The following note proposes a simple solution for an insufficiently considered difficulty in the much-debated dialogue between Mary and Joseph, the seventh of the extant lyrical divisions of the Old English Advent . In what follows I am assuming that the usual assignment of speeches, first set forth by Thorpe in the editio princeps of the Exeter Book, and accepted in all major editions up to and including that of Campbell, is to be preferred to the various alternatives that (...) have been proposed, notably the radically different assignment by Cosijn that has been tentatively adopted and defended by Robert B. Burlin. (shrink)
Pediatric psychopharmacology is a relatively new science. Although the use of psychotropic medications in children has risen in the past decade, there are few standard treatments for serious psychiatric or developmental disorders of childhood. The relative absence of standard treatments is further complicated by the fact that many of the agents used in pediatric psychopharmacology have been adapted from other fields. Therefore, investigators have a responsibility to make incremental progress from concept through pilot studies and large-scale, multisite efficacy and safety (...) trials. Thus, although there is a pressing need to conduct medication trials that can guide clinical practice, there are scientific and ethical considerations to bear in mind when designing clinical trials in pediatric psychopharmacology. This article reviews essential ethical and scientific issues that are relevant to designing clinical trials in children with psychiatric and developmental disorders. Using examples from recently published literature, the article describes the challenges and pitfalls of various clinical trial study designs. The application of sound ethical and scientific principles is necessary to ensure that clinical trials are properly conducted and to guard against ambiguous results that can not guide practice. (shrink)
Guidelines advise that x-rays do not contribute to the clinical management of simple nasal fractures. However, in cases of simple nasal fracture secondary to assault, a facial x-ray may provide additional legal evidence should the victim wish to press charges, though there is no published guidance. We examine the ethical and medico-legal issues surrounding this controversial area.
Comme l’indique le sous-titre, ce livre n’est pas une biographie, mais une enquête sur la disparition dans la mémoire collective d’une grande résistante, une des six femmes Compagnons de la Libération, Laure Diebold-Mutschler. Engagée dès 1940 dans la Résistance, à l’âge de vingt-cinq ans, elle est notamment agent de liaison du réseau Mithridate avant d’entrer à Lyon dans les Forces Françaises libres et de devenir la secrétaire de Jean Moulin. Elle sera arrêtée le 24 septembre 1943 à Paris, a...
This international and interdisciplinary collection presents and discusses the many issues and educational practices that are touched on by constructivism. Drawing on perspectives from a range of different fields, this book invites us to reposition ourselves in relation to the major currents that have influenced education in this century, namely pragmatism, genetic epistemology, and social interactionism. The essays call for new reflection on the questions that are central to the project of education and that, in particular, involve the validity of (...) knowledge and types of knowledge, the compartmentalization of school subjects, the mediating role of teachers, and, above all, the ends of education. In so doing, this book relaunches the discussion on constructivism's potential for the social empowerment of groups and individuals. (shrink)
There is a need for empirically based research on social and ethical challenges related to informed consent processes, particularly in studies focusing on adolescent sexual and reproductive health. In a pilot study of a school-based pregnancy prevention intervention in rural Zambia, the majority of the guardians who were asked to consent to their daughters’ participation, refused. In this paper we explore the reasons behind the low participation in the pilot with particular attention to challenges related to the community engagement and (...) informed consent process. The pilot was implemented in two schools and examined the acceptability of a package of interventions including economic support to families to keep their girls in school, pocket money for girls, youth club meetings on reproductive health, and community meetings to sensitize the community. Focus group discussions were conducted with girls who participated in the pilot, boys in their class and with parents. Individual semi-structured interviews were conducted with teachers, peer educators and community health workers involved in the coordination of the intervention as well as with religious and traditional leaders. Data were analyzed through thematic analysis. The findings indicate that inadequate use of recognized community communication channels during the community engagement process and dissemination of information about the pilot resulted in limited understanding of the pilot concept by the community. This surfaced through uncertainty and fear that the intervention may result in loss of control over daughters, worries about why money was provided unconditionally to girls, and suspicion of links to satanism. The sense of insecurity appeared to be exacerbated by low literacy levels, poverty, fear of loss of bride wealth, perceived disregard for local perceptions of social status, and scanty trust in the actors implementing the pilot. Inadequate use of locally appropriate channels in the dissemination of information created room for interpretation and facilitated development of mistrust, undermining the conditions for community engagement and actual informed consent. A key lesson learnt is the importance of taking seriously the complexity of local values and structures that may impact people’s capability to consent or not consent to a study in an informed manner. (shrink)
In a world with limited resources, allocation of resources to certain individuals and conditions inevitably means fewer resources allocated to other individuals and conditions. Should a patient's personal responsibility be relevant to decisions regarding allocation? In this project we combine the normative and the descriptive, conducting an empirical bioethical examination of how both Norwegian and British doctors think about principles of responsibility in allocating scarce healthcare resources. A large proportion of doctors in both countries supported including responsibility for illness in (...) prioritization decisions. This finding was more prominent in zero‐sum scenarios where allocation to one patient means that another patient is denied treatment. There was most support for incorporating prospective responsibility (through patient contracts), and low support for integrating responsibility into co‐payments (i.e. through requiring responsible patients to pay part of the costs of treatment). Finally, some behaviours were considered more appropriate grounds for deprioritization (smoking, alcohol, drug use)—potentially because of the certainty of impact and direct link to ill health. In zero‐sum situations, prognosis also influenced prioritization (but did not outweigh responsibility). Ethical implications are discussed. We argue that the role that responsibility constructs appear to play in doctors' decisions indicates a needs for more nuanced—and clear—policy. Such policy should account for the distinctions we draw between responsibility‐sensitive and prognostic justifications for deprioritization. (shrink)
There is not much of a substantive nature to add to Robert Neville’s thorough and thoughtful exposition of Grange’s work in systematic cosmology. I wish to pick up briefly, however, on where Neville leaves off, namely on the topic of “soul” and on the “astonishingly transformative” nature of Grange as a teacher. I had the good fortune to have Professor Grange as my very first philosophy teacher, and I feel that further comment on this aspect of his life is necessary (...) to complete this remembrance. Joseph Grange spent nearly forty years teaching undergraduate students at the University of Southern Maine, in Portland. His four decades of teaching included occasional assignments in China and also at the.. (shrink)
Although clinical ethics consultation is a high-stakes endeavor with an increasing prominence in health care systems, progress in developing standards for quality is challenging. In this article, we describe the results of a pilot project utilizing portfolios as an evaluation tool. We found that this approach is feasible and resulted in a reasonably wide distribution of scores among the 23 submitted portfolios that we evaluated. We discuss limitations and implications of these results, and suggest that this is a significant step (...) on the pathway to an eventual certification process for clinical ethics consultants. (shrink)
Simone Weil was a defining figure of the twentieth century; a philosopher, Christian, resistance fighter, Labour activist and teacher, described by Albert Camus as 'the only great spirit of our time'. In 1941 Weil was introduced to Father Joseph-Marie Perrin, a Dominican priest whose friendship became a key influence on her life. When Weil asked Perrin for work as a farm hand he sent her to Gustave Thibon, a farmer and Christian philosopher. Weil stayed with the Thibon family, working in (...) the fields and writing the notebooks which became _Gravity and Grace _and other posthumous works. Perrin and Thibon met Weil at a time when her spiritual life and creative genius were at their height. During the short but deep period of their acquaintance with her, they came to know her as she actually was. First published in English in 1953, and now introduced by J.P. Little, this unique portrait depicts Weil through the eyes of her friends, not as a strange and unaccountable genius but as an ardent and human person in search of truth and knowledge. (shrink)
When the COVID-19 surge hit New York City hospitals, the Division of Medical Ethics at Weill Cornell Medical College, and our affiliated ethics consultation services, faced waves of ethical issues sweeping forward with intensity and urgency. In this article, we describe our experience over an eight-week period (16 March through 10 May 2020), and describe three types of services: clinical ethics consultation (CEC); service practice communications/interventions (SPCI); and organizational ethics advisement (OEA). We tell this narrative through the prism of time, (...) describing the evolution of ethical issues and trends as the pandemic unfolded. We delineate three phases: anticipation and preparation, crisis management, and reflection and adjustment. The first phase focused predominantly on ways to address impending resource shortages and to plan for remote ethics consultation, and CECs focused on code status discussions with surrogates. The second phase was characterized by the dramatic convergence of a rapid increase in the number of critically ill patients, a growing scarcity of resources, and the reassignment/ redeployment of staff outside their specialty areas. The third phase was characterized by the recognition that while the worst of the crisis was waning, its medium- and long-term consequences continued to pose immense challenges. We note that there were times during the crisis that serving in the role of clinical ethics consultant created a sense of dis-ease as novel as the coronavirus itself. In retrospect we learned that our activities far exceeded the familiar terrain of clinical ethics consultation and extended into other spheres of organizational life in novel ways that were unanticipated before this pandemic. To that end, we defined and categorized a middle level of ethics consultation, which we have termed service practice communication intervention (SPCI). This is an underappreciated dimension of the work that ethics consult services are capable of in times of crisis. We believe that the pandemic has revealed the many enduring ways that ethics consultation services can more robustly contribute to the ethical life of their institutions moving forward. (shrink)
The visual attention (VA) span is defined as the amount of distinct visual elements which can be processed in parallel in a multi-element array. Both recent empirical data and theoretical accounts suggest that a VA span deficit might contribute to developmental dyslexia, independently of a phonological disorder. In this study, this hypothesis was assessed in two large samples of French and British dyslexic children whose performance was compared to that of chronological-age matched control children. Results of the French study show (...) that the VA span capacities account for a substantial amount of unique variance in reading, as do phonological skills. The British study replicates this finding and further reveals that the contribution of the VA span to reading performance remains even after controlling IQ, verbal fluency, vocabulary and single letter identification skills, in addition to phoneme awareness. In both studies, most dyslexic children exhibit a selective phonological or VA span disorder. Overall, these findings support a multi-factorial view of developmental dyslexia. In many cases, developmental reading disorders do not seem to be due to phonological disorders. We propose that a VA span deficit is a likely alternative underlying cognitive deficit in dyslexia. (shrink)
The way in which medical professionals engage in bioethical issues ultimately reflects the type of care such patients are likely to receive. It is therefore critical for doctors and other health care professionals to have a broad understanding of disability. Our purpose in this paper is to explore ways of teaching bioethical issues to first year medical students by integrating alternative approaches. Such approaches include (a) the use of the narrative format, (b) the inclusion of a disability perspective, and (c) (...) the presentation and facilitation of classes by people with disabilities. We consider how these new kinds of presentations are evaluated by students, faculty, people with disabilities and professional ethicists. We hope new knowledge may provide health care professionals with a greater understanding of the perspectives of patients with disabilities, who are confronted by conflicting ethical values and frameworks for decision-making in their interaction with such professionals. (shrink)
In 1941 Simone Weil was introduced to Father Jean-Marie Perrin, a priest of the Dominican order whose friendship became one of the most significant influences on her spiritual development. It was for Father Perrin that she wrote her 'spiritual autobiography', contained in Waiting for God, and to him that she later wrote 'Letter to a Priest'. When Weil requested work as a field hand, Perrin sent her to Gustave Thibon, a farmer and Christian philosopher. From 1941-2, Weil stayed with the (...) Thibon family, working in the fields by day while writing by night the notebooks which posthumously became Gravity and Grace and other seminal works. Perrin and Thibon met Weil at a time when her interior life and her creative genius were at the height of their glowing maturity. During the short but deep period of their acquaintance with her, they came to know her as she actually was. Their accounts of this time reveal her to us in the bare parlour of the Dominican convent at Marseilles where, after waiting her turn among a stream of refugees, she discussed her personal problems with Father Perrin. They show her to us in the vineyards of Ardèche, and on the stone seat by the fountain overlooking the Rhone valley where she read Plato to Thibon, her host. First published in 1953, and now newly introduced by Patricia Little, this unique portrait depicts Weil through the eyes of her friends, not as a strange and unaccountable genius but as an ardent and very human young person in search of truth and knowledge. (shrink)
The life of Joseph Dalton Hooker (1817-1911) provides an invaluable lens through which to view mid-Victorian science. A biographical approach makes it clear that some well-established narratives about this period need revising. For example, Hooker's career cannot be considered an example of the professionalisation of the sciences, given the doubtful respectability of being paid to do science and his reliance on unpaid collectors with pretensions to equal scientific and/or social status. Nor was Hooker's response to Darwin's theories either straightforward or (...) contradictory; it only makes sense as carefully crafted equivocation when seen in the context of his life and career. However, the importance of Hooker's life is ultimately its typicality; what was true of Hooker was true of many other Victorian men of science. (shrink)
Respected Catholic ethicists have recently defended the use of salpingostomy and methotrexate in the management of ectopic pregnancies.This article examines the arguments for the revised assessments to determine whether there are sound reasons to believe that these two methods do not constitute the direct and immediate killing of innocent human beings. National Catholic Bioethics Quarterly 11.1 (Spring 2011): 65–82.