As the United States population ages, there is a growing group of aging, elderly, individuals who may consider "preemptive suicide"(Prado, 1998). Healthy aging patients who preemptively attempt to end their life by suicide and who have clearly expressed a desire not to have life -sustaining treatment present a clinical and public policy challenge. We describe the clinical, ethical, and medical-legal decision making issues that were raised in such a case that presented to an academic emergency department. We also review and (...) evaluate a decision making process that emergency physicians confront when faced with such a challenging and unusual situation. (shrink)

It is argued that the way towards understanding the experiments with visible light which purport to exhibit nonlocality lies in a return to the wave theory of light. A connection is also indicated between the present-day photon description and the pre-wave-theory corpuscular description, and hence we see that, essentially, the problem of nonlocality in physics was solved nearly two centuries ago by Young and Fresnel.

There has long been interest in why languages are shaped the way they are, and in the relationship between sign language and gesture. In sign languages, entity classifiers are handshapes that encode how objects move, how they are located relative to one another, and how multiple objects of the same type are distributed in space. Previous studies have shown that hearing adults who are asked to use only manual gestures to describe how objects move in space will use gestures that (...) bear some similarities to classifiers. We investigated how accurately hearing adults, who had been learning British Sign Language for 1–3 years, produce and comprehend classifiers in locative and distributive constructions. In a production task, learners of BSL knew that they could use their hands to represent objects, but they had difficulty choosing the same, conventionalized, handshapes as native signers. They were, however, highly accurate at encoding location and orientation information. Learners therefore show the same pattern found in sign-naïve gesturers. In contrast, handshape, orientation, and location were comprehended with equal accuracy, and testing a group of sign-naïve adults showed that they too were able to understand classifiers with higher than chance accuracy. We conclude that adult learners of BSL bring their visuo-spatial knowledge and gestural abilities to the tasks of understanding and producing constructions that contain entity classifiers. We speculate that investigating the time course of adult sign language acquisition might shed light on how gesture became conventionalized during the genesis of sign languages. (shrink)

We show that the divergence between the predictions of quantum optics and the local realist theory known as stochastic optics, for the extended type of photon-coincidence experiment described recently by de Caro, is of the same order of magnitude as for Aspect-type experiments. This means that, in such new experiments, as in those so far performed, counting statistics will have to be greatly improved before a discrimination between the two theories becomes possible.We also show that the outstanding difference between the (...) two theories is that, while stochastic optics uses a genuine, that is, positive, detection probability, the corresponding quantum formalism leads to a pseudoprobability. Nevertheless, there is a striking parallel, in that both theories recognize the phenomenon known as enhancement, and both describe it as having its origin in a mixing of the signal field with the zero-point field by a polarizing device. (shrink)

Each Local Research Ethics Committee (LREC) is expected to produce an annual report for its establishing authority. Reports from 145 LRECs were examined with regard to (a) whether the committees were working within the terms of the most recent guidelines from the Department of Health and (b) observations on the role of LRECs with particular reference to accountability. Most LRECs had produced a report, although their length varied greatly. Most reports showed how seriously the committee took its task. Most committees (...) met many of the guidelines; for example, almost all had two or more lay-members. The guideline most frequently not met was that committees should have no more than 12 members. Many committees review very large numbers of projects (maximum 351). Approximately two-thirds provide details in the annual report of individual project titles, their author and the committee decision; all reports should contain this information. Although it may in fact happen more generally, only 23 per cent of the reports referred to any form of monitoring of the eventual outcome of the research. A significant issue to arise from the reports is the extent to which the framework for the operation of LRECs has been confused by the development of the purchaser-provider split. The paper concludes with suggestions for remedying the situation. (shrink)

Using the Q representation, we study the disagreement between quantum optical formalism and local realism and we show that the phenomenon of enhancement, first revealed by the local realist analysis, could receive a simple explanation if we use this particular version of the quantum formalism. Nevertheless, some fundamental difficulties remain.

Over the last thirty years there have been a number of attempts to analyse the distinction between intrinsic and extrinsic properties. This article discusses three leading attempts to analyse this distinction that don’t appeal to the notion of nat-uralness: the duplication analysis endorsed by G. E. Moore and David Lewis, Peter Vallentyne’s analysis in terms of contractions of possible worlds, and the analysis of Gene Witmer, William Butchard and Kelly Trogdon in terms of grounding.

In the study of education, as in many more travelled regions of Classical scholarship, democratic Athens is something of a special case. The cautions formulation is appropriate: in the case of education, surprisingly few studies have sought to establish quite how special Athens was, and those which have, have often raised more questions than they answered. The subject itself is partly to blame. The history of education invites comparison with the present day, while those planning the future of education rarely (...) fail to invoke the past. The place of Classical Athens in European culture has ensured a place for Athenian education in almost every debate from the relation between education and democracy to the value of educationversustraining, and as the original champion of causes as varied as mass education, co-education, and the national curriculum. Desirable as it is to be in demand, such treatment is not calculated to produce the most circumspect account of the subject. The study of education is further hampered by the fact that our knowledge of Athenian culture is so vibrant and diverse in some ways and so partial in others. Plato and Aristophanes present a vivid fictional picture of education in the late fifth century. If we add a few passages from Xenophon and Aristotle, a large number of vases depicting men, women, and children reading, playing the lyre, and doing athletics, and one or two archaeological finds of an educational appearance, it is tempting to take the result as a clear portrait of a society at school. (shrink)

In ‘Discrimination Against the Dying’, Phillip Reed argues that terminally ill patients are subjected to a distinct form of discrimination called ‘terminalism’. One of Reed’s primary examples of terminalism is right to try laws, which offer terminally ill patients the option to request medications that are not FDA-approved and without IRB involvement. In this analysis, we consider additional contextual factors about right to try, suggesting that it may not neatly count as an exemplar of terminalism. When pursued with appropriate protocols (...) and oversight, right to try has the potential to broaden treatment opportunities for the terminally ill by bypassing FDA and IRB restrictions, functioning as a less stringent alternative to expanded access for patients with limited time and dwindling options. Reed acknowledges that differential treatment of patients is not inherently unjust. For instance, Reed praises expanded access laws that grant patients with severe or life-threatening diseases access to treatment options otherwise unavailable. Patients not afflicted by severe illness or who have found success with standard treatment options are unlikely to face discrimination for inability to access nonessential treatment. Conversely, availability of these treatments for the terminally ill could enhance their well-being and prolong their lifespan. It is also significant to highlight important …. (shrink)

Background: Black, Asian and minority ethnic groups have a high need for organ transplantation but deceased donation is low. This restricts the availability of well-matched organs and results in relatively long waiting times for transplantation, with increased mortality risks. Objective: To identify barriers to organ donor registration and family consent among the BAME population, and to develop and evaluate a training intervention to enhance communication with ethnic minority families and identify impacts on family consent. Methods: Three-phase programme comprising community-based research (...) involving two systematic reviews examining attitudes and barriers to organ donation and effective interventions followed by 22 focus groups with minority ethnic groups; hospital-based research examining staff practices and influences on family consent through ethics discussion groups with staff, a study on intensive care units and interviews with bereaved ethnic minority families; and development and evaluation of a training package to enhance cultural competence among ICU staff. Setting: Community focus group study in eight London boroughs with high prevalence of ethnic minority populations. Hospital studies at five NHS hospital trusts. Participants: Community studies: 228 focus group participants; hospital studies: 35 nurses, 28 clinicians, 19 hospital chaplains, 25 members of local Organ Donation Committees, 17 bereaved family members; and evaluation: 66 health professionals. Data sources: Focus groups with community residents, systematic reviews, qualitative interviews and observation in ICUs, EDGs with ICU staff, bereaved family interviews and questionnaires for trial evaluation. Review methods: Systematic review and narrative synthesis. Results: Community studies: Organ Donor Register – different ethnic/faith and age groups were at varying points on the ‘pathway’ to organ donor registration, with large numbers lacking knowledge and remaining at a pre-contemplation stage. Key attitudinal barriers were uncertainties regarding religious permissibility, bodily concerns, lack of trust in health professionals and little priority given to registration, with the varying significance of these factors varying by ethnicity/faith and age. National campaigns focusing on ethnic minorities have had limited impact, whereas characteristics of effective educational interventions are being conducted in a familiar environment; addressing the groups’ particular concerns; delivery by trained members of the lay community; and providing immediate access to registration. Interventions are also required to target those at specific stages of the donation pathway. Hospital studies: family consent to donation – many ICU staff, especially junior nurses, described a lack of confidence in communication and supporting ethnic minority families, often reflecting differences in emotional expression, faith and cultural beliefs, and language difficulties. The continuing high proportion of family donation discussions that take place without the collaboration of a specialist nurse for organ donation reflected consultants’ views of their own role in family consent to donation, a lack of trust in SNODs and uncertainties surrounding controlled donations after circulatory death. Hospital chaplains differed in their involvement in ICUs, reflecting their availability/employment status, personal interests and the practices of ICU staff. Evaluation: professional development package – a digital versatile disk-based training package was developed to promote confidence and skills in cross-cultural communication. Initial evaluation produced positive feedback and significant affirmative attitudinal change but no significant difference in consent rate over the short follow-up period with requirements for longer-term evaluation. Limitations: Participants in the focus group study were mainly first-generation migrants of manual socioeconomic groups. It was not permitted to identify non-consenting families for interview with data regarding the consent process were therefore limited to consenting families. Conclusions: The research presents guidance for the effective targeting of donation campaigns focusing on minority ethnic groups and provides the first training package in cultural competence in the NHS. Future work: Greater evaluation is required of community interventions in the UK to enhance knowledge of effective practice and analysis of the experiences of non-consenting ethnic minority families. Funding: The National Institute for Health Research Programme Grants for Applied Research programme. (shrink)

Policies promoted and adopted for allocating ventilators during the COVID-19 pandemic have often prioritised healthcare workers or other essential workers. While the need for such policies has so far been largely averted, renewed stress on health systems from continuing surges, as well as the experience of allocating another scarce resource—vaccination—counsel revisiting the justifications for such prioritisation. Prioritising healthcare workers may have intuitive appeal, but the ethical justifications for doing so and the potential harms that could follow require careful analysis. Ethical (...) justifications commonly offered for healthcare worker prioritisation for ventilators rest on two social value criteria: instrumental value, also known as the ‘multiplier effect’, which may preserve the ability of healthcare workers to help others, and reciprocity, which rewards past usefulness or sacrifice. We argue that these justifications are insufficient to over-ride the common moral commitment to value each person’s life equally. Institutional policies prioritising healthcare workers over other patients also violate other ethical norms of the healthcare professions, including the commitment to put patients first. Furthermore, policy decisions to prioritise healthcare workers for ventilators could engender or deepen existing distrust of the clinicians, hospitals and health systems where those policies exist, even if they are never invoked. (shrink)

This volume examines some of the most contentious social justice issues present in the corpus of Augustine's writings. Whether one is concerned with human trafficking and the contemporary slave trade, the global economy, or endless wars, these essays further the conversation on social justice as informed by the writings of Augustine of Hippo.