The introduction of novel diagnostic techniques in clinical domains such as genomics and radiology has led to a rich ethical debate on how to handle unsolicited findings that result from these innovations. Yet while unsolicited findings arise in both genomics and radiology, most of the relevant literature to date has tended to focus on only one of these domains. In this article, we synthesize and critically assess similarities and differences between “scanning the body” and “sequencing the genome” from an ethical (...) perspective. After briefly describing the novel diagnostic contexts leading to unsolicited findings, we synthesize and reflect on six core ethical issues that relate to both specialties: terminology; benefits and risks; autonomy; disclosure of unsolicited findings to children; uncertainty; and filters and routine screening. We identify ethical rationales that pertain to both fields and may contribute to more ethically sound policies. Considerations of preserving public trust and ensuring that people perceive healthcare policies as fair also support the need for a combined debate. (shrink)

Bernard Mandeville construiu sua obra-prima de dois volumes, A fábula das abelhas, em torno de um poema largamente ignorado originalmente publicado em 1705, sua "A colmeia resmungona". Esse poema tenta proporcionar o contexto literário para a escolha feita por Mandeville da metáfora apiana. Examinamos exemplos antigos e modernos de teoria social e política informados e articulados por referência à organização e estrutura dos apiários e seus habitantes. A consideração desse contexto, conforme argumentamos, demonstra de uma nova maneira o caráter subversivo (...) de “A colmeia resmungona” e suas iterações subsequentes como A fábula das abelhas. Mandeville vira do avesso as suposições desgastadas pelo tempo sobre a harmonia natural das colmeias, sua relação com a sociedade humana, e o papel da fala e da razão em seu florescimento. (shrink)

In this paper we integrate a sorted unification calculus into free variable tableau methods for logics with term declarations. The calculus we define is used to close a tableau at once, unifying a set of equations derived from pairs of potentially complementary literals occurring in its branches. Apart from making the deduction system sound and complete, the calculus is terminating and so, it can be used as a decision procedure. In this sense we have separated the complexity of sorts from (...) the undecidability of first order logic. (shrink)

This volume is published concurrently with the one reviewed below and together they unite a number of Quine's previously scattered papers into two compact volumes; this volume deals with his more philosophical work while the other is concerned with more purely technical logical studies. The twenty-one essays cover the period 1934-1964 and none have appeared between hard covers before. Several of the articles—"The ways of paradox," "Foundations of mathematics," "On the application of modern logic," and "Necessary truth"—are essentially popular expositions. (...) The others are generally more restricted in both scope and appeal, and deal with the ontology of the sentential calculus, truth by convention, implicit definition, modal logic, and ontological reduction in the sciences. Several articles concern the philosophy of science directly: "On simple theories of a complex world," "Posits and reality," and "The scope and language of science." This fine collection will be of significant help in presenting the work of a distinguished philosopher to a wider audience, as well as providing the professional with a source of discussion.—P. J. M. (shrink)

Observations with respect to the relationship between symptoms and diseases can seriously be biased by selection phenomena. This selection may occur from the general population, via consultation behavior, diagnostic and therapeutic activities of the general practitioner, and by referral.Relationships may be suggested and reproduced even if they do not exist in unselected populations, as a product of diagnostic routines. Correction for selection bias can only be achieved by choosing proper comparison groups. While this can be done in a general practice (...) setting, this is almost impossible after referral, as is demonstrated in this paper. Surprisingly, the most unbiased estimation of the relationship between symptoms and diseases after referral can be made from patient groups that are referred for reason unrelated to the disease under study. (shrink)

The Gibbs states of binary lattice systems can be characterized by their stability with respect to certain microscopic transitions which have a simple physical interpretation. A detailed analysis is provided for the case of a one-dimensional lattice gas with nearest-neighbor interactions.

OBJECTIVES: To identify the factors that influence the assessment of reported cases of physician-assisted death by members of the public prosecution. DESIGN/SETTING: At the beginning of 1996, during verbal interviews, 12 short case-descriptions were presented to a representative group of 47 members of the public prosecution in the Netherlands. RESULTS: Assessment varied considerably between respondents. Some respondents made more "lenient" assessments than others. Characteristics of the respondents, such as function, personal-life philosophy and age, were not related to the assessment. Case (...) characteristics, i.e. the presence of an explicit request, life expectancy and the type of suffering, strongly influenced the assessment. Of these characteristics, the presence or absence of an explicit request was the most important determinant of the decision whether or not to hold an inquest. CONCLUSIONS: Although the presence of an explicit request, life expectancy and the type of suffering each influenced the assessment, each individual assessment was dependent on the assessor. The resulting danger of legal inequality and legal uncertainty, particularly in complicated cases, should be kept to a minimum by the introduction of some form of protocol and consultation in doubtful or boundary cases. The notification procedure already promotes a certain degree of uniformity in the prosecution policy. (shrink)

Rationale, aims and objectives To compare the pharmacotherapeutic approaches to diabetic hypertension of family physicians (FPs) and general practitioners (GPs). Methods A retrospective prescription-based study was conducted in 15 out of a total of 20 health centres, involving 115 primary care physicians – 77 FPs and 38 GPs, representing 74% of the primary care physicians of Bahrain. Prescriptions were collected during May and June 2000 to comprise a study population of 1266 diabetic-hypertensive patients. Results As monotherapy, angiotensin-converting enzyme (ACE) inhibitors (...) (37.9%) and β-blockers (38.3%) were the most commonly prescribed classes of antihypertensives by FPs and GPs, respectively. Calcium channel blockers (CCBs) were ranked third by both categories of physicians. For two-drug combinations, a β-blocker and an ACE inhibitor was the combination of choice for both physician categories. Patients managed by the FPs were more likely to receive a β-blocker–CCB combination (17.4 vs. 14.9%) or a diuretic–ACE inhibitor combination (16.7 vs. 11.4%) and less likely to receive a β-blocker–diuretic combination (11.8 vs. 16.7%) than those managed by the GPs. The proportion of patients receiving antihypertensive combinations was 40.6 and 38.5% for FPs and GPs, respectively. While the GPs prescribed CCB as a monotherapy to the elderly most often, the FPs choice was a β-blocker. Diuretics were less preferred by both FPs and GPs. β-Blocker–ACE inhibitor was again the most preferred combination of both FPs and GPs. FPs prescribed CCB–β-blocker combinations more often than GPs (P = 0.01), whereas CCB–ACE inhibitor combinations were less preferred (P = 0.09). A trend towards excessive use of short-acting nifedipine as monotherapy for elderly patients, both by FPs and by GPs, was noticed. Glibenclamide, alone or in combination with metformin, was the foremost antidiabetic drug prescribed by FPs and GPs. Middle-aged (45–64 years) patients seen by GPs were more likely to receive glibenclamide than those treated by FPs (P = 0.001) and less likely to receive gliclazide (P = 0.01). Combinations of a β-blocker with either glibenclamide or insulin were prescribed considerably more often by GPs.Conclusions Within the same practice setting, a substantial difference was observed between FPs and GPs in terms of preference for different classes of drugs in the management of diabetic hypertension. The compliance of both FPs and GPs was suboptimal; overall, the compliance of the FPs was closer to the recommended guidelines, however. Educational programmes should specifically address these inadequacies in order to improve the quality of health care. (shrink)

Theism, according to David O'Connor, has in recent centuries been on trial for its life, the charge being that the existence of so much evil in the world is incompatible with belief in a benevolent creator. But this trial, he claims is incapable of producing a reasoned verdict.

Between 1787, and the end of his life in 1832, Bentham turned his attention to the development and application of economic ideas and principles within the general structure of his legislative project. For seventeen years this interest was manifested through a number of books and pamphlets, most of which remained in manuscript form, that develop a distinctive approach to economic questions. Although Bentham was influenced by Adam Smith's An Inquiry into the Nature and Causes of the Wealth of Nations, he (...) neither adopted a Smithian vocabulary for addressing questions of economic principle and policy, nor did he accept many of the distinctive features of Smith's economic theory. One consequence of this was that Bentham played almost no part in the development of the emerging science of political economy in the early nineteenth century. The standard histories of economics all emphasize how little he contributed to the mainstream of late eighteenth and early nineteenth-century debate by concentrating attention on his utilitarianism and the psychology of hedonism on which it is premised. Others have argued that the calculating nature of his theory of practical reason reduced the whole legislative project to a crude attempt to apply economics to all aspects of social and political life. Put at its simplest this argument amounts to the erroneous claim that Bentham's science of legislation is reducible to the science of political economy. A different but equally dangerous error would be to argue that because Bentham's conception of the science of legislation comprehends all the basic forms of social relationships, there can be no science of political economy as there is no autonomous sphere of activity governed by the principles of economics. This approach is no doubt attractive from an historical point of view given that the major premise of this argument is true, and that many of Bentham's ‘economic’ arguments are couched in terms of his theory of legislation. Yet it fails to account for the undoubted importance of political economy within Bentham's writings, not just on finance, economic policy, colonies and preventive police, but also in other aspects of his utilitarian public policy such as prison reform, pauper management, and even constitutional reform. All of these works reflect a conception of political economy in its broadest terms. However, this conception of political economy differs in many respects from that of Bentham's contemporaries, and for this reason Bentham's distinctive approach to problems of economics and political economy has largely been misunderstood. (shrink)

This study assessed the possibility that the Budner Intolerance of Ambiguity Scale can offer an ideologically biased understanding of religious commitments. In a large sample of university undergraduates , Budner Scale correlations with Religious Interest, Religious Orientation, Need for Cognition, and Response Uncertainty supported the conclusion that religion predicts an inability to cope with uncertainty. At the same time, however, special procedures were used to create new scales expressing a Christian Tolerance of Ambiguity by translating Budner Scale items into a (...) language that was more compatible with religious beliefs. These Christian Tolerance of Ambiguity measures revealed that religiousness was associated with an ability rather than an inability to cope with uncertainty. Conflicting results between these Christian and nonreligious Tolerance of Ambiguity measures yielded additional support for the Ideological Surround Model of the psychology of religion. (shrink)

The European Union welfare standardsfor intensively kept pigs have steadilyincreased over the past few years and areproposed to continue in the future. It isimportant that the cost implications of thesechanges in welfare standards are assessed. Theaim of this study was to determine theprofitability of rearing pigs in a range ofhousing systems with different standards forpig welfare. Models were constructed tocalculate the cost of pig rearing (6–95 kg) in afully-slatted system (fulfilling minimum EUspace requirements, Directive 91630/EEC); apartly-slatted system; a high-welfare,straw-based system (...) (complying with the UK-basedRoyal Society for the Prevention of Cruelty toAnimals, Freedom Food standards) and afree-range system. The models were also used toassess the consequences of potential increasesin space allowance, and to estimate the cost ofrearing pigs under organic standards.The cost of rearing pigs ranged from92.0 p/kg carcass weight (cw) and 94.6 p/kgcw forthe partly-slatted and fully-slatted systems,to 98.8 p/kgcw and 99.3 p/kgcw for the FreedomFood and free-range systems respectively. Whenspace allowance was increased by 60% to levelsin a recent proposal to revise pig welfareDirective (91/630/EEC), the rearing costs wereunchanged for the free-range system but rose by4.6 p/kgcw for the fully-slatted system. Rearingcosts under organic standards were 31% higherthan in the free-range system. These resultssuggest that improved pig welfare can beachieved with a modest increase in cost. (shrink)