OBJECTIVE: To report and analyse the pattern of end-of-life decision making for terminal Chinese cancer patients. DESIGN: Retrospective descriptive study. SETTING: A cancer clinical trials unit in a large teaching hospital. PATIENTS: From April 1992 to August 1997, 177 consecutive deaths of cancer clinical trial patients were studied. MAIN MEASUREMENT: Basic demographic data, patient status at the time of signing a DNR consent, or at the moment of returning home to die are documented, and circumstances surrounding these events evaluated. RESULTS: (...) DNR orders were written for 64.4% of patients. Patients in pain (odds ratio 0.45, 95% CI 0.22-0.89), especially if requiring opioid analgesia (odds ratio 0.40, 95% CI 0.21-0.77), were factors associated with a higher probability of such an order. Thirty-five patients were taken home to die, a more likely occurrence if the patient was over 75 years (odds ratio 0.12, 95% CI 0.04-0.34), had children (odds ratio 0.14, 95% CI 0.02-0.79), had Taiwanese as a first language (odds ratio 6.74, 95% CI 3.04-14.93), or was unable to intake orally (odds ratio 2.73, 95% CI 1.26-5.92). CPR was performed in 30 patients, none survived to discharge. CONCLUSIONS: DNR orders are instituted in a large proportion of dying Chinese cancer patients in a cancer centre, however, the order is seldom signed by the patient personally. This study also illustrates that as many as 20% of dying patients are taken home to die, in accordance with local custom. (shrink)

Interactions with teachers and peers are critical for children’s social, behavioral, and academic development in the classroom context. However, these two types of interpersonal interactions in the classroom are usually pursued via separate lines of inquiries. The current study bridges these two areas of research to examine the way in which teachers influence child-perceived peer social support and peer victimization for 2,678 children within 183 classrooms in preschool through grade three. Two levels of teacher influence are considered, namely teacher-child closeness (...) and conflict relationships at the child-level, and teacher management of interpersonal interactions at the classroom-level. Results of multilevel regression models showed that teacher-child closeness was associated with the growth of child-perceived peer social support from fall to spring, whereas teacher-child conflict and teachers’ behavior management practices were associated with the change in child-perceived peer victimization across the academic year. These associations were unique and above and beyond the influence of children’s actual peer social interactions, including reciprocal friendships and the collective classroom reputation of peer victimization. Collectively, findings highlight the multi-faceted teacher roles in shaping children’s perceptions of their peer social experiences during the earliest years of schooling. (shrink)

The development of genomic technologies has seemed almost magical. Excitement about it, both in medicine and among the public, stems from the belief that genomic techniques will illuminate the causes of health and disease, will lead to effective interventions for both rare and common genetic conditions, and will inform reproductive decision‐making. Novel diagnostic tools, however, are often deployed before targeted therapies are developed, tested, or available and before their psychosocial implications are explored. Newer technologies such as prenatal whole exome screening (...) are seen as offering “decisional autonomy” to expectant parents, although such technologies identify information about genetic sequencing that may not have clear meaning. The “therapeutic gap” between the ability to conduct genetic sequencing and the ability to fully understand what the test results mean, much less what treatments to offer, leaves families with complex and unclear information they cannot act upon with confidence during pregnancy. In this essay, we will consider the psychosocial and ethical implications of such assumptions—and of the uncertain information produced by these technologies—for individuals and families and for societal aspects such as medical service usage and demographic inequities. (shrink)

Phraseology is a treasury of language. It is the fruit, which was born in the result of a long process of the practical use of the language. Phraseologisms give the speech power, persuasiveness, brilliance and imagery. They enliven the language and make it more emotional. In this article, we focus on the negative psycho-emotional state of a person. The negative psycho-emotional state of a person is emotion and feelings that are formed in the result of the negative mood of a (...) person and related to the dissatisfaction with vital needs. The authors of the article identified 5 phraseological subgroups that characterize the negative psycho-emotional state of a person: anger ; disgust, hatred; terror ; anxiety, agitation; sadness, melancholy. (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)

Lucius Annaeus Seneca was a Roman Stoic philosopher, dramatist, statesman, and advisor to the emperor Nero, all during the Silver Age of Latin literature. The Complete Works of Lucius Annaeus Seneca is a fresh and compelling series of new English-language translations of his works in eight accessible volumes. Edited by world-renowned classicists Elizabeth Asmis, Shadi Bartsch, and Martha C. Nussbaum, this engaging collection helps restore Seneca—whose works have been highly praised by modern authors from Desiderius Erasmus to Ralph Waldo Emerson—to (...) his rightful place among the classical writers most widely studied in the humanities. _Hardship and Happiness_ collects a range of essays intended to instruct, from consolations—works that offer comfort to someone who has suffered a personal loss—to pieces on how to achieve happiness or tranquility in the face of a difficult world. Expertly translated, the essays will be read and used by undergraduate philosophy students and experienced scholars alike. (shrink)

Research investigating the underlying mechanisms and boundary conditions under which leader humility influences employee voice remains underdeveloped. Drawing from approach–inhibition theory of power and leader humility literature, we developed a moderated-mediation model in which personal sense of power was theorized as a unique mechanism underlining why employees feel motivated to speak up under the supervision of humble leaders. Additionally, the cultural value of power distance was proposed to be a relevant boundary condition to influence such relationship. We tested the model (...) using time-lagged supervisor–subordinate matched data. Results of mixed models analyses provided support for our hypotheses confirming that employees’ personal sense of power mediates the relationship between leader humility and employee voice, and such relationship was found to be stronger when employees’ power distance was lower rather than higher. (shrink)

The Monographs produced by the International Agency for Research on Cancer (IARC) apply rigorous procedures for the scientific review and evaluation of carcinogenic hazards by independent experts. The Preamble to the IARC Monographs, which outlines these procedures, was updated in 2019, following recommendations of a 2018 expert Advisory Group. This article presents the key features of the updated Preamble, a major milestone that will enable IARC to take advantage of recent scientific and procedural advances made during the 12 years since (...) the last Preamble amendments. The updated Preamble formalizes important developments already being pioneered in the Monographs Programme. These developments were taken forward in a clarified and strengthened process for identifying, reviewing, evaluating and integrating evidence to identify causes of human cancer. The advancements adopted include strengthening of systematic review methodologies; greater emphasis on mechanistic evidence, based on key characteristics of carcinogens; greater consideration of quality and informativeness in the critical evaluation of epidemiological studies, including their exposure assessment methods; improved harmonization of evaluation criteria for the different evidence streams; and a single-step process of integrating evidence on cancer in humans, cancer in experimental animals and mechanisms for reaching overall evaluations. In all, the updated Preamble underpins a stronger and more transparent method for the identification of carcinogenic hazards, the essential first step in cancer prevention. (shrink)

Structured interviews were held with 149 registered nurses in seven countries in America, Asia, Australia and Europe concerning the feeding of severely demented patients who do not accept food. The most common reasons for nurses being willing to change their decision to feed or not to feed were an order from the medical head, a request from the patient's husband and/or the staff meeting. There was a connection between the willingness to feed and the ranking of ethical principles. Nurses who (...) were most prone to feed the patient most often gave a high rank to the ethical principle of sanctity of life, while those who primarily chose not to feed the patient gave a high rank to the ethical principle of autonomy. All nurses stressed the ethical principle of beneficence. Des interviews structurés ont eu lieu avec 149 infirmiers/ères dans sept pays en Amérique, Asie, Australie et Europe concernant l'alimentation des malades gravement dément qui refusent de manger. La raison la plus générale pour des infirmiers/ères d'être prêt à changer leures décisions de donner à manger ou non sont: un ordre du médecin, la demande du mari de la malade ou de la réunion du personnel. Il y avait un lien entre la volonté de nourir et le rang des principes éthiques. Les infirmiers/ères les plus enclins de nourir la malade le plus souvent donnaient un rang supérieur au principe éthique de la sainteté de vie, pendant que ceux et celles qui choisissaient de ne pas nourrir la malade donnaient un rang supérieur au principe éthique de l'autonomie. Tous insistaient sur l'importance du principe éthique de la bienfaisance. Konstruktive Interviews wurden mit 149 ausgebildeten Krankenschwestern und Pfleger in sieben Ländern in Amerika, Asien, Australien und Europa gehalten über die Ernährung von schwer von Dementia praecox leidenden Patienten, die das Essen verweigern. Die gewöhnlichsten Gründe des Pflegepersonals für die Bereitwilligkeit, ihre Entscheidung, zu ernähren oder nicht, zu ändern, waren Anordnungen vom medizinischen Chef, Anfragen vom Ehemann der Patientin und/oder einer Personalsitzung. Es bestand ein Zusammenhang zwischen der Bereitwilligkeit zur Ernährung und dem Rang der ethischen Prinzipien. Die Pflegenden, die sich am meisten neigten, die Patientin zu ernähren, gaben dem ethischen Prinzip der Heiligkeit des Lebens einen hohen Rang, während die, die meistens vorzogen, die Patientin nicht zu ernähren, gaben dem ethischen Prinzip der Autonomie einen hohen Rang. Alle Pflegenden legten grossen Wert auf das ethische Prinzip der Wohltätigkeit. (shrink)

This study provides a comparison of thinking style and ethical decision-making patterns between 386 U.S. students and 506 students from the People’s Republic of China enrolled in undergraduate business education in their respective countries. Contrary to our expectations, the Chinese students demonstrated a significantly greater linear thinking style compared to American students. As hypothesized, both Chinese and U.S. students possessing a balanced linear and nonlinear thinking style profile demonstrated greater ethical intent across a series of ethics vignettes. Chinese students also (...) were more likely to adopt an act utilitarian rationale, an ethical philosophy that in practice may violate government regulations or social rules to benefit one’s family instead of society for explaining their decisions across the vignettes. We conclude with a discussion of important theoretical as well as practical and potential future implications based on this comparative study. (shrink)

Animal welfare in livestock farming is a general concept that involves many concrete ethical issues for which solutions need to be developed. To avoid disturbing the internal market, the European Union encourages market players to develop harmonized solutions to such issues. One issue is the castration of piglets without pain relief, the practice of which causes pain to piglets. Although scientists have found alternatives to replace castration without pain relief, the process of solving the castration issue has stagnated. Questions remain (...) as to why this painful castration practice has still not been addressed after three decades, how it is likely to develop in the near future, and whether it will lead to a single harmonized solution for the EU. To answer these questions, this study examines the development of the castration issue using in-depth interviews and desk research. The results show that different countries have developed different solutions at different stages of the issue’s development. For a long period, the developments did not set a course toward a single solution; most EU pork producers waited for a castration ban in Germany. Such a situation was turbulent in solving the issue because the heterogeneous EU was unlikely to agree upon on a single alternative. With the EU now taking a market-based orientation, however, solving the issue now seems more likely. More attention is needed to understand market opportunities and chain integration in this area. (shrink)

In the course of an immune response, antibodies undergo affinity maturation in order to increase their efficiency in neutralizing foreign invaders. Affinity maturation occurs by the introduction of multiple point mutations in the variable region gene that encodes the antigen binding site. This somatic hypermutation is restricted to immunoglobulin genes and occurs at very high rates. The precise molecular basis of this process remains obscure. However, recent studies using a variety of in vivo and in vitro systems have revealed important (...) regulatory regions, base motifs that are preferred targets of mutation and evidence that transcription may play an active role in hypermutation. BioEssays 20:227–234, 1998. © 1998 John Wiley & Sons, Inc. (shrink)

Anxiety disorders are more predominant in women than men, however there is a lack of understanding as to what neurocognitive mechanisms drive this sex difference. Recent investigation has found a potential moderating role of sex in the relationship between anxiety and the error related negativity —a component of error-monitoring that is prevalent in high anxiety individuals—such that females display a positive relationship between anxiety/worry and ERN amplitude. We strove to further explore the influence of sex on the relationship between trait (...) anxiety and performance monitoring, specifically with ERN, as well as extend this work to include another hallmark of anxiety, attentional bias to threat. To meet this end, participants performed the flanker and dot-probe tasks, respectively. We did not find a significant difference in the relationship between attention bias scores and anxiety for female vs. males participants. Furthermore, ΔERN amplitudes were greater in males compared to females, and males had more positive CRN amplitudes than females. There were no significant associations between ERN or ΔERN with anxiety in both male and female participants. However, there was a significant relationship between CRN amplitudes and trait anxiety in male but not female participants. Given these results, the effect of sex on the relationship between components of performance monitoring—namely the CRN and ERN—and anxiety may be more nuanced than the current understanding. Our study was limited to detecting medium to large sized moderation effects. Our findings may be important for future meta-analysis on sex differences in anxiety. (shrink)

© The Author 2016. Published by Oxford University Press on behalf of Japanese Society of Plant Physiologists. All rights reserved.Cell walls of grasses, including cereal crops and biofuel grasses, comprise the majority of plant biomass and intimately influence plant growth, development and physiology. However, the functions of many cell wall synthesis genes, and the relationships among and the functions of cell wall components remain obscure. To better understand the patterns of cell wall accumulation and identify genes that act in grass (...) cell wall biosynthesis, we characterized 30 samples from aerial organs of rice at 10 developmental time points, 3-100 d post-germination. Within these samples, we measured 15 cell wall chemical components, enzymatic digestibility and 18 cell wall polysaccharide epitopes/ligands. We also used quantitative reverse transcription-PCR to measure expression of 50 glycosyltransferases, 15 acyltransferases and eight phenylpropanoid genes, many of which had previously been identified as being highly expressed in rice. Most cell wall components vary significantly during development, and correlations among them support current understanding of cell walls. We identified 92 significant correlations between cell wall components and gene expression and establish nine strong hypotheses for genes that synthesize xylans, mixed linkage glucan and pectin components. This work provides an extensive analysis of cell wall composition throughout rice development, identifies genes likely to synthesize grass cell walls, and provides a framework for development of genetically improved grasses for use in lignocellulosic biofuel production and agriculture. (shrink)

The practice of respecting patients’ autonomy is rooted in the healthcare professionals’ empathy for patients’ situations, without which appropriate supports to the patients during the informed consent process may be remarkably moderated. The purpose of this study was to explore elective surgery patients’ experiences during their decision-making process. This research was conducted using a phenomenological approach, and the data analysis was guided by Colaizzi’s method. A total of 17 participants were recruited from a hospital in southern Taiwan. Two major themes (...) emerged from the analyses: (a) a voluntary yet necessary alternative—to undergo a surgery and (b) alternatives compelled by the unalterable decision—the surgery. It was concluded that unless healthcare professionals can empathize with the distressed situation of their patients who are facing elective surgery, the practice of informed consent may become merely a routine. Nurses can be the best advocates for patients and facilitators to enhance communication between patients and healthcare personnel. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

Most children experience some form of grouping in the classroom every day. Understanding how teachers make grouping decisions and their impacts on children’s social development can shed light on effective teacher practices for promoting positive social dynamics in the classroom. This study examined the influence of teachers’ grouping strategies on changes in young children’s social experiences with peers across an academic year. A total of 1,463 children and 79 teachers from kindergarten to third-grade classrooms participated in this study. Teachers rated (...) children’s behavioral problems as the most important consideration when creating seating charts or assigning children to small groups. Promoting existing or new friendships was rated as the least important consideration. Heterogeneous ability grouping, rated as somewhat important by the teachers, was associated with a decrease in children’s friendships and yet also a decrease in girls’ experience with peer conflicts. Our findings begin to fill in the gaps in the literature on the social impacts of ability grouping for young children. (shrink)

Research investigating the underlying mechanisms and boundary conditions under which leader humility influences employee voice remains underdeveloped. Drawing from approach–inhibition theory of power and leader humility literature, we developed a moderated-mediation model in which personal sense of power (i.e., employees’ ability to influence other individuals such as their leader) was theorized as a unique mechanism underlining why employees feel motivated to speak up under the supervision of humble leaders. Additionally, the cultural value of power distance was proposed to be a (...) relevant boundary condition to influence such relationship. We tested the model using time-lagged supervisor–subordinate matched data. Results of mixed models analyses provided support for our hypotheses confirming that employees’ personal sense of power mediates the relationship between leader humility and employee voice, and such relationship was found to be stronger when employees’ power distance was lower rather than higher. (shrink)

Is the societal-level of analysis sufficient today to understand the values of those in the global workforce? Or are individual-level analyses more appropriate for assessing the influence of values on ethical behaviors across country workforces? Using multi-level analyses for a 48-society sample, we test the utility of both the societal-level and individual-level dimensions of collectivism and individualism values for predicting ethical behaviors of business professionals. Our values-based behavioral analysis indicates that values at the individual-level make a more significant contribution to (...) explaining variance in ethical behaviors than do values at the societal-level. Implicitly, our findings question the soundness of using societal-level values measures. Implications for international business research are discussed. (shrink)

The current COVID-19 pandemic and the previous SARS/MERS outbreaks of 2003 and 2012 have resulted in a series of major global public health crises. We argue that in the interest of developing effective and safe vaccines and drugs and to better understand coronaviruses and associated disease mechenisms it is necessary to integrate the large and exponentially growing body of heterogeneous coronavirus data. Ontologies play an important role in standard-based knowledge and data representation, integration, sharing, and analysis. Accordingly, we initiated the (...) development of the community-based Coronavirus Infectious Disease Ontology in early 2020. -/- As an Open Biomedical Ontology (OBO) library ontology, CIDO is open source and interoperable with other existing OBO ontologies. CIDO is aligned with the Basic Formal Ontology and Viral Infectious Disease Ontology. CIDO has imported terms from over 30 OBO ontologies. For example, CIDO imports all SARS-CoV-2 protein terms from the Protein Ontology, COVID-19-related phenotype terms from the Human Phenotype Ontology, and over 100 COVID-19 terms for vaccines (both authorized and in clinical trial) from the Vaccine Ontology. CIDO systematically represents variants of SARS-CoV-2 viruses and over 300 amino acid substitutions therein, along with over 300 diagnostic kits and methods. CIDO also describes hundreds of host-coronavirus protein-protein interactions (PPIs) and the drugs that target proteins in these PPIs. CIDO has been used to model COVID-19 related phenomena in areas such as epidemiology. The scope of CIDO was evaluated by visual analysis supported by a summarization network method. CIDO has been used in various applications such as term standardization, inference, natural language processing (NLP) and clinical data integration. We have applied the amino acid variant knowledge present in CIDO to analyze differences between SARS-CoV-2 Delta and Omicron variants. CIDO's integrative host-coronavirus PPIs and drug-target knowledge has also been used to support drug repurposing for COVID-19 treatment. -/- CIDO represents entities and relations in the domain of coronavirus diseases with a special focus on COVID-19. It supports shared knowledge representation, data and metadata standardization and integration, and has been used in a range of applications. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

2 female Taiwanese scholars of Chinese philosophy - Lin Yue-huei and Wu Hui-Ling.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:The Inner Citadel. The Meditations of Marcus AureliusJames KerPierre Hadot. The Inner Citadel. The Meditations of Marcus Aurelius. Translated by Michael Chase. Cambridge: Harvard University Press, 1998. Pp. xii + 351. Cloth, $45.00Marcus Aurelius has sometimes been viewed as a Stoic "half-way to Platonism," so overawed by the brevity of human life within the infinite procession of eternity that he "almost lost faith in his own existence" (J. (...) M. Rist). Hadot's book, however, in this excellent English translation (first published as La Citadelle Intérieure: Introduction aux "Pensées" de Marc Aurèle, Paris, 1992), argues not only that the Meditations are thoroughly Stoic in their doctrine, but that to call Marcus a Platonist (or a pessimist) is to misinterpret the techniques by which he seeks to live a Stoic life. For Hadot it is the teachings of the philosopher-slave Epictetus that explain the Meditations, and the bulk of the book is concerned with demonstrating that Marcus's writings are spiritual exercises by which the author seeks to instill in himself three basic Epictetan disciplines corresponding to the tripartite Stoic system of logic, physics, and ethics. Readers of Hadot's other works will already recognize his concern with the ancient conception of philosophy as a way of life [3]. This study aims to show how Marcus's self-therapy relates to specific elements of Stoic doctrine and to redefine our understanding of the Meditations as a literary work.The book begins by tracing Marcus's initiation into the philosophic life, with special emphasis on the role of statesman-philosopher Junius Rusticus, who introduced Marcus to the writings of his influential teacher, Epictetus. In Chapter Two Hadot approaches the text which we refer to as the Meditations and argues that they are better referred to as Marcus's "personal notes" (hypomnêmata): their characteristic features (discontinuity, repetition, self-address, and refined literary form) are due to their being the product of day-by-day exercises in which Marcus, focussed upon the definitiveness of the present moment, strove to keep the essential rules of life ever present in his mind. Marcus's constant repetition of familiar doctrine indicates that for him "the [End Page 116] essential thing was not to invent or to compose, but to influence himself and produce an effect upon himself" (244).Hadot is at pains in Chapter Three, however, to reveal that these exercises derive from the "highly rigorous conceptual system" which he calls "the true key to the Meditations," namely, a set of three dogmas that require (a) the regulation of judgment to assent only to what is objectively true; (b) the restriction of the desires to that which is in accordance with universal Nature and Destiny; and (c) the disciplining of one's impulse toward action to be just and altruistic, in agreement with one's human nature. According to Hadot, this systematic distinction between the disciplines of judgement, desire, and impulse, and the three dogmas on which they depend, is "a doctrine which is peculiar to Epictetus and which is not found in Stoicism prior to him" (70). Marcus, then, in organizing his spiritual exercises around these three disciplines, "was working with pre-existing materials" (52). Thus Chapter Five is dedicated entirely to explaining how the practical disciplines of judgment, desire, and impulse to action, which Hadot argues correspond respectively to logic, physics, and ethics, operate within "the Stoicism of Epictetus."There is a certain apparent tension generated by Hadot's argument concerning the Stoicism of Epictetus. Although he depicts him as a distinctive innovator, Hadot also states that Epictetus does not change the system of Zeno and Chrysippus but simply adds "color and tonality" (73)—a statement that allows him to classify both Epictetus and Marcus as authentic Stoics but thereby risks undermining his argument about Epictetus's distinctiveness. This real ambiguity could be explained by reference to the emphasis on originality in Stoicism, in which the embodiment of philosophy in each new Stoic establishes him as an independent authority. (As Seneca says to Lucilius, "Zeno said this. But what do you say?" Epistulae Morales 33.7.) Indeed Hadot illustrates how didactic procedures in particular were... (shrink)