illustrating how they thought about animals and illuminating they might help us to rethink our relationships with them. Not many contemporary readers will know, for example, the compelling arguments the second century AD Greek philosopher Porphyry makes for vegetarianism, long before a plant-based diet began to garner headlines. Plutarch's serio-comic exposition of the rationality and inherent dignity of (...) non-human creatures-put on the lips of one of Circe's pigs-is so fresh that it sounds like it was formulated just yesterday. The knowledge the poet Theognis derived from Greek sponge divers about the behavior of octopods rivals our contemporary fascination with the octopus. Aristotle's introduction to the scientific study of animal morphology and behavior remains unparalleled for its elegance and insight, and it represents one of the first forays into natural history writing. Seneca, employing an ingenious etymological pun on the word animal, endeavors to show that we humans are morally inferior to our animal cousins, who instinctively know and are satisfied with their place in Nature. The Greeks and Romans, amidst all their magnificent cultural achievements and reckless, destructive behavior, lived closer than most of us to the perils and prospects of their environments. This afforded them a sensitivity to their environments and, in particular, to their fellow creatures that can perhaps help to disabuse us of our disconnectedness from animal life. This small volume demonstrates how astoundingly relevant the ancients still are in this regard. (shrink)

In recent years, we have seen a new concern with ethics training for research and development professionals. Although ethics training has become more common, the effectiveness of the training being provided is open to question. In the present effort, a new ethics training course was developed that stresses the importance of the strategies people apply to make sense of ethical problems. The effectiveness of this training was assessed in a sample of 59 doctoral students working in the biological and social (...) sciences using a pre–post design with follow-up and a series of ethical decision-making measures serving as the outcome variable. Results showed not only that this training led to sizable gains in ethical decision making but also that these gains were maintained over time. The implications of these findings for ethics training in the sciences are discussed. (shrink)

Objective: The field of clinical ethics is relatively new and expanding. Best practices in clinical ethics against which one can benchmark performance have not been clearly articulated. The first step in developing benchmarks of clinical ethics services is to identify and understand current practices.Design and setting: Using a retrospective case study approach, the structure, activities, and resources of nine clinical ethics services in a large metropolitan centre are described, compared, and contrasted.Results: The data yielded a unique and detailed account of (...) the nature and scope of clinical ethics services across a spectrum of facilities. General themes emerged in four areas—variability, visibility, accountability, and complexity. There was a high degree of variability in the structures, activities, and resources across the clinical ethics services. Increasing visibility was identified as a significant challenge within organisations and externally. Although each service had a formal system for maintaining accountability and measuring performance, differences in the type, frequency, and content of reporting impacted service delivery. One of the most salient findings was the complexity inherent in the provision of clinical ethics services, which requires of clinical ethicists a broad and varied skill set and knowledge base. Benchmarks including the average number of consults/ethicist per year and the hospital beds/ethicist ratio are presented.Conclusion: The findings will be of interest to clinical ethicists locally, nationally, and internationally as they provide a preliminary framework from which further benchmarking measures and best practices in clinical ethics can be identified, developed, and evaluated. (shrink)

The editorial in the September 1982 issue of this journal and many articles before and since have addressed the problem of informed consent. Is it possible? Is it a useful concept? Is there anything new to be said about it? In this article the basic rationale of the rule (patient autonomy) is explained and the extent of the rule explored. Various exceptions have been offered by the law and an attempt is made to catalogue the chief of these. A number (...) of specially vulnerable groups are then identified, the most important, and vexed, being children. How can informed consent be secured in the case of young patients? Finally, a few problems are mentioned in an attempt to get this subject back to reality. The appeal to the principle primum non nocere may be medical paternalism in disguise. Informed consent is the competing principle that reminds us of the primacy of human autonomy. A pointer is given to the future: even the use of sound recordings to explain medical procedures and to activate informed consent so that it may become a reality and not just a lawyer's myth, should be considered. (shrink)

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in (...) the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible. (shrink)

Citizens today are increasingly expected to be knowledgeable about and prepared to engage with biomedical knowledge. In this article, I wish to reframe this ‘public understanding of science’ project, and place fresh emphasis on public understandings of research: an engagement with the everyday laboratory practices of biomedicine and its associated ethics, rather than with specific scientific facts. This is not based on an assumption that non-scientists are ‘ignorant’ and are thus unable to ‘appropriately’ use or debate science; rather, it is (...) underpinned by an empirically-grounded observation that some individuals may be unfamiliar with certain specificities of particular modes of research and ethical frameworks, and, as a consequence, have their autonomy compromised when invited to participate in biomedical investigations. Drawing on the perspectives of participants in my own sociological research on the social and ethical dimensions of neuroscience, I argue that public understanding of biomedical research and its ethics should be developed both at the community level and within the research moment itself in order to enhance autonomy and promote more socially robust science. Public bioethics will have to play a key role in such an endeavour, and indeed will contribute in important ways to the opening up of new spaces of symmetrical engagement between bioethicists, scientists and wider publics—and hence to the democratisation of the bioethical enterprise. (shrink)

This article identifies two trends in Dooyeweerd’s conception of ‘cosmic time’, and elaborates their consequences for the philosophy of history. The first trend, connecting time to modal diversity and the order of the modal aspects, prevails in Dooyeweerd’s analysis. The application of the second trend, emphasizing that in each relation frame the temporal order governs subject-subject relations and subjectobject relations, sheds a new light on the interpretation of history conceived of as development of the culture and civilization of mankind. The (...) distinction of faith and religion and the position of the aspect of faith in the order of the modal aspects play important parts in this discussion, in particular with respect to the possibility of transcending time. (shrink)

At the law side of the creation, the Philosophy of the Cosmonomic Idea distinguishes between natural laws, values and norms. Natural laws are coercive both for human beings and for any other subject or object. Like natural laws, values or normative principles belong to the creation, being universal and invariable. Both people and associations are subject to values, which they can obey or disobey. Values characterize the relation frames following the natural ones. Norms are man-made realizations of values, historically and (...) culturally different. Philosophical ethics investigates the normativity of human acts. This paper argues that ethics cannot be related to a single relation frame and that the designation ‘ethical’ or ‘moral’ modal aspect is a misnomer. (shrink)

The Greeks and Romans have been charged with destroying the ecosystems within which they lived. In this book, however, M. D. Usher argues rather that we can find in their lives and thought the origin of modern ideas about systems and sustainability, important topics for humans today and in the future. With chapters running the gamut of Greek and Roman experience – from the Presocratics and Plato to Roman agronomy and the Benedictine Rule – Plato's Pigs brings together unlikely bedfellows, (...) both ancient and modern, to reveal surprising connections. Lively prose and liberal use of anecdotal detail, including an afterword about the author's own experiments with sustainable living on his sheep farm in Vermont, add a strong authorial voice. In short, this is a unique, first-of-its-kind book that is sure to be of interest to anyone working in Classics, environmental studies, philosophy, ecology, or the history of ideas. (shrink)

Discussions about the aesthetic relation frame are often focused on subject-object relations, on objects of arts, their production and their perception.1 A Christian philosophical anthropology emphasizes human subject-subject relations and human acts, including more than the production of artefacts. According to the philosophy of the cosmonomic idea, any kind of human act has an aesthetic aspect. Yet, I shall restrict myself to types of characters that are aesthetically qualified. I shall discuss characters of acts, which objects are not typically aesthetic; (...) characters of acts, which objects are aesthetically qualified; characters of acts performed in subject-subject relations, and characters of aesthetically qualified associations. (shrink)

To avoid misinterpretations one should substitute the ambiguous notion of 'new disease' with 'emerging disease'. A disease can be classified emergent in at least five dif férent historical situations; 1) it existed before it could be first identified but was overlooked from a médical point of view because it could not be conceptualized as a nosological entity; 2) it existed but was not noticed until a quantitative and/or qualitative change in its mani festations; 3) it did not exist in a (...) particular région of the world before its introduction from other régions; 4) it never existed in a human population but only in an animal population; 5) it is completely new - the triggering germ and/or necessary environmental conditions did not exist prior to the first clinical manifestations. A sériés of historical examples illustrate this classification. (shrink)

While much has been written on the cultural and intellectual antecedents that gave rise to Carolus Linnaeus?s herbarium and his Systema Naturae, the tools that he used to transform his raw observations into nomenclatural terms and categories have been neglected. Focusing on the Philosophia Botanica, the popular classification handbook that he published in 1751, it can be shown that Linnaeus cleverly ordered and reordered the work by employing commonplacing techniques that had been part of print culture since the Renaissance. Indeed, (...) the functional adaptability of commonplace heads allowed him to split and combine the book?s chapters and tables and played a notable conceptual role in the way in which he spatialized words and, to a certain extent, specimens. (shrink)

Discusses the metaphysics of the iterative conception of set.

The British National Institute for Health and Clinical Excellence has recently released new guidelines for the diagnosis, treatment and prevention of the psychiatric category antisocial personality disorder. Evident in these recommendations is a broader ambiguity regarding the ontology of ASPD. Although, perhaps, a mundane feature of much of medicine, in this case, ontological uncertainty has significant ethical implications as a product of the profound consequences for an individual categorised with this disorder. This paper argues that in refraining from emphasising uncertainty, (...) NICE risks reifying a controversial category. This is particularly problematical given that the guidelines recommend the identification of individuals “at risk” of raising antisocial children. Although this paper does not argue that NICE is “wrong” in any of its recommendations, more emphasis should have been placed on discussions of the ethical implications of diagnosis and treatment, especially given the multiple uncertainties associated with ASPD. It is proposed that these important issues be examined in more detail in revisions of existing NICE recommendations, and be included in upcoming guidance. This paper thus raises key questions regarding the place and role of ethics within the current and future remit of NICE. (shrink)

Disjunctivism about sensory experience is frequently put forward in defence of a particular conception of perception and perceptual experience known as naïve realism. In this paper, I present an argument against naïve realism that proceeds through a rejection of disjunctivism. If the naïve realist must also be a disjunctivist about the phenomenal nature of experience, then naïve realism should be abandoned.

This book studies the interfaces of ethics, economics, and politics. Public policy issues involve all three of these subjects. Although it may be seen as suggesting the nucleus of a joint university course, the book is accessible to and should interest all those concerned with political decisions. Any such decision needs a criterion for judging whether one action or outcome is better than another. Even a dictator must to some extent be concerned about the economic elfare of the citizens; and (...) a democratic government more so. But how is a person's economic welfare to be judged? Furthermore, any political decision affects the economic welfare of different people differently. How then is the welfare of a community to be judged? This is an ethical question. Underlying any coherent public policy there must be a relevant moral code. (shrink)

This book studies the interfaces of ethics, economics, and politics. Public policy issues involve all three of these subjects. Although it may be seen as suggesting the nucleus of a joint university course, the book is accessible to and should interest all those concerned with political decisions. Any such decision needs a criterion for judging whether one action or outcome is better than another. Even a dictator must to some extent be concerned about the economic welfare of the citizens; and (...) a democratic government more so. But how is a person's economic welfare to be judged? Furthermore, any political decision affects the economic welfare of different people differently. How then is the welfare of a community to be judged? This is an ethical question. Underlying any coherent public policy there must be a relevant moral code. (shrink)

Open peer commentary on the article “Exploring the Depth of Dream Experience: The Enactive Framework and Methods for Neurophenomenological Research” by Elizaveta Solomonova & Xin Wei Sha. Upshot: This commentary focuses on an ontological claim made by the authors of this target article: that perceiving, imagining and dreaming are inseparable. It explores how best to understand this “inseparability condition.” It is shown that the evidence needed to justify a strict reading of the inseparability condition is lacking, while there is room (...) for a more relaxed rendition of the inseparability condition. The inferred lesson is that in developing an enactive neurophenomenology of dreaming, it is a non-trivial task to achieve clarity about the ontology of dreaming, and its relationship to imagining as well as perceiving. (shrink)

Legislation that authorises controversial organ procurement strategies but ignores respect for autonomy is flawed in principle and predictably unworkable in practiceThe UK Human Tissue Act 2004,1 designed to regulate all activity involving human tissue, organs, or bodies, was introduced in the House of Commons in December 2003, received Royal Assent on 15 November 2004,2 and has been partially implemented by Commencement Orders from April 2005. The new act, which repeals and replaces the Human Tissue Act 1961, the Anatomy Act 1984, (...) and the Human Organ Transplants Act 1989, has its origins in events of serious public concern, namely the retained organs scandals at Bristol Royal Infirmary3 and the Royal Liverpool Childrens’ Hospital.4 The act is correspondingly dominated by regulation of postmortem examinations and retention of human tissue, with consistent emphasis on the need for fully informed consent. Compliance with these requirements is now mandatory with the threat of up to three years’ imprisonment and/or fines for any deviation.The impact of the original proposals within the bill on research and the clinical practice of pathology have been carefully considered and documented,5 with subsequent amendments to ameliorate professional concerns.6 The act, however, also carries significant implications for medical practice in areas where donor recruitment for transplantation can take place, and representations on these aspects during readings of the bill7 have produced neither clarification, justification, nor amendment within the final legislation.Section 43 will make it lawful for hospital authorities “to take steps for the purpose of preserving the part for use for transplantation and to retain the body for that purpose”. The original explanatory notes for the bill8 while it proceeded through parliament implied that such action, prior to consent to transplantation being sought, was then lawful, clause 44 as section 43 …. (shrink)

The Chairman of the Australian Law Reform Commission summarizes the discussion of in vitro fertilization (IVF) at the 1983 Mogul International Management Consultants Ltd. Conference on "Bioethics and Law of Human Conception in Vitro." Participants included IVF pioneers Patrick Steptoe and Robert Edwards, as well as other British physicians, scientists, sociologists, and moral philosophers. They raised questions about multiple embryo implantations, the risks and benefits of IVF, the ethical responsibilities of investigators, public policy and social control of IVF, threats to (...) the family and to genetic integrity, and the implications of IVF for determining criteria of personhood and the beginning of life. (shrink)

Upshot: We respond to three main challenges that the commentaries have raised. First, we argue that to deal successfully with the hard problem of consciousness, it is not enough to posit a remedy by which to move beyond the hard problem. Second, we argue that it makes no sense to explain identity. Yet this does not commit us to definitions by fiat. The strategy we pursue here, and in the target article, is not to explain identity but to explain away (...) the appearance of non-identity. Finally, while we are sympathetic to Varela’s call for a paradigm shift in consciousness studies, we argue here, and in the target article, that this call can only be properly successful if the hard problem is dismantled. (shrink)