Introduction: The decision of “do not attempt resuscitation” in the event of cardiopulmonary arrest is usually made when the patients are critically ill and cannot make an informed choice. Although, various professional bodies have published guidelines, little is know about the patients’ own views regarding DNAR discussion.Aim: The aim of this study was to determine patients’ attitudes regarding discussing DNAR before they are critically ill.Methods: A prospective study was performed in a general out patients department. A questionnaire was distributed to (...) consecutive outpatients along with an explanatory leaflet in the adult outpatient clinic.Results: 364 patients completed the questionnaire . 90% of respondents wanted all patients to be asked regarding DNAR decision at some point during a hospital admission. The majority would not find a DNAR discussion distressing. Only 10% would find it upsetting, however, 48% of these still wanted a discussion. 37% of respondents wanted to discuss DNAR decisions on admission; 32% in outpatients; 17% at consent for surgery, 14% when they are critically ill. 87% of respondents would not object to their relatives being involved in making decisions about their resuscitation status. However, only 12% of the subjects in the study had been involved in discussing the resuscitation status of a relative and 21% would not be comfortable to discuss a relative’s resuscitation status. Although 33% of patients preferred their resuscitation status to simply be documented within their clinical notes, 77% wanted it to be more easily accessible.Conclusions: This study suggests that contrary to current practice most patients want to discuss their DNAR status prior to becoming critically ill. This includes half of the small number that find it distressing to discuss. Although most patients are comfortable with relatives being involved in discussing DNAR, a significant proportion do not want their relatives to be asked. Furthermore, once a decision has been made, the majority of patients want it to be more accessible than current practice allows. (shrink)

Introduction: The decision of “do not attempt resuscitation” in the event of cardiopulmonary arrest is usually made when the patients are critically ill and cannot make an informed choice. Although, various professional bodies have published guidelines, little is know about the patients’ own views regarding DNAR discussion.Aim: The aim of this study was to determine patients’ attitudes regarding discussing DNAR before they are critically ill.Methods: A prospective study was performed in a general out patients department. A questionnaire was distributed to (...) consecutive outpatients along with an explanatory leaflet in the adult outpatient clinic.Results: 364 patients completed the questionnaire . 90% of respondents wanted all patients to be asked regarding DNAR decision at some point during a hospital admission. The majority would not find a DNAR discussion distressing. Only 10% would find it upsetting, however, 48% of these still wanted a discussion. 37% of respondents wanted to discuss DNAR decisions on admission; 32% in outpatients; 17% at consent for surgery, 14% when they are critically ill. 87% of respondents would not object to their relatives being involved in making decisions about their resuscitation status. However, only 12% of the subjects in the study had been involved in discussing the resuscitation status of a relative and 21% would not be comfortable to discuss a relative’s resuscitation status. Although 33% of patients preferred their resuscitation status to simply be documented within their clinical notes, 77% wanted it to be more easily accessible.Conclusions: This study suggests that contrary to current practice most patients want to discuss their DNAR status prior to becoming critically ill. This includes half of the small number that find it distressing to discuss. Although most patients are comfortable with relatives being involved in discussing DNAR, a significant proportion do not want their relatives to be asked. Furthermore, once a decision has been made, the majority of patients want it to be more accessible than current practice allows. (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)

Ethics support staff help others to deal with moral challenges. However, they themselves can also experience moral challenges such as issues regarding (breaching) confidentiality when practicing ethics support. Currently there is no insight in these confidentiality issues and also no professional guidance for dealing with them. To gain insight into moral challenges related to Moral Case Deliberation (MCD), we studied a) beliefs and experiences of MCD facilitators regarding breaching confidentiality, b) considerations for (not) breaching confidentiality, and c) needs for an (...) ethics support tool. Data collection consisted of qualitative research methods: six semi-structured interviews; analyses of a) two recorded MCD sessions, and b) a focus group with MCD facilitators. Findings: MCD facilitators mention different conceptions and interpretations of confidentiality and various moral challenges. Questions concerning confidentiality ultimately cause reflections on roles and responsibilities of facilitators. Needs for ethics support vary from seeking advice to procedural and sometimes normative guidance for MCD facilitators. Education for MCD facilitators should focus on developing a concrete tool that stimulates awareness and reflection(skills). (shrink)

Precision Medicine has become a common label for data-intensive and patient-driven biomedical research. Its intended future is reflected in endeavours such as the Precision Medicine Initiative in the USA. This article addresses the question whether it is possible to discern a new ‘medical cosmology’ in Precision Medicine, a concept that was developed by Nicholas Jewson to describe comprehensive transformations involving various dimensions of biomedical knowledge and practice, such as vocabularies, the roles of patients and physicians and the conceptualisation of disease. (...) Subsequently, I will elaborate my assessment of the features of Precision Medicine with the help of Michel Foucault, by exploring how precision medicine involves a transformation along three axes: the axis of biomedical knowledge, of biomedical power and of the patient as a self. Patients are encouraged to become the managers of their own health status, while the medical domain is reframed as a data-sharing community, characterised by changing power relationships between providers and patients, producers and consumers. While the emerging Precision Medicine cosmology may surpass existing knowledge frameworks; it obscures previous traditions and reduces research-subjects to mere data. This in turn, means that the individual is both subjected to the neoliberal demand to share personal information, and at the same time has acquired the positive ‘right’ to become a member of the data-sharing community. The subject has to constantly negotiate the meaning of his or her data, which can either enable self-expression, or function as a commanding Superego. (shrink)

In Fiction, Truth and Literature, Lamarque and Olsen argue that if a critic claims or attempts to prove that the outlook of a work of literature is true or false, he is not engaging in literary or aesthetic appreciation. This paper argues against this position by adducing cases where literary critics discuss the truth or falsity of a work’s view, when their opinions are obviously relevant to the work’s aesthetic assessment. The paper considers in detail the way factual errors damage (...) a work’s aesthetic standing, and shows that Lamarque and Olsen’s alternative account of the role of propositional truths in literature only looks plausible because it considers a restricted range of examples. Finally, it considers the role intention, date and genre play in discussions of the aesthetic damage done by literal falsehood. (shrink)

An attitude which hopes to derive aesthetic pleasure from an object is often thought to be in tension with an attitude which hopes to derive knowledge from it. The current article argues that this alleged conflict only makes sense when the aesthetic attitude and knowledge are construed unnaturally narrowly, and that when both are correctly understood there is no tension between them. To do this, the article first proposes a broad and satisfying account of the aesthetic attitude, and then considers (...) and rejects twelve reasons for thinking that deriving knowledge from something is incompatible with maintaining an aesthetic attitude towards it. Two main conclusions are drawn. 1) That the representational arts are often in a good position to communicate non-propositional knowledge about human beings. 2) That while our desire to obtain pleasure from a work's manifest properties, and our desire to obtain knowledge from it, are not the same motive, the formal similarities between them are sufficiently impressive to warrant both being seen as elements of the aesthetic attitude. (shrink)

Humans do two types of actions, polimorphic actions and mimeomorphic actions. The ability to carry out polimorphic actions cannot be mastered outside of socialization. Mimeomorphic actions, however, can be learned in other ways; sometimes, they can be learned away from the context of practice. Polimorphic actions cannot be mimicked by machines, but some mimeomorphic actions can. Other mimeomorphic actions are too complex to mechanize. Actions that cannot be mechanized because they are physically complicated should not be confused with actions that (...) cannot be mechanized because socialization is needed to master them. The analysis has implications for recent debates concerning the differences and similarities between humans and machines. The implica tion of the analysis is that much more can be understood about the relationship between humans and machines if the difference is treated as being a consequence of the unique properties of human societies. In this article, the analysis is applied to cardiac catheteriza tion, pacemaker implantation, simulation of bodies, and work in a medical "SkillsLab.". (shrink)

Sartre rationalizes sexuality much like Plato. Rationalization here refers to the way Sartre tries to facilitate explanation by changing the terms of the discussion from sexual to nonsexual concepts. As a philosophy which, above all, highlights those features of human existence which seem most resistant to explanation, one would expect existentialism to highlight sexuality as a category that is crucial for considering human existence. Descartes comes immediately to mind when one focuses on Sartre's major categories. In Sartre's case however, it (...) is not mind and matter but consciousness and its opposite: "nothingness" and "being." This irreducible dualism is the key to the trouble human beings have with existence. Humans try to deal with the tensions implied by this dualism by trying to pretend people are not subjects but objects. Sartre calls this "bad faith." He begins by attempting to take human sexuality seriously as a fundamental category, but ends by abandoning the effort in favor of other substitutes. (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)

The theory of personal identity should illuminate and be illuminated by the theory of personality, of which it is a part. I believe that Locke's theory succeeds in this more than that of any other great philosopher, and the modifications which it may need are not fundamental ones. The problems raised by Butler and Flew can be made to disappear.

The influence of Goethe on Wittgenstein is just beginning to be appreciated. Hacker and Baker, Westphal, Monk, and Haller have all drawn attention to significant affinities between the two men's work, and the number of explicit citations of Goethe in Wittgenstein's texts supports the idea that we are not dealing simply with a matter of deeplying similarities of aim and method, but of direct and major influence. These scholarly developments are encouraging because they help to place Wittgenstein's work within an (...) important tradition of German letters which goes far beyond his contemporaries and immediate forebears in Vienna; and they show that Wittgenstein's profound interest in literature and music is ceasing to be merely a matter of biographical anecdote, and is being used to illuminate some of the most central areas of his work. (shrink)

THE PROBLEM OF THE INTERPRETATION OF HAMANN Johann Georg Hamann is an intriguing but poorly known figure in the contemporary intellectual world. Yet this is the man whom Kierkegaard saluted as "Emperor!", whose writings were to have been arranged for publication by none other than Goethe himself, and whom Dilthey numbered among the primordial figures in the rise of modern historical consciousness. There are reasons for the persistence of this general ignorance. Hamann is deep. And, in addition, there is his (...) forbidding style. The readers of Kierkegaard and Dilthey, two other giants who them selves achieved late recognition, have not had to face this kind of imposing obstacle. Not only does Hamann expect his readers to handle themselves in deep water, but to intuit their way between his ideas which bob up like islands with no visible connection between them. Like Kierkegaard too, Hamann has had his troubles with the public. He himself referred to the hope that he would be understood by a "better posterity". In fact only the last few years have seen the printing of some of his more controversial writings, in particular his theories on the nature of human sexuality. (shrink)

According to some, the combatant-noncombatant distinction has lost its relevance in today’s world. I examine two arguments to this effect. The first states that the distinction has become irrelevant when it categorizes children as combatants. I reply that the distinction has nothing to do with innocence or guilt, but with the degree to which a violent group poses a threat to others, even when it does so legitimately. The second argues that every civilian can be construed as a kind of (...) combatant, thus obliterating the distinction. My answer notes an error: states are representatives of citizens, not the other way around.My position in this paper is that individuals take on legitimate combatancy as a function of membership in an organization with legitimate combatancy. This paper attempts to construct a concept of the fighting organization that will allow us to determine the legitimate combatancy of such organizations. The three combatancy criteria I offer are military command structure, observance of the war convention, and representativeness. The first is a requirement for legitimate combatancy because it facilitates the prevention of ius in bello violations of the war convention and can enable the transition from war to diplomacy. My second criterion, the observance of the war convention, too, must be retained as a condition for legitimate combatancy: targeting noncombatants as a means of fighting the war certainly disqualifies organizations from potential POW status, and other ius in bello infractions might, as well. My third condition, representativeness, requires that fighters serve as moral proxies for a geographically contiguous, politically viable people in order to retain legitimate combatancy. If a fighting organization does not represent such a people, then it is a group of criminals rather than soldiers. (shrink)

After presenting a variety of arguments in support of the idea that ordinary names are indexical, I respond to John Perry's recent arguments against the indexicality of names. I conclude by indicating some connections between the theory of names defended here and Wittgenstein's observations on naming, and suggest that the latter may have been misconstrued in the literature.

After presenting a variety of arguments in support of the idea that ordinary names are indexical, I respond to John Perry's recent arguments against the indexicality of names. I conclude by indicating some connections between the theory of names defended here and Wittgenstein's observations on naming, and suggest that the latter may have been misconstrued in the literature.

W G M Elliott; Ideology and School Mathamatics: Reply to C. P. Ormell, Journal of Philosophy of Education, Volume 3, Issue 1, 30 May 2006, Pages 55–64, https://.

This chapter contains section titled: I Aristotle and Early Modern Philosophy II Medieval Thought in Early Modern Scholasticism III The Philosophical Textbook IV Conclusions.