Deep brain stimulation is an experimental procedure for treatment-resistant depression. Some results show promise, but blinded trials had limited success. Ethical questions center on vulnerability: especially on whether depressed patients can weigh the risks and benefits effectively, whether depression causes “desperation,” and whether media portrayals create unrealistic hopes. We interviewed 24 psychiatric inpatients with treatment-resistant depression, qualitatively analyzing their comments. Most had minimal interest in deep brain stimulators. Some might consider them if their depression worsened, if alternatives were exhausted, or (...) if the evidence were stronger. Fears focused on the surgery, adverse effects, and the novelty of the device. Patients felt the depression interfered with their ability to weigh the risks and benefits. Patients seemed highly attuned to the risks, and were skeptical that the treatment would be effective. We conclude that ethical concerns about vulnerability remain, yet patients with treatment-resistant depression were thoughtful and cautious about trying a novel therapy. (shrink)

We present a rendering of some common grammatical formalisms in terms of evolving algebras. Though our main concern in this paper is on constraint-based formalisms, we also discuss the more basic case of context-free grammars. Our aim throughout is to highlight the use of evolving algebras as a specification tool to obtain grammar formalisms.

Examining the ethics of long-term, career involvement by physicians in global health work is vital, given growing professional interest and potential health implications for communities abroad. However, current literature remains heavily focused on ethical considerations of short-term global health training experiences. A literature review informed our development of an ethics framework centered on two perspectives: the practitioner perspective, further subdivided into extrinsic and intrinsic factors, and community perspectives, specifically that of the host community and the physician’s home community. Some physician (...) factors included cultural/linguistic differences, power imbalances, and sustainable skills/competencies. Receiving community factors included resource limitations, standard of care disparities, and community autonomy. Home community factors focused on the opportunity cost of an unavailable physician who was trained and supported by the local community. Descriptive review permitted comparison with existing short-term literature, noting similarities and differences. Our framework provides a basis for further research and critical analysis of ethical implications of career-long physician global health work. (shrink)

In our article, we share the lessons we have learned after creating and running a successful legal laboratory over the past seven years at Yale Law School. Our legal laboratory, which focuses on the intersection of law and severe brain injury, represents a unique pedagogical model for legal academia, and is closely influenced by the biomedical laboratory.

We consider the use ofevolving algebra methods of specifying grammars for natural languages. We are especially interested in distributed evolving algebras. We provide the motivation for doing this, and we give a reconstruction of some classic grammar formalisms in directly dynamic terms. Finally, we consider some technical questions arising from the use of direct dynamism in grammar formalisms.

Increasingly, clinical research is evaluated on the quality of its statistical analysis. Traditionally, statistical analyses in clinical research have been carried out from a ‘frequentist’ perspective. The presence of an alternative paradigm – the Bayesian paradigm – has been relatively unknown in clinical research until recently. There is currently a growing interest in the use of Bayesian statistics in health care research. This is due both to a growing realization of the limitations of frequentist methods and to the ability of (...) Bayesian methods explicitly to incorporate prior expert knowledge and belief into the analyses. This is in contrast to frequentist methods, where prior experience and beliefs tend to be incorporated into the analyses in an ad hoc fashion. This paper outlines the frequentist and Bayesian paradigms. Acute myocardial infarction mortality data are then analysed from both a Bayesian and a frequentist perspective. In some analyses, the two methods are seen to produce comparable results; in others, they produce different results. It is noted that in this example, there are clinically relevant questions that are more easily addressed from a Bayesian perspective. Finally, areas in clinical research where Bayesian ideas are increasingly common are highlighted. (shrink)

Background Although medical ethicists and educators emphasise patient-centred decision-making, previous studies suggest that patients often prefer their doctors to make the clinical decisions. Objective To examine the associations between a preference for physician-directed decision-making and patient health status and sociodemographic characteristics. Methods Sociodemographic and clinical information from all consenting general internal medicine patients at the University of Chicago Medical Center were examined. The primary objectives were to (1) assess the extent to which patients prefer an active role in clinical decision-making, (...) and (2) determine whether religious service attendance, the importance of religion, self-rated spirituality, Charlson Comorbidity Index, self-reported health, Vulnerable Elder Score and several demographic characteristics were associated with these preferences. Results Data were collected from 8308 of 11 620 possible participants. Ninety-seven per cent of respondents wanted doctors to offer them choices and to consider their opinions. However, two out of three (67%) preferred to leave medical decisions to the doctor. In multiple regression analyses, preferring to leave decisions to the doctor was associated with older age (per year, OR=1.019, 95% CI 1.003 to 1.036) and frequently attending religious services (OR=1.5, 95% CI 1.1 to 2.1, compared with never), and it was inversely associated with female sex (OR=0.6, 95% CI 0.5 to 0.8), university education (OR=0.6, 95% CI 0.4 to 0.9, compared with no high school diploma) and poor health (OR=0.6, 95% CI 0.3 to 0.9). Conclusions Almost all patients want doctors to offer them choices and to consider their opinions, but most prefer to leave medical decisions to the doctor. Patients who are male, less educated, more religious and healthier are more likely to want to leave decisions to their doctors, but effects are small. (shrink)

Focusing on Truth explores the question of what truth is, balancing historical with issue-orientated discussion. The book offers a comprehensive survey of all the major theories of truth. Lawrence Johnson investigates a number of closely related matters of truth in his inquiry, such as: What sorts of things are true or false? What is attributed to them when they are said to be true or false? What do facts have to do with truth? What can we learn from previous (...) theories? The book opens with an analysis of the coherence theory of truth and then the correspondence theory of truth, as developed by Moore, Russell and Wittgenstein. Through a study of the semantic conceptions of truth, the author reveals that an adequate theory of truth must take account of the pragmatics of person, purpose, and circumstance. A full understanding of facts and truth bearers is considered central to Johnson's criticism of the opposing truth theories of J. L. Austin and P. F. Strawson. Drawing on the merits of these theories and others, while identifying their deficiencies, Johnson presents a new account of truth, based on the correlation of referential foci and the use of linguistic conventions. This account is defended as being adequate to meet the legitimate demands made on a theory of truth. Johnson argues that the account leaves scope for statements of many different sorts to be true in their own widely varying ways, without the existence of a need to posit fundamentally different kinds of truth. (shrink)

The work of justus buchler is used to critique and to suggest a reformulation of certain ideas in jurgen habermas's "theory of communicative action", Most especially his analysis of modernity in terms of the conflict between "lifeworld" and "system." the difficulties of this dualistic analysis are examined. A buchlerian "pluralistic" alternative is suggested, For which the pathologies of modernity are attributed, Not to the dominance of the system, But to the condition of dominance "per se", That is, The reduction of (...) effective plurality. (shrink)

This book offers an introductory account of the central theories of truth. A wide range of theories, from those of correspondence and coherence to Tarski's semantic conception of truth are presented and assessed in order to profit from that which is of value in them. The authot proposes a new account which it is asserted is adequate to meet the legitimate demands made on the theory of truth.

This article enlarges classical syllogistic logic with assertions having to do with comparisons between the sizes of sets. So it concerns a logical system whose sentences are of the following forms: Allxareyand Somexarey, There are at least as manyxasy, and There are morexthany. Herexandyrange over subsets (not elements) of a giveninfiniteset. Moreover,xandymay appear complemented (i.e., as$\bar{x}$and$\bar{y}$), with the natural meaning. We formulate a logic for our language that is based on the classical syllogistic. The main result is a soundness/completeness theorem. (...) There are efficient algorithms for proof search and model construction. (shrink)

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

In this probing examination of the meaning and function of culture in contemporary society, Lawrence Cahoone argues that reason itself is cultural, but no less reasonable for it. While recent political and philosophical movements have recognized that cognition, the self, and politics are embedded in culture, most fail to appreciate the deep changes in rationalism and liberal theory this implies, others leap directly into relativism, and nearly all fail to define culture. Cultural Revolutions systematically defines culture, gauges the consequences (...) of the ineradicably cultural nature of cognition and action, yet argues that none of this implies relativism. After showing where other &“new culturalists&” have gone wrong, Cahoone offers his own definition of culture as teleologically organized practices, artifacts, and narratives and analyzes the notion of cultural membership in relation to race, ethnicity, and &“primordialism.&” He provides a theory of culture&’s role in how we form our sense of reality and argues that the proper conception of culture dissolves &“the problem&” of cultural relativism. Applying this perspective to Islamic fundamentalism, Cahoone identifies its conflict with the West as representing the break between two of three historically distinctive forms of reason. Rather than being &“irrational,&” he shows, fundamentalism embodies a rationality only recently devalued&—but not entirely abandoned&—by the West. The persistence of plural forms of reason suggests that modernization in various world cultures is compatible with continued, even magnified, cultural differences. (shrink)

In this probing examination of the meaning and function of culture in contemporary society, Lawrence Cahoone argues that reason itself is cultural, but no less reasonable for it. While recent political and philosophical movements have recognized that cognition, the self, and politics are embedded in culture, most fail to appreciate the deep changes in rationalism and liberal theory this implies, others leap directly into relativism, and nearly all fail to define culture. Cultural Revolutions systematically defines culture, gauges the consequences (...) of the ineradicably cultural nature of cognition and action, yet argues that none of this implies relativism. After showing where other "new culturalists" have gone wrong, Cahoone offers his own definition of culture as teleologically organized practices, artifacts, and narratives and analyzes the notion of cultural membership in relation to race, ethnicity, and "primordialism." He provides a theory of culture's role in how we form our sense of reality and argues that the proper conception of culture dissolves "the problem" of cultural relativism. Applying this perspective to Islamic fundamentalism, Cahoone identifies its conflict with the West as representing the break between two of three historically distinctive forms of reason. Rather than being "irrational," he shows, fundamentalism embodies a rationality only recently devalued--but not entirely abandoned--by the West. The persistence of plural forms of reason suggests that modernization in various world cultures is compatible with continued, even magnified, cultural differences. (shrink)

“Whatever else of metaphysical or philosophical significance may be involved in a biblical pericope, it remains true that the writer or speaker was directing his words to something which he considered to be a vital element in the human situation, to understanding man's humanness as it finds expression in his life with others in a social context.”.

Shaftesbury's Characteristics of Men, Manners, Opinions, Times was first published in 1711. It ranges widely over ethics, aesthetics, religion, the arts, and ancient and modern history, and aims at nothing less than a new ideal of the gentleman. Together with Locke's Essay Concerning Human Understanding and Addison and Steele's Spectator, it is a text of fundamental importance for understanding the thought and culture of Enlightenment Europe. This volume, first published in 2000, presents an edition of the text together with an (...) introduction, explanatory notes and a guide to further reading. (shrink)

Shaftesbury's Characteristics of Men, Manners, Opinions, Times was first published in 1711. It ranges widely over ethics, aesthetics, religion, the arts, and ancient and modern history, and aims at nothing less than a new ideal of the gentleman. Together with Locke's Essay Concerning Human Understanding and Addison and Steele's Spectator, it is a text of fundamental importance for understanding the thought and culture of Enlightenment Europe. This volume, first published in 2000, presents an edition of the text together with an (...) introduction, explanatory notes and a guide to further reading. (shrink)

This revised and expanded second edition of Cahoone's classic anthology provides an unparalleled collection of the essential readings in modernism and postmodernism. Places contemporary debate in the context of the criticism of modernity since the seventeenth century. Chronologically and thematically arranged. Indispensable and multidisciplinary resource in philosophy, literature, cultural studies, social theory, and religious studies.

The marketing of health care services raises the prospect that an ethic of strangers will govern relations between providers and patients. A fiduciary model that emphasizes honesty and public accountability, as well as the patient's good and avoiding unnecessary services, can keep marketing consistent with the ethical tradition of medicine.

Examines the cultural implications of society's declining appreciation and recognition of common sense while exploring the process by which the concept is learned.

Disc 1. Philosophy and the modern age ; Scholasticism and the scientific revolution -- Disc 2. The rationalism and dualism of Descartes ; Locke's empiricism, Berkeley's idealism -- Disc 3. Neo-Aristotelians : Spinoza and Leibniz ; The Enlightenment and Rousseau -- Disc 4. The radical skepticism of Hume ; Kant's Copernican revolution -- Disc 5. Kant and the religion of reason ; The French Revolution and German idealism -- Disc 6. Hegel, the last great system ; Hegel and the English (...) century -- Disc 7. The economic revolution and its critic, Marx ; Kierkegaard's Critique of reason -- Disc 8. Nietzsche's Critique of morality and truth ; Freud, Weber, and the mind of modernity -- Disc 9. Rise of 20th-century philosophy, pragmatism ; analysis -- Disc 10. Rise of 20th-century philosophy, phenomenology ; Physics, positivism and early Wittgenstein -- Disc 11. Emergence and Whitehead ; Dewey's American naturalism -- Disc 12. Heidegger's Being and time ; Existentialism and the Frankfurt School -- Disc 13. Heidegger's turn against humanism ; Culture, hermeneutics, and structuralism -- Disc 14. Wittgenstein's turn to ordinary language ; Quine and the end of positivism -- Disc 15. New philosophies of science ; Derrida's deconstruction of philosophy -- Disc 16. The challenge of postmodernism ; Rorty and the end of philosophy -- Disc 17. Rediscovering the premodern ; Pragmatic realism, reforming the modern -- Disc 18. The reemergence of emergence ; Philosophy's death greatly exaggerated. (shrink)

The Affordable Care Act did not start the consolidation rapidly occurring with hospitals/health systems and medical groups, but it most definitely accelerated the movement to combine. In the last five years, the number and size of consolidations have been at an all-time high. This comment reviews the degree to which consolidation has occurred and explores the key reasons behind these consolidations. It then posits that consolidations should be evaluated in light of the Triple Aim goals of enhancing access to care, (...) reducing cost, and strengthening quality, and looks at the evidence to date in light of these goals. (shrink)

Background: Patient autonomy has been promoted as the most important principle to guide difficult clinical decisions. To examine whether practising physicians indeed value patient autonomy above other considerations, physicians were asked to weight patient autonomy against three other criteria that often influence doctors’ decisions. Associations between physicians’ religious characteristics and their weighting of the criteria were also examined. Methods: Mailed survey in 2007 of a stratified random sample of 1000 US primary care physicians, selected from the American Medical Association masterfile. (...) Physicians were asked how much weight should be given to the following: (1) the patient’s expressed wishes and values, (2) the physician’s own judgment about what is in the patient’s best interest, (3) standards and recommendations from professional medical bodies and (4) moral guidelines from religious traditions. Results: Response rate 51% (446/879). Half of physicians (55%) gave the patient’s expressed wishes and values “the highest possible weight”. In comparative analysis, 40% gave patient wishes more weight than the other three factors, and 13% ranked patient wishes behind some other factor. Religious doctors tended to give less weight to the patient’s expressed wishes. For example, 47% of doctors with high intrinsic religious motivation gave patient wishes the “highest possible weight”, versus 67% of those with low (OR 0.5; 95% CI 0.3 to 0.8). Conclusions: Doctors believe patient wishes and values are important, but other considerations are often equally or more important. This suggests that patient autonomy does not guide physicians’ decisions as much as is often recommended in the ethics literature. (shrink)

This revised and expanded second edition of Cahoone's classic anthology provides an unparalleled collection of the essential readings in modernism and postmodernism. Places contemporary debate in the context of the criticism of modernity since the seventeenth century. Chronologically and thematically arranged. Indispensable and multidisciplinary resource in philosophy, literature, cultural studies, social theory, and religious studies.

Hume's is/ought distinction has long limited the role of empirical research in ethics, saying that data about what something is cannot yield conclusions about the way things ought to be. However, interest in empirical research in ethics has been growing despite this countervailing principle. We attribute some of this increased interest to a conceptual breakdown of the is/ought distinction. MacIntyre, in reviewing the history of the is/ought distinction, argues that is and ought are not strictly separate realms but exist in (...) a close relationship that is clarified by adopting a teleological orientation. We propose that, instead of recovering a teleological orientation, society tends to generate its own goals via democratic methods like those described by Rousseau or adopt agnosticism about teleology such as described by Richard Rorty. In both latter scenarios, the distinction between is and ought is obscured, and the role for empirical research grows, but for controversial reasons. MacIntyre warns that the is/ought distinction should remain, but reminds ethicists to make careful arguments about when and why it is legitimate to move from is to ought. (shrink)

Conscientious objection among physicians is a perennial hot topic on both sides of the Atlantic. Sven Nordstrand's survey of Norwegian medical students adds fresh data to this ongoing debate.1Their starting point, whether doctors should be allowed to refuse any procedure to which they object on cultural, moral or religious grounds, is truly at the heart of the debate. Their finding that only 20.8% of students endorse this position is striking as it is less than half the number reported by Sophie (...) Strickland in her survey of medical students in the UK.2 It also suggests much less support for conscientious objection than was found among USA primary care physicians, where 78% agreed that “A physician should never do what he or she believes is morally wrong, no matter what experts say.”3These data invite speculation about why there is such dramatic variation between countries. Much can be made of Nordstrand's comments that in Norway “each citizen is assigned a particular general practitioner” and “In the Norwegian healthcare system the general practitioner has a crucial role as …. (shrink)

What role should the physician's conscience play in the practice of medicine? Much controversy has surrounded the question, yet little attention has been paid to the possibility that disputants are operating with contrasting definitions of the conscience. To illustrate this divergence, we contrast definitions stemming from Abrahamic religions and those stemming from secular moral tradition. Clear differences emerge regarding what the term conscience conveys, how the conscience should be informed, and what the consequences are for violating one's conscience. Importantly, these (...) basic disagreements underlie current controversies regarding the role of the clinician's conscience in the practice of medicine. Consequently participants in ongoing debates would do well to specify their definitions of the conscience and the reasons for and implications of those definitions. This specification would allow participants to advance a more philosophically and theologically robust conversation about the means and ends of medicine. (shrink)

The Editor of The Owl and the Treasurer of the Hegel Society of America share the same residence, i.e., the body of Lawrence S. Stepelevich. The Treasurer insists upon having a few words to say. These will be followed by a few from the Editor.

At the entrance to Berlin’s Humboldt University where Hegel once taught, one of Marx’s slogans has been carved into the wall in large gilded letters: “Die Philosophen haben die Welt nur verschieden interpretiert; es kömmt darauf an, sie zu verändem.” Well, the world has certainly changed for the instructors and staff who once worked for the East German regime. For these former members of the Akademie, the days of wine and roses are over, with nothing remaining but a bad hangover. (...) What had been considered a pedagogical virtue, i.e., to appear as if convinced and to convince others that communist political propaganda was indeed philosophy, is now a discredited vice. For over four decades, the academic apparatchiks said it was the best of times, even if others were saying it was worst. Today, unsustained by bureaucratic fiat, the former staff and faculty find themselves confronted with a confusing new world - one which they had been assured had been consigned to the historical dustbin. Of course, without recourse to the formalities of a trial, it is almost impossible to determine the particular degree of complicity, if any, on the part of any individual related to the miserable doings of the Akademie. All of them claim to be innocent of any wrongdoing, of any action that would have inhibited the development of any would-be philosopher. Some, who even find friends among us, remain committed to the principle that philosophy has meaning only as a rationale for political correctness. Others simply claim to have had no role in past misdemeanors, having served as minor functionaries, a type found in any government. But despite these and other explanations, more than a few West German scholars have found it difficult to forgive and forget the prolonged degradation of Berlin’s famous university. (shrink)

Disputes regarding the ethics of work by children have intensified in recent years, with little resolution. The impasses stem from failure to recognize the diverse forms of child work and a lack of empirical research regarding its causes and consequences. We report on data gathered in Brazil’s export-oriented shoe industry, which is notorious for the employment of children. Central findings are: 1) the causes of child work have less to do with backwardness and more to do with how shoe workers (...) are integrated into the global order; 2) local employers and children regard this work as benign, but the U.S. government sees it as hazardous to children and unfair to U.S. producers; 3) efforts to remove children from the shoe industry have been frustrated by local resistance and raise ethical questions; and 4) in certain circumstances, efforts to eliminate hazards from the workplace are morally superior to campaigns to remove childworkers from employment. (shrink)

In August of 1978, the XVI World Congress of Philosophy convened in Düsseldorf. As the European Hegel societies were then unable to prepare a common program, it first appeared as if Hegel would be left unrepresented in this most important of philosophical gatherings. As this seemed not right, the Hegel Society of America took the initiative, at the last moment, to prepare a special section. The result proved, not unexpectedly, to be a great success. The special program featured two of (...) the finest Hegel scholars, Professors John N. Findlay and Errol E. Harris. The papers they delivered at that time, before a large and appreciative audience, were subsequently published in the Owl. (shrink)

In defining the Wise Man, the Man of absolute Knowledge, as perfectly self‐conscious – i. e., omniscient, at least potentially – Hegel nevertheless had the unheard‐of audacity to assert that he realized Wisdom in his own person.

Progressive supranuclear palsy is a movement disorder with prominent tau neuropathology. Brain diseases with abnormal tau deposits are called tauopathies, the most common of which is Alzheimer's disease. Environmental causes of tauopathies include repetitive head trauma associated with some sports. To identify common genetic variation contributing to risk for tauopathies, we carried out a genome-wide association study of 1,114 individuals with PSP and 3,247 controls followed by a second stage in which we genotyped 1,051 cases and 3,560 controls for the (...) stage 1 SNPs that yielded P ≤ 10-3. We found significant previously unidentified signals associated with PSP risk at STX6, EIF2AK3 and MOBP. We confirmed two independent variants in MAPT affecting risk for PSP, one of which influences MAPT brain expression. The genes implicated encode proteins for vesicle-membrane fusion at the Golgi-endosomal interface, for the endoplasmic reticulum unfolded protein response and for a myelin structural component. © 2011 Nature America, Inc. All rights reserved. (shrink)

Pancreatitis is a complex, progressively destructive inflammatory disorder. Alcohol was long thought to be the primary causative agent, but genetic contributions have been of interest since the discovery that rare PRSS1, CFTR and SPINK1 variants were associated with pancreatitis risk. We now report two associations at genome-wide significance identified and replicated at PRSS1-PRSS2 and X-linked CLDN2 through a two-stage genome-wide study. The PRSS1 variant likely affects disease susceptibility by altering expression of the primary trypsinogen gene. The CLDN2 risk allele is (...) associated with atypical localization of claudin-2 in pancreatic acinar cells. The homozygous CLDN2 genotype confers the greatest risk, and its alleles interact with alcohol consumption to amplify risk. These results could partially explain the high frequency of alcohol-related pancreatitis in men. © 2012 Nature America, Inc. All rights reserved. (shrink)

Few figures of the Middle Ages command the attention of so many modern disciplines as Robert Grosseteste (c. 1170-1253). Theology, Philosophy, History, and Science are all areas which his life and thought continue to have significance and to inspire re-interpretation. Accompanied by a series of original commentaries, this new edition of Grosseteste's work, with English translation, draws together the perspectives of modern scientists and medieval specialists. Volume I of a six volume series, Knowing and Speaking presents two of the earliest (...) of Grosseteste's works, the treatises On the Liberal Arts and On the Generation of Sounds. These are accompanied by a significant Middle English treatise on the Seven Liberal Arts whose anonymous fifteenth-century author translated and excerpted passages from Grosseteste's treatises in a re-imagining of their structure and function.0Each work is treated separately within the volume, which is constructed in three parts. On the Liberal Arts sets Grosseteste's thoughts on the arts subjects and emphasises moral concerns about the purpose of learning. On the Generation of Sounds builds on the theories and statements of On the Liberal Arts in connection to the production of sound, elaborating the earlier position, relating the generation of sounds to human vocal and speech production. (shrink)