Various emerging technologies, from social robotics to social media, appeal to our desire for social interactions, while avoiding some of the risks and costs of face-to-face human interaction. But can they offer us real friendship? In this book, Alexis Elder outlines a theory of friendship drawing on Aristotle and contemporary work on social ontology, and then uses it to evaluate the real value of social robotics and emerging social technologies. In the first part of the book Elder develops (...) a robust and rigorous ontology of friendship: what it is, how it functions, what harms it, and how it relates to familiar ethical and philosophical questions about character, value, and well-being. In Part II she applies this ontology to emerging trends in social robotics and human-robot interaction, including robotic companions for lonely seniors, therapeutic robots used to teach social skills to children on the autism spectrum, and companionate robots currently being developed for consumer markets. Elder articulates the moral hazards presented by these robots, while at the same time acknowledging their real and measurable benefits. In the final section she shifts her focus to connections between real people, especially those enabled by social media. Arguing against critics who have charged that these new communication technologies are weakening our social connections, Elder explores ways in which text messaging, video chats, Facebook, and Snapchat are enabling us to develop, sustain, and enrich our friendship in new and meaningful ways. (shrink)

The Search for the Legacy of the USPHS Syphilis Study at Tuskegee is a collection of essays from experts in a variety of fields seeking to redefine the legacy of the infamous Tuskegee Syphilis Study. The essayists place the legacy of the study within the evolution of racial and ethnic relations in the United States. Contributors include two leading historians on the study, two former United States Surgeons General, and other prominent scholars from a wide range of fields.

Purpose This paper aims to survey the moral psychology of emoji, time-restricted messaging and other non-verbal elements of nominally textual computer-mediated communication. These features are increasingly common in interpersonal communication. Effects on both individual well-being and quality of intimate relationships are assessed. Results of this assessment are used to support ethical conclusions about these elements of digital communication. Design/methodology/approach Assessment of these non-verbal elements of CMC is framed in light of relevant literature from a variety of fields, including neuroscience, behavioral (...) economics and social psychology. The resulting ethical analysis is informed by both Aristotelian and Buddhist virtue ethics. Findings This paper finds that emoji and other nonverbal elements of CMC have positive potential for individual well-being and interpersonal communication. They can be used to focus and direct attention, express and acknowledge difficult emotions and increase altruistic tendencies. Research limitations/implications This paper is conceptual, extrapolating from existing literature to investigate possibilities rather than reporting on novel experiments. It is not intended to substitute for empirical research on use patterns and their effects. But by identifying positive potential, it can help both users and designers to support individual and relational well-being. Practical implications The positive effects identified here can be incorporated into both design and use strategies for CMC. Social implications Situating ethical analysis of these trending technologies within literature from the social sciences on the effects of stylized faces, disappearing messages and directed attention can help us both understand their appeal to users and best practices for using them to enrich our social lives. Originality/value The paper uses empirically informed moral psychology to understand a deceptively trivial-looking phenomenon with wide-ranging impacts on human psychology and relationships. (shrink)

Scientific progress in the areas of health and biological science is phenomenal. Still, current health policies limit optimal benefit for our peoples. Our present system costs too much, delivers too little, is not comprehensive, coherent, or cost-effective, does not allow choice, is not equitable, and is not universal. We must overcome many crises if we are to create a healthy people fro the twenty-first century in the US. We will need to use multiple strategies to achieve the nation's goals of (...) Healthy People 2010, which are to: 1) increase the quality and years of healthy live; 2) eliminate health disparities; 3) provide access to primary preventive care for all citizens. We are the richest country in the world and the only industrialized country that does not provide health care for its entire people. Health care costs are escalating and insurance is out of reach for many. Public policy changes are necessary to provide universal access to basic health care. We have advances in sciences; now we need the science delivered to our people in an equitable way. Politicians will respond proportionately to the insistence of the people. Healthcare professionals and scientists should lead the way. (shrink)

This white paper outlines the plans of the History Philosophy Culture Working Group of the Next Generation Event Horizon Telescope Collaboration.

“Congealing” is a word that evokes senses of unpleasantness where perhaps something inviting had once been. It also implies that things are becoming less fluid and more rigid. As we began organizing ETHICOMP 2018, we wanted a theme that reflected the impact of technologies on human cultures, practices and lives. Our initial draft of the theme was “Creating, Changing, and Congealing Ways of Life with Technologies.” And while we were eventually persuaded to use a more congenial way of putting the (...) idea (it became “Creating, Changing, and Coalescing Ways of Life with Technologies”), in some ways, it remains true for us that “congealing,” and its connotations of something less pleasant, gets at the original idea. As we incorporate technologies into our practices, much attention is paid to how they change our ways of doing things. But technologies can also help ways of life set-up and harden like yesterday’s leftovers – not appealing, yet difficult to budge and sometimes quite unhealthy. Once a particular process is built around a piece of technology, it can become entrenched and increasingly difficult to change. For a historical example, consider how difficult it was to adapt records and software on the eve of the 21st century in response to the so-called “Y2K” problem. In early software development, efficient use of memory was an important design consideration. It had become a standard practice to use a 2-digit field for the year, which would roll to from “99” to “00” in the year 2000, causing problems for datedependent functions. Technologies can also reflect and reinforce existing cultural tendencies. For a recent example, consider the human resources software created by Amazon that used its existing hiring data to train a machine-learning system to rate applicants. The resulting system turned out to be biased against women applicants, downranking resumes that included the word “woman” or “women’s.” Amazon ended up scrapping the project altogether. Because of these kinds of effects, we wanted to encourage people to think beyond well-worn paradigms like “technologies are disruptive” to consider other kinds of effects they can have. As it happened, the imagery of “congealing” proved distasteful enough that the steering committee opted for a more neutral term. But even with the less-dramatic wording the conference ended up attracting a rich and diverse range of papers that examined technological issues from a variety of angles, exactly as we had hoped. (shrink)

Research involving transgender and gender diverse people (TGD) increased in the last years, mostly concerning healthcare associated to this population. Few studies dedicated their analysis to the impact of parental support on transgender people, even though this is an important aspect in creating a safe environment on which these individuals can build their identity. In addition, the link between family support, TGD identity and homelessness is not completely established. Thus, due to the specificities of the family context of TGD individuals, (...) the aim of this study is to investigate the association between family support and TGD in different moments of the process of gender affirmation. In addition, this study also aims to explore the relationship between a lack of social support and low self-esteem, home abandonment, and dwelling in the street. The survey was designed based on the TransPULSE project and was made available in electronic format. The sample was constituted of 423 TGD residents in two Brazilian states. A Structural Equation Model analysis suggested that the impact of gender affirmation status on homelessness was mediated by parental support, through self-esteem, and the need to move from home. The association between the status of the gender affirmation procedures, family support and self-esteem was significant and indicated that the further TGD individuals advanced in gender affirmation, the more self-esteem and family support they would have. The association between family support and self-esteem indicated that family support was associated with higher self-esteem. Low family support was associated with the willingness to move from home due to one’s TGD status and there was also a significant correlation between low self-esteem and the willingness to move from home due to one’s TGD status. Finally, homelessness was associated with the willingness to move with a large effect size. Limitations include the sample that was constituted by individuals with Internet access and who had more contact with TGD communities. The findings indicate directions for interventions involving TGD people and their families, considering the parental relationship as a critical variable to improve TGD quality of life in the process of gender affirmation. (shrink)

When we discuss the value of a work of art we are confronted immediately with two difficulties: the terms we use, and the peculiar character of art. No one, to my knowledge, has ever doubted that an artist produces a form of some kind, and that in any discussion of art as art that form must somehow be considered; but the terms we use generally have no reference to form. We miss the form in various ways We use terms that (...) are nonartistic—that is, terms that refer to something external to the work, as when we speak of the subject of a painting, of what was depicted rather than the depiction of it, though we know full well that what we respond to is not what was depicted but the depiction of it. "This is a play about Oedipus— what does that tell us of the diverse forms produced by Sophocles, Seneca, Dryden, Voltaire, Gide, Cocteau? Or again, we use terms which are analogical, for example, the "rhythm" of a painting; the difficulty with these is that they are ambiguous and also that, while they may relate to the work, they can designate it only insofar as there is similarity between it and the analogue. Again, we use terms which seem to designate a single form when in fact they refer to forms of the utmost heterogeneity, as when we speak of "the novel"; this usually arises out of the indiscriminate application of the term over some considerable span of history, so that the "historical slippage" of meaning is gradual and goes unnoticed. As the term broadens in meaning to include more and more heterogeneous forms, the essence of each is lost, and the term comes to apply only to accidental analogies between the forms. In the end very little can then be said, involving only the most abstract and general accidents of likeness. Henry James' The Art of Fiction, Percy Lubbock's The Craft of Fiction, and E.M. Forster's Aspects of the Novel illustrate this condition perfectly. The complaint that it is impossible to discuss tragedy because the term has been diversely employed and its proffered justification stem from this condition. The complaint and the justifications are both trivial, and the solution of the difficulty is simple. All that is necessary is to distinguish the different senses of the term by distinguishing the different things to which it is applied. Language is ambiguous, and we use it ambiguously; this in no way implies that the ambiguities cannot be cleared up. Finally, we may use terms which indeed have reference to the form of the work but place the part for the whole; that is, terms which are elements in its definition but do not constitute the complete definition. Thus we designate something, not through the form proper but through the device or method used, as in "drama," "sculpture," "etching," "collage," or through the means or medium, as in "charcoal sketch," "watercolor," "oil painting." The point is not that the object is not, say, a drama or a watercolor; of course it is. The point is rather that these terms do not as such refer to the form and refer to it completely. If in fact they stipulated form, all charcoal sketches would be alike in form, and all oil paintings, and all dramas. One consequence of speaking in such a fashion is that we are likely to confuse the method with the form and talk of, say, "the nature of drama" as though all drama were of the same "nature," whereas the dramatic method is used in a wide variety of forms; or to confuse the medium or means with the form and to assure that the work can have no properties beyond those of its medium, as though artists did not exist and all art were simply nature.Elder Olson, poet and critic, has received numerous awards for his verse . Among his many works are Tragedy and the Theory of Drama, and The Theory of Comedy. His contributions to Critical Inquiry are "The Poetic Process"" , Part 1 of a "Conspectus of Poetry", and Part 2 of a "Conspectus of Poetry". (shrink)

PURPOSE:To report the localization of a gene causing drusen and macular degeneration in a previously undescribed North American family. METHODS:Genetic mapping studies were performed using linkage analysis in a single family with drusen and atrophic macular degeneration. RESULTS:The clinical manifestations in this family ranged from fine macular drusen in asymptomatic middle-aged individuals to atrophic macular lesions in two children and two elderly patients. We mapped the gene to chromosome 6q14 between markers D6S2258 and D6S1644. CONCLUSIONS:In a family with autosomal dominant (...) drusen and atrophic macular degeneration, the gene maps to a 3.2-cM region on chromosome 6q14. This locus appears to be distinct from, but adjacent to, the loci for cone-rod dystrophy 7 (CORD7) and North Carolina macular dystrophy (MCDR1). Future identification of the gene responsible for the disease in this family will provide a better understanding of macular degeneration. (shrink)

A growing phenomenon in contemporary society is adult children caring for their elderly parents. Although some interest has been directed to the question of filial piety in general, surprisingly, scant attention has been focused on the ethical dimensions of caring for elderly parents. This article explores the contribution that Aquinas’s theory of the virtues of filial piety and prudence can make to the ethical dilemmas of elder care. In examining Aquinas’s theory, I explicate the relationship between moral agency and (...) prudence, with a special emphasis on the relationship between the integral parts of prudence and the exercise of moral virtue. In doing so, I suggest how Aquinas’s theory can shape and guide contemporary filial piety in order to advance quality elder care. (shrink)

MR. R. G. M. Nisbet has made the attractive suggestion that the Vinnius to whom Horace addressed his thirteenth epistle was the Vinnius Valens mentioned by the elder Pliny as a centurion of immense strength who had served in the praetorian guard of Augustus . To the points which he has made in support of this identification may be added the appropriateness, if Horace's Vinnius was a soldier, of the words victor propositi and the fact that Horace's comparison between (...) Vinnius and a pack-animal gains in point if Vinnius was famous for feats of strength involving wagons and beasts of burden. (shrink)

OBJECTIVES: Cognitive and sensory difficulties frequently jeopardize informed consent of frail elderly patients This study is the first to test whether preliminary research experience could enhance geriatric patients' capacity to consent. DESIGN/SETTING: A step-wise consent procedure was introduced in a study on fluid balance in geriatric patients. Eligible patients providing verbal consent participated in a try-out of a week, during which bioelectrical impedance and weight measurements were performed daily. Afterwards, written informed consent was requested. Comprehension, risk and inconvenience scores (ranges: (...) 0-10) were obtained before and after the try-out by asking ten questions about the study's essentials and by asking for a risk and inconvenience assessment on a ten-points rating scale. SUBJECTS AND RESULTS: Seventy of the 78 eligible subjects started the try-out and 53 (68%) provided written consent. The comprehension score increased from 5.0 (+/- 2.3) to 7.0 (+/- 1.9) following the try-out (P < 0.001). The number of subjects capable of weighing risks and inconveniences increased from 32 to 48 (P < 0.001). CONCLUSIONS: Research experience improved the capacity to consent, still enabling an acceptable participation rate. Therefore, experienced consent seems a promising tool to optimize informed consent in frail elderly subjects. (shrink)

In 1997 an international conference on Aristotle and modern science took place in Thessaloniki. Aristotle’s view of nature—his criticism of the atomists, on the one hand, and modern science, on the other—seem to be widely opposed, but in recent years science has changed so much that scientists resort to certain basic notions of Aristotle’s natural philosophy to underpin their theories and make material nature more intelligible. In a first paper Hilary Putnam argues against Victor Gaston that Aristotle’s theory of cognition (...) is a “ direct realism” and not as many say a theory based on representation. Perception and thinking are in direct contact with things and their properties. In a charming comparison Bas C. van Fraassen argues that both tragedy and science are subspecies of representation. As in poetry, in science the inexplicable is kept off stage. John P. Anton is confident that the revival of Aristotle’s model of science can provide a solution to the question of the unity of the various sciences. He levels a stinging attack at Putnam’s interpretation of Aristotle’s theory of cognition. Lambros Couloubaritsis voices amazement that in Physics IV Aristotle says nothing about the creative capacity of time, but believes that the notion of “appropriate time” will bring this out. James R. Brown argues that the main stream of science stemming from the seventeenth century is a fusion of the Platonic and mechanic traditions, but that in recent years Aristotle has made an impressive comeback. He examines to what extent the notion of potentiality may be in agreement with and help explain certain physical facts perceived by common sense observation, although it does no justice to quantum “ bizarreness”. He sees better help in the Platonic account of formal causality. Speaking about levels of reality Basarab Nicolescu believes that the universe is self-creating, showing an open structure. A flow of information traverses the various levels of reality. The notion of potency, we are told by Ephtichios Bitsakis, exercises quite some attraction on scientists. Indeed, Aristotle is a precursor of scientific realism, but his theories are marred by many inconsistencies: the Prime Mover, final causality, and entelechy contradict his dynamic view of nature and should be abandoned. In the transformation of massive particles into nonmassive ones the actual mass becomes potential. Thomas M. Olshewsky points out that Aristotle has a differentiated notion of prime matter and rejects absolute prime matter. Jagdish Hattiangadi suggests giving up the idea of substance. Demetra Sfendoni-Mentzou also tackles “the always actual question” of what matter is for Aristotle. Nowadays the idea of stable particles has disappeared and we have to deal with what is potentially real. (shrink)

Reale points out that the good and the demiurgic intelligence are radically distinct, a conclusion denied by J. Seifert in the last paper of the book. Fourteen characteristics of the idea of the good are listed by T. A. Szlezák. It is obvious, he argues, that the theory of principles of Plato’s unwritten doctrines is not identical with what Republic 6 and 7 say about the good, but there is no real opposition. In the next paper, however, H. W. Ausland, (...) after a sober evaluation of the esoteric teachings, suspects that Reale and Szlezák succumb to a certain romanticism. According to L. Brisson, the good belongs to the sphere of being, even if it is not being ; it is not in every way beyond being. Plotinus was the first to place it above being. M. Erler shows what must be the attitude of the philosopher with regard to the information orally received by him. Although Plato did not want to define the good, he pointed out several of its characteristics. The good, M. Migliori notes, combines in itself beauty, proportion, and unity. The Philebus pursues the doctrine of the Republic and goes into the direction of the unwritten doctrines. The ultimate reality, however, is beyond our understanding. E. Cattanei attempts to explain how for Plato mathematics is a way of access to the knowledge of the good. R. Ferber, on the other hand, stresses that Plato nowhere directly says that the essence of the good is the one. Beauty, symmetry, and truth are not the good itself. According to C. Gill, Gadamer demystified the idea of the good, a view which shows some common ground with the position of analytical philosophy: the good is not a transcendent entity. M. Vegetti, however, upholds the transcendent character of the good as a cause of being. G. A. Press argues that over the past hundred years Plato was considered a dogmatic philosopher, and it was believed that the leading speaker in the dialogues states Plato’s own views, but the situation is far more complex. Plato wants us to acquire a vision rather than propositional knowledge. The idea of the good should not be accorded a special position. C. Rowe tries to demystify some current interpretations, whereas F. Ferrari insists on the causality of the good, and sees Plato’s teaching as the origin of the entire tradition of negative theology. Yet some texts give the impression that the good belongs to the ontological order. C. Porebski reminds us that problems of ethics are the starting point of what Plato says about the good in the Republic. According to F. Trabattoni, Aristotle’s description of Plato’s theory of principles is wrong and his philosophy differs fundamentally from Plato’s. The School of Tübingen is a prisoner of Aristotle’s interpretation. Plato’s reluctance to describe the good in detail may mark the beginning of a skeptic trend in the Academy. The Parmenides tells us, E. Berti says, that one has first to remove all hypotheses before a definition of the Good can be given. E. Moutsopoulos draws attention to some simplistic and wrong qualifications of Plato’s thought as related to idealism and mentions Kant and Hegel’s attitudes with regard to Platonism. J. F. Crosby points to a clear leaving behind of the Socratic “no one knowingly does wrong” in the Alcibiades 216b: as Plato explains in the Protagoras, one may live according to one’s lower appetite or follow the insight of the rational soul. G. Santos makes a strong stand in favor of the identity of goodness and reality. L. P. Gerson examines theories of Platos’s development: there is no evidence of a theory of the form of the good earlier than the Republic. Aristotle, J. Dudley writes, upheld an ethical ideal resembling that of Plato, substituting the contemplation of the unmoved mover for that of the idea of the good. In the last paper J. Seifert argues that Plato identified the demiurge and the good. (shrink)

It is not without a certain emotion that one opens this book devoted to the memory of a great scholar of medieval thought who worked and lived in the certainty that there cannot be a conflict between the Christian faith and science. In a significant essay, Benedict M. Ashley defends the idea of the philosophy of nature as continuous or identical with natural science. Ashley does allow, however, for so many divergences between philosophy of nature and natural science due to (...) later developments in science that this identification must be qualified. Steven E. Baldner points out some of the contradictions of Hartshorne's atomism: Hartshorne denies change and real causality. Anthony J. Celano recalls that Robert Kilwardby was very much aware that happiness as described by Aristotle is quite different from the beatitude promised by the Christian faith. The order of the divine entitative attributes in the Summa theologiae I, qq. 3-11 has baffled many a commentator. Lawrence Dewan connects it with some texts of Aristotle's Metaphysics. Jeremiah Hackett studies Roger Bacon's Moralis philosophia. Dealing with Luther's attitude toward St. Thomas, Denis R. Tanz accepts Erasmus's verdict that the weight given to Thomas in theology was an important factor in propelling Luther out of the Roman Catholic orbit. This opinion, however, confounds appearances with the real reason for leaving, namely, estrangement from several central positions of Catholic doctrine. It is a tribute to the Catholicity of Thomas that after 1519 Luther came to identify the Pope, the Church and all scholastic doctors with the Thomists and said that the Church had become the synagogue of the papists and the Thomists: Thomas had been made the arbiter of heresy. Mark F. Johnson stresses the sapiential character of the sacra doctrina. Mark D. Jordan wrestles with the question why Thomas wrote his Aristotelian commentaries. Arguing in the line of Owens's interpretation he reduces their importance with regard to Thomas's own positions. Jordan seems to think that Thomas's philosophy cannot be formulated without his theology, an explanation which is hardly satisfactory. Armand Maurer submits some reflections on St. Thomas's notion of presence. The question to what extent Albert the Great contributed to Aquinas's treatises of the morality of human acts and of natural law is examined by Ernest J. McCullough. Walter H. Principe points out how, according to Aquinas, food is assimilated into the veritas humanae naturae. Eric A. Reitan retraces Weisheipl's analysis of Aristotle's Physics and of St. Thomas' Commentary: the axiom, "whatever is moved, is moved by another" can be understood only within the context of the general science of nature. In his Liber de causis et processu universitatis Albert came to hold the same position as Thomas on the demonstrability of creation and of its beginning in time. Two final articles concern the difficulties underlying Aristotle's arguments in Physics 7 and 8, and Aquinas and Newton on causality: William Wallace connects Newton's universal gravitation with the axiom that nothing acts on itself. (shrink)

It is not without a certain emotion that one opens this book devoted to the memory of a great scholar of medieval thought who worked and lived in the certainty that there cannot be a conflict between the Christian faith and science. In a significant essay, Benedict M. Ashley defends the idea of the philosophy of nature as continuous or identical with natural science. Ashley does allow, however, for so many divergences between philosophy of nature and natural science due to (...) later developments in science that this identification must be qualified. Steven E. Baldner points out some of the contradictions of Hartshorne's atomism: Hartshorne denies change and real causality. Anthony J. Celano recalls that Robert Kilwardby was very much aware that happiness as described by Aristotle is quite different from the beatitude promised by the Christian faith. The order of the divine entitative attributes in the Summa theologiae I, qq. 3-11 has baffled many a commentator. Lawrence Dewan connects it with some texts of Aristotle's Metaphysics. Jeremiah Hackett studies Roger Bacon's Moralis philosophia. Dealing with Luther's attitude toward St. Thomas, Denis R. Tanz accepts Erasmus's verdict that the weight given to Thomas in theology was an important factor in propelling Luther out of the Roman Catholic orbit. This opinion, however, confounds appearances with the real reason for leaving, namely, estrangement from several central positions of Catholic doctrine. It is a tribute to the Catholicity of Thomas that after 1519 Luther came to identify the Pope, the Church and all scholastic doctors with the Thomists and said that the Church had become the synagogue of the papists and the Thomists: Thomas had been made the arbiter of heresy. Mark F. Johnson stresses the sapiential character of the sacra doctrina. Mark D. Jordan wrestles with the question why Thomas wrote his Aristotelian commentaries. Arguing in the line of Owens's interpretation he reduces their importance with regard to Thomas's own positions. Jordan seems to think that Thomas's philosophy cannot be formulated without his theology, an explanation which is hardly satisfactory. Armand Maurer submits some reflections on St. Thomas's notion of presence. The question to what extent Albert the Great contributed to Aquinas's treatises of the morality of human acts and of natural law is examined by Ernest J. McCullough. Walter H. Principe points out how, according to Aquinas, food is assimilated into the veritas humanae naturae. Eric A. Reitan retraces Weisheipl's analysis of Aristotle's Physics and of St. Thomas' Commentary: the axiom, "whatever is moved, is moved by another" can be understood only within the context of the general science of nature. In his Liber de causis et processu universitatis Albert came to hold the same position as Thomas on the demonstrability of creation and of its beginning in time. Two final articles concern the difficulties underlying Aristotle's arguments in Physics 7 and 8, and Aquinas and Newton on causality: William Wallace connects Newton's universal gravitation with the axiom that nothing acts on itself. (shrink)

Dr. Oguejiofor argues that Aquinas’s philosophical anthropology “is not much more than his philosophy of the human soul.” In his well-documented book he first gives a survey of the positions of philosophers on our question during the earlier part of the thirteenth century paying special attention to Albert the Great. Albert hesitated to accept Aristotle’s definition of the soul as the act of the body, believing that it is not compatible with the soul’s immortality. The second chapter explains this definition (...) and stresses the fact that the soul is immaterial and therefore subsistent. The author might have argued from the fact that it does not share its intellectual activity with the body. Surprisingly he thinks that many of M. Kelly’s remarks against the main argument of the mind’s immateriality—the mainstay of Thomas’s theory—are correct. The third, central chapter deals with Aquinas’s proofs of the soul’s immortality. It examines in their chronological order passages from six works of Thomas where they are put forward, paying special attention to chapters 79 to 81 of the Summa contra gentiles, II. The argument from man’s natural desire is linked to the immateriality of intellectual knowledge. The main arguments are: thought is immaterial and therefore the soul as its source also is; the rational soul transcends the contrary qualities responsible for corruption; the natural desire to exist for ever cannot be in vain. (shrink)

Background: Debates over legalisation of physician-assisted suicide or euthanasia often warn of a “slippery slope”, predicting abuse of people in vulnerable groups. To assess this concern, the authors examined data from Oregon and the Netherlands, the two principal jurisdictions in which physician-assisted dying is legal and data have been collected over a substantial period.Methods: The data from Oregon comprised all annual and cumulative Department of Human Services reports 1998–2006 and three independent studies; the data from the Netherlands comprised all four (...) government-commissioned nationwide studies of end-of-life decision making and specialised studies. Evidence of any disproportionate impact on 10 groups of potentially vulnerable patients was sought.Results: Rates of assisted dying in Oregon and in the Netherlands showed no evidence of heightened risk for the elderly, women, the uninsured , people with low educational status, the poor, the physically disabled or chronically ill, minors, people with psychiatric illnesses including depression, or racial or ethnic minorities, compared with background populations. The only group with a heightened risk was people with AIDS. While extralegal cases were not the focus of this study, none have been uncovered in Oregon; among extralegal cases in the Netherlands, there was no evidence of higher rates in vulnerable groups.Conclusions: Where assisted dying is already legal, there is no current evidence for the claim that legalised PAS or euthanasia will have disproportionate impact on patients in vulnerable groups. Those who received physician-assisted dying in the jurisdictions studied appeared to enjoy comparative social, economic, educational, professional and other privileges. (shrink)

MR. R. G. M. Nisbet has made the attractive suggestion that the Vinnius to whom Horace addressed his thirteenth epistle was the Vinnius Valens mentioned by the elder Pliny as a centurion of immense strength who had served in the praetorian guard of Augustus. To the points which he has made in support of this identification may be added the appropriateness, if Horace's Vinnius was a soldier, of the words victor propositi and the fact that Horace's comparison between Vinnius (...) and a pack-animal gains in point if Vinnius was famous for feats of strength involving wagons and beasts of burden. (shrink)

The subject of sexuality among elderly patients with dementia was examined, focusing on two main aspects: the sexual behaviour of institutionalized elderly people with dementia; and the reactions of other patients, staff and family members to this behaviour. The behaviour was found to be mostly heterosexual and ranged from love and caring to romance and outright eroticism. Reactions varied, being accepting of love and care but often objecting to erotic behaviour. Understanding of the sexual needs of elderly people should become (...) an integral part of the training and continued education of health care staff, thus helping to resolve conflicts and clarify common misconceptions. (shrink)

Background: Sharing information with relatives of elderly patients in primary care and in hospital has to fit into the complex set of obligations, justifications and pressures concerning the provision of information, and the results of some studies point to the need for further empirical studies exploring issues of patient autonomy, privacy and informed consent in the day-to-day care of older people.Objectives: To know the frequency with which “capable” patients over 65 years of age receive information when admitted to hospital, the (...) information offered to the families concerned, the person who gives consent for medical intervention, and the degree of satisfaction with the information received and the healthcare provided.Method: A descriptive questionnaire given to 200 patients and 200 relatives during the patients’ stay in hospital.Results: Only 5% of patients confirmed that they had been asked whether information could be given to their relatives. A significantly higher proportion of relatives received information on the successive stages of the care offered than did patients themselves. As the age of the patients increased, so the number who were given information, understood the information and were asked for their consent for complementary tests decreased. The degree of satisfaction with the information offered was high for both patients and relatives , despite the irregularities observed.Conclusions: The capacity of elderly patients to participate in the decision-making process is frequently doubted simply because they have reached a certain age and it is thought that relatives should act as their representatives. In Spain, the opinion of the family and doctors appears to play a larger role in making decisions than does the concept of patient autonomy. (shrink)

Objective: To evaluate moral development as an indicator of the capacity to consent among two groups of patients from the Hospital de Clínicas in Porto Alegre, RS, Brazil.Method: Fifty-nine adolescents and 60 patients over 60 years of age participated in a cross-sectional study to assess moral development using Loevinger’s model of ego stages.Results: Age and moral development showed no association, with most participants in the two groups being in the conscientious phase.Conclusions: Age is probably not an adequate variable to measure (...) decision-making capacity, because questions of medical consent relate to participants’ own personal health. Decision-making capacity should be viewed as a continuous function. While the age of the person whose consent is needed should be considered, age alone, from a moral perspective, is not the main determinant of this capacity. (shrink)

This article argues that the early Christian ?order of widows? provides a fruitful model for Christian ethicists struggling to address the medical and social problems of elderly women today. After outlining the precarious state of the ?almanah? - or widow - in biblical times, it describes the emergence of the order of widows in the early Church. Turning to the contemporary situation, it argues that demographics both in the United States and around the globe suggest that meeting the needs of (...) elderly women will become an enormous challenge in the years to come. The order of widows illustrates a three-fold conception of solidarity that has immediate implications today. That conception of solidarity encourages us: 1) to identify the unique medical needs of elderly women (e.g., osteoporosis); 2) to find ways of overcoming their societal isolation, which can increase their risk of medical and psychological problems; and 3) to develop strategies for enabling them to remain contributing members of the community for as long as possible. This essay is a slightly revised version of a keynote address given by the author at a conference on ?Women?s Health and Human Rights? held in Rome, Italy in February 1998 and sponsored by the Vatican, Georgetown University, and the Università Cattolica del Sacro Cuore. The proceedings of that conference were published in Italy by the Società Editrice Universo-Roma in a volume entitled Women?s Health Issues, edited by Spagnolo and Gambino (2003). (shrink)

Objective: Little empirical evidence exists to support either side of the ongoing debate over whether legalising physician aid in dying would undermine patient trust.Design: A random national sample of 1117 US adults were asked about their level of agreement with a statement that they would trust their doctor less if “euthanasia were legal [and] doctors were allowed to help patients die”.Results: There was disagreement by 58% of the participants, and agreement by only 20% that legalising euthanasia would cause them to (...) trust their personal physician less. The remainder were neutral. These attitudes were the same in men and women, but older people and black people had more agreement that euthanasia would lower trust. However, overall, only 27% of elderly people and 32% of black people thought that physician aid in dying would lower trust. These views differed with physical and mental health, and also with education and income, with those having more of these attributes tending to view physician aid in dying somewhat more favourably. Again, however, overall views in most of these subgroups were positive. Views about the effect of physician aid in dying on trust were significantly correlated with participants’ underlying trust in their physicians and their satisfaction with care. In a multivariate regression model, trust, satisfaction, age, and white/black race remained independently significant.Conclusion: Despite the widespread concern that legalising physician aid in dying would seriously threaten or undermine trust in physicians, the weight of the evidence in the USA is to the contrary, although views vary significantly. (shrink)

Traditional welfare states were based on passive solidarity. Able bodied, healthy minded citizens paid taxes and social premiums, usually according to a progressive taxation logic following the ability to pay principle. Elderly, fragile, weak, unhealthy and disabled citizens were taken care of in institutions, usually in quiet parts of the country. During the nineteen eighties and nineties of the twentieth century, ideas changed. Professionals, patients and policy makers felt that it would be better for the weak and fragile to live (...) in mainstream society, rather than be taken care of in institutions outside society. This might be cheaper too. Hence policy measures were taken to accomplish deinstitutionalization. This article discusses the implications of deinstitutionalization for distributive justice. It is argued that the weakest among the weak and fragile stand to lose from this operation. For able bodied citizens deinstitutionalization entails a move from passive to active solidarity. Rather than just pay taxes they have to actively care for and help the needy themselves. The move from passive to active solidarity tends to take advantage of benevolent citizens and burden the socioeconomically disadvantaged. This may be a reason to reconsider the policy move toward deinstitutionalization. (shrink)

Acceptance of elderly or marginal health individuals as kidney donors is debated, with practices varying between centres. Transplant recipients, live kidney donors and health-care professionals caring for patients with renal failure were surveyed regarding their views on live donor kidney transplantation (LDKT) of marginal health (diabetes, hypertension, atherosclerosis, obesity, etc.) and elderly donors. Participants were recruited within a tertiary renal and transplant centre and invited to participate in focus groups and structured interviews. They also completed an anonymous questionnaire. Of 464 (...) participants who completed the questionnaire (36% health-care professionals and 64% patients), 49% and 64%, respectively, stated that marginal and elderly donors should be accepted for LDKT. In the structured interviews, emphasis was given to presenting to donor, recipient and their respective families a calculated risk regarding the effect that either a nephrectomy or transplant has on long-term quality of life. Participants stated that an independent third party in addition to the transplant team should discuss involved risks. Issues of ‘how desperate’ the recipient's situation is should also be considered. Health-care professionals stated that regardless of the strength of will of an individual to donate a kidney (despite age, health problems or personal risk), they should always have the right to say ‘no’ if performing a specific LDKT was against their professional and ethical values. About half of those surveyed considered that marginal health and elderly donors were acceptable for LDKT. Emphasis was given to the explanation to donors and recipients of the risks involved in such transplantation. (shrink)

This essay argues for a renewed institution of an ancient Christian practice, the Order of Widows. Drawing on the Roman Catholic tradition’s recent writings on the elderly, particularly the 1998 document from the Pontifical Council for the Laity entitled “The Dignity of Older People and their Mission in the Church and in the World,” I argue that we find within the Roman Catholic tradition advocacy for a renewed understanding of the vocation of the elderly within the Church. Building on this, (...) I then trace in the broadest of outlines some elements of what a renewal of the Order of Widows might look like. In doing so, it becomes clear how this new ecclesial practice addresses health issues of older women (devaluation, marginalization, loss of voice, impoverishment, debilitation, loneliness, isolation, and euthanasia). More importantly, such a practice moves beyond principles to demonstrate a concrete alternative. As such it would provide a powerful witness to the very culture the Church seeks to transform. (shrink)

Dementia accompanies aging in certain susceptible individuals. The chemical function of the brain remains normal, but certain neurotransmitter-selective diseases, such as Parkinson's disease, Huntington's disease, and Alzheimer's disease occur more commonly with age.There are at least two issues troubling researchers of senile dementia at the moment. One is the contribution of cell death, as opposed to selective neuronal atrophy, to the pathology of degenerative disorders. The other is how early the onset of dementia might be detected. The resolution of such (...) issues is important for the design of therapies for the common and most serious chronic, rather than acute, neurodegenerative disease.Alzheimer's disease is one of the most devastating neurological disorders. The ethical debate is often related to when human biological life ceases or when a person ceases to exist. If the elder is still a person, he/she is no more the same person. Huntington's disease is inherited as a highly penetrant, autosomal dominant neuronal disorder. A genetic test can accurately predict a person's risk and that of the children. As the knowledge of the genetic basis is increasing and prenatal diagnosis gets easier, the possibilities to avoid child disorders will become greater, but genetic testing raises problematic ethical issues. Ethical action involves the right to know and the right not to know, it involves freedom of choice and freedom implies knowledge. It is ethical that relatives in age of procreation should be informed. In any case, efficacy and safety of the procedure, the risk-benefit ratio for a particular disease must be judged to be acceptable and understood through informed consent by the patient or the family or both. (shrink)

ABSTRACTElder abuse is a serious and under-detected problem. Law reform agencies and legal profession regulatory authorities have called for action to ensure that lawyers meet their ethical obligations to older clients, including identifying and acting on risk factors for abuse. Screening tools to detect situations of elder abuse exist, but they are targeted mainly at health and social care practitioners. Drawing on international literature, this article identifies and discusses screening tools that could be adapted for use by legal professionals. (...) Three general categories of screening are relevant for lawyers who serve older clients: elder abuse screening tools that cover all domains of abuse or target specific behaviours, such as financial exploitation; screening for decision-making capacity, especially taking account of the impact of abuse or neglect on capacity; and screening to probe the suitability of a person to act in a formal decision-making role for an older person. The article emphas... (shrink)

Elder abuse presents difficult ethical considerations that the field of psychology has yet to sufficiently address. As demographics and sociocultural factors shift in the coming decade, this deficit in ethical competence may become an increasingly serious problem. Although legal definitions of elder abuse lack uniformity and clarity, there is much room for improvement in the field of psychology. Ethical considerations most relevant to professionals in psychology draw heavily on the principles of beneficence and nonmaleficence and respect for people's (...) rights and dignity. Professional standards of competence, discrimination, informed consent, privacy and confidentiality, and cooperation with other professionals are also critical in these considerations. A number of recommendations are made, centering around the needs for more education, frank discussion, and empirical examination of the complexities of elder abuse. (shrink)

Traditionally clinicians have determined their patients' resuscitation status without consultation. This has been condemned as morally indefensible in cases where not for resuscitation (NFR) orders are based on quality of life considerations and when the patient's true wishes are not known. Such instances would encompass most resuscitation decisions in elderly patients. Having previously involved patients in CPR decision-making, we chose formally to explore the reasons behind the choices made. Although the patients were not upset, and readily decided at the time (...) of initial consultation, on later analysing the decision-making we found poor understanding of the procedure, poor recall of information given and in some cases evidence of harm. This may be attributed to impaired decision-making capacity of elderly hospitalised patients as previously shown, or to the discomfort precipitated by having to contemplate the apparent immediacy of cardiac arrest by these patients. We propose that subscribing to autonomy as a general principle needs to be balanced against particular cases where distress may be caused by, or result in, diminished competence and limited autonomy. (shrink)