_341_ _Objectives: _In patients with multivessel disease both the detection of the culprit lesion and the exact allocation are important preconditions for sufficient treatment and improved outcome. In a vessel based approach the combination of quantitative coronary angiography and fractional flow reserve measured by a pressure wire should be advantageous compared to myocardial SPECT, as morphological and functional information is delivered simultaneously. Therefore our aim was to evaluate MS in the detection and allocation of hemodynamically significant stenoses obtained by the (...) combined gold standard QCA plus FFR in patients with multivessel disease. _Methods: _FFR and QCA of 95 vessels in 80 patients have been evaluated. Hemodynamically significant target lesions were defined as intermediate stenoses between 50 and 75% with an FFR. (shrink)

Contemporary research ethics policies started with reflection on the atrocities perpetrated upon concentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim (...) of this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

Common morality has been the touchstone of medical ethics since the publication of Beauchamp and Childress's Principles of Biomedical Ethics in 1979. Rosamond Rhodes challenges this dominant view by presenting an original and novel account of the ethics of medicine, one deeply rooted in the actual experience of medical professionals. She argues that common morality accounts of medical ethics are unsuitable for the profession, and inadequate for responding to the particular issues that arise in medical practice. Instead, Rhodes argues (...) that medicine's distinctive ethics should be explained in terms of the trust that society allows to the profession. Trust is the core and starting point of Rhodes' moral framework, which states that the most basic duty of doctors0is to "seek trust and be trustworthy." 0Building from this foundation, Rhodes explicates the sixteen specific duties that doctors take on when they join the profession, and demonstrates how her view of these duties is largely consistent with the codes of medical ethics of medical societies around the world. She then explains why it is critical for physicians to develop the attitudes or "doctorly" virtues that comprise the character of trustworthy doctors and buttress physicians' efforts to fulfil their professional obligations. Her book's presentation of physicians' duties and the elements that comprise a doctorly character, together add up to a cohesive and comprehensive description of what medical professionalism really entails. Rhodes's analysis provides a clear understanding of medical professionalism as well as a guide for doctors navigating the ethically challenging situations that arise in clinical practice. (shrink)

In this chapter, the author argues against the commonly accepted reading, which was most fully articulated by Larry May in his article “Hobbes's Contract Theory ”. Contrary to that widely accepted interpretation, he shows that scholars overlook crucial distinctions that play a critical role in Hobbes's account. There Hobbes explained that reasonable men would appreciate the necessity of creating an artificial power to ensure that covenants would be “constant and lasting”. For Hobbes, the commonwealth is a distinct entity that men (...) “Cause” into existence by accepting “restraint” on their liberty in order to achieve “their own preservation, and a more contented life thereby”. The power fused in the People gives the congregation inordinate strength for security against the sovereign; the might of a Leviathan exceeds the power of any solitary sovereign. Adopting the complex account of the creation of civil society and the authorization of its sovereign has important implications for understanding Hobbes's political theory. (shrink)

This article is an extended discussion from the recent opening presentation for the Annual Winchester Advanced ‘Philosophy for Children’ Seminar in Climate Change Education, Hope and Philosophy for Children. The presentation and text originate from Rosamonde Birch's (2019) Masters’ dissertation research discerning hope through an Education for Sustainable Development Philosophy for Children workshop.

The human microbiome is the bacteria, viruses, and fungi that cover our skin, line our intestines, and flourish in our body cavities. Work on the human microbiome is new, but it is quickly becoming a leading area of biomedical research. What scientists are learning about humans and our microbiomes could change medical practice by introducing new treatment modalities. This new knowledge redefines us as superorganisms comprised of the human body and the collection of microbes that inhabit it and reveals how (...) much we are a part of our environment. The understanding that microbes are not only beneficial but sometimes necessary for survival recasts our interaction with microbes from adversarial to neighborly. This volume explores some of the science that makes human microbiome research possible. It then considers ethical, legal, and social concerns raised by microbiome research. Chapters explore issues related to personal identity, property rights, and privacy. The authors reflect on how human microbiome research challenges reigning views on public health and research ethics. They also address the need for thoughtful policies and procedures to guide the use of the biobanked human samples required for advancing this new domain of research. In the course of these explorations, they introduce examples from the history of biomedical science and recent legal cases that shed light on the issues and inform the policy recommendations they offer at the end of each topic's discussion.This volume is the product of an NIH Human Microbiome Project grant. It represents three years of conversations focused on consensus formation by the twenty-seven members of the interdisciplinary Microbiome Working Group. (shrink)

Over the past 15 years, medical schools have paid some attention to the importance of developing students' communication skills as part of their medical education. Over the past decade, medical ethics has been added to the curriculum of most U.S. medical schools, at least on paper. More recently, there has been growing discussion of the importance of professionalism in medical education. Yet, the nature and content of these fields and their relationship to one another remains confused and vague, and that (...) lack of clarity, in turn, impairs the effectiveness of medical education. This ambiguity invites serious contention over who should design and teach the curriculum as well as when, where, and how it should be taught. (shrink)

The need for organs to transplant is clear. Due to the lack of transplants, people suffer, they die, and the cost of taking care of them until they die is huge. There is general agreement that it would be good to increase the supply of organs in order to meet the demand for organ transplantation.

Medicine needs our trust. We need to be able to rely on individual clinicians and researchers, and we need to be able to have confidence in hospitals and clinics. Yet the organization of our healthcare institutions is not designed to promote that trust. In fact, the structure of our medical institutions seems to undermine our faith.

Because the process of moving from moral principles and facts to action-guiding moral conclusions has not been articulated clearly enough to be useful in a practical way, we designed a systematic approach to aid learners and clinicians in their application of ethical principles to the resolution of clinical dilemmas. Our model for clinical moral reasoning is intended to provide a clear and replicable structure that makes the thought process involved in reasoning about clinical cases explicit. In this paper we present (...) the model and demonstrate how it can be used in three clinical cases. (shrink)

We whole-heartedly support Andrew Garland, Stephanie Morain, and Jeremy Sugarman’s claim that clinicians have a duty to participate in pragmatic clinical trials (Garland, Morain, and Sugarman 2023)...

Traditional moral theories of rights and principles have dominated medical ethics discussions for decades. Appeals to utilitarian consequences, as well as the principles of respect for autonomy, beneficence, and justice, have provided the standard vocabulary and filled the literature of the field.Recently on the bioethics scene, however, there has been some discussion of virtue, and, particularly within the nursing ethics literature, appeals are being made to the feminist ethics of care. This intimation of a shift in the wind may have (...) to do with postmodern doubt, or it may be attributable to the claim that virtue theory and the ethics of care are more appropriate to private interaction; theories of rights and justice are best applied to the political domain of public policy. (shrink)

This sourcebook, a corrected reprint of the University of South Carolina Press edition of 1972, contains a complete English translation of the sophist material collected in the critical edition of Diels-Krantz, as well as Euthydemus and a completely re-edited Antiphon.

Through a number of studies recently published in the psychology literature, T.D. Wilson, D.T. Gilbert, and others have demonstrated that our judgments about what our future mental states will be are contaminated by various distortions. Their studies distinguish a variety of different distortions, but they refer to them all with the generic term “affective forecasting.” The findings of their studies on normal volunteers are remarkably robust and, therefore, demonstrate that we are all vulnerable to the distortions of affective forecasting. a.

Contemporary research ethics policies started with reflection on the atrocities perpetrated upoconcentration camp inmates by Nazi doctors. Apparently, as a consequence of that experience, the policies that now guide human subject research focus on the protection of human subjects by making informed consent the centerpiece of regulatory attention. I take the choice of context for policy design, the initial prioritization of informed consent, and several associated conceptual missteps, to have set research ethics off in the wrong direction. The aim of (...) this paper is to sort out these confusions and their implications and to offer instead a straightforward framework for considering the ethical conduct of human subject research. In the course of this discussion I clarify different senses of autonomy that have been confounded and present more intelligible justifications for informed consent. I also take issue with several of the now accepted dogmas that govern research ethics. These include: the primacy of informed consent, the protection of the vulnerable, the substitution of beneficence for research's social purpose, and the introduction of an untenable distinction between innovation and research. (shrink)

Those who read only the introductory section of “Physician Obligation in Disaster Preparedness and Response,” the statement from the AMA's Council on Ethical and Judicial Affairs, apparently an elaboration on CEJA Opinion 3-I-04, E-9.067, will find an expression of laudable professional responsibility in the face of a disaster. There the AMA authors explicitly acknowledge “that unique responsibilities beyond planning rest on the shoulders of the medical profession”. They also declare that, “physicians are needed to care for victims. In some instances, (...) this will require individual physicians to place their health or their lives at risk”. As the AMA authors note, these responsibilities have been accepted at least since the writing of Thomas Percival in 1803 and endorsed by the AMA in posting their 1847 code. The commitments are also asserted in the preamble of the AMA's most current Principles of Medical Ethics, which states that “a physician must recognize responsibility to patients, first and foremost,” and again in Principle VIII, which states that “[a] physician shall, when caring for a patient, regard responsibility to the patient as paramount”. (shrink)

What are the consequences of the tendency for ubiquitous online reputation calculation to lead not to more precise expressions of reputation capital but, rather, to greater reputational instability? This article contrasts two conceptions of online reputation, which enact opposing attitudes about the relation between reputation and the calculable. According to an early online reputation paradigm – reputation capital – users strove to achieve high scores, performing the presumption that reputation could be incrementally accumulated and consistently measured within relatively stable spheres (...) of value. Yet, ubiquitous calculation led not to more precise measurements of reputation, but rather to the increasing volatility of online reputation. Thus, a second online reputation paradigm – reputation warfare – has become increasingly prevalent, in which strategic actors indirectly capitalize on systemic volatility produced by reputation’s ubiquitous online calculation. Steve Bannon’s 2016 Trump campaign strategy, which mobilized trolls, exemplifies the indirect optimization of online reputation, placing an option on reputational volatility. (shrink)

This paper challenges the leading common morality accounts of medical ethics which hold that medical ethics is nothing but the ethics of everyday life applied to today’s high-tech medicine. Using illustrative examples, the paper shows that neither the Beauchamp and Childress four-principle account of medical ethics nor the Gert et al 10-rule version is an adequate and appropriate guide for physicians’ actions. By demonstrating that medical ethics is distinctly different from the ethics of everyday life and cannot be derived from (...) it, the paper argues that medical professionals need a touchstone other than common morality for guiding their professional decisions. That conclusion implies that a new theory of medical ethics is needed to replace common morality as the standard for understanding how medical professionals should behave and what medical professionalism entails. En route to making this argument, the paper addresses fundamental issues that require clarification: what is a profession? how is a profession different from a role? how is medical ethics related to medical professionalism? The paper concludes with a preliminary sketch for a theory of medical ethics. (shrink)

a This paper is a revised and shortened version of my chapter, “Justice in Allocations for Terrorism, Biological Warfare, and Public Health” in Public Health Ethics, edited by Michael Boylan, Kluwer; 2004. Portions of this material were presented at the International Bioethics Retreat, Pavia, Italy, June 2003, and at the meetings of the Association for Politics and the Life Sciences, Philadelphia, September 2003.

As the possibility of cloning humans emerges on the horizon people are worrying about the morality of using the new technology. They are anxious about the ethical borders that might be crossed when duplicate humans can be produced by separating the cells of a newly fertilized human egg or, in the more distant future, by creating a zygote from an existing person's genetic material. They are apprehensive about eugenics, concerned about creating humans as sources of spare parts for others, uneasy (...) about producing humans without intending to allow them to live and develop, and uncomfortable about using duplicate humans as business ventures. (shrink)

Currently, some of the most significant moral issues involving genetic links relate to genetic knowledge. In this paper, instead of looking at the frequently addressed issues of responsibilities professionals or institutions have to individuals, I take up the question of what responsibilities individuals have to one another with respect to genetic knowledge. I address the questions of whether individuals have a moral right to pursue their own goals without contributing to society's knowledge of population genetics, without adding to their family's (...) knowledge of its genetic history, and without discovering genetic information about themselves and their offspring. These questions lead to an examination of the presumed right to genetic ignorance and an exploration of a variety of social bonds. Analyzing cases in light of these considerations leads to a surprising conclusion about a widely accepted precept of genetic counseling, to some ethical insights into typical problems, and to some further unanswered questions about personal responsibility in the face of genetic knowledge. (shrink)

Volumes have been written arguing the morality of abortion. A crucial premise in many of these arguments concerns the status of the fetus; specifically, that the fetus has or does not have a right to life. Opponents of abortion typically argue that fetuses are persons and hence have an inviolable right to life. Advocates of the right to abortion typically maintain that fetuses are not persons and hence have no right to life.

Policies for the allocation of COVID-19 vaccine were implemented in early 2021 as soon as vaccine became available. Those responsible for the planning and execution of COVID-19 vaccination had to make choices about who received vaccination first while numerous authors offered their own recommendations. This paper provides an account of how such decisions should be made by focusing on the specifics of the situation at hand. In that light, I offer an argument for prioritising those who are likely vectors of (...) the disease and a criticism of the victim-focused priority proposals put forward by the US Centers for Disease Control and Prevention, the National Academies of Sciences, Engineering, and Medicine, the UK National Health Service, and others. I also offer thoughts on how those authors may have gone astray. (shrink)

A complete translation of Aristotle's classic that is both faithful and readable, along with an introduction that provides the modern reader with a means of understanding this seminal work and its impact on our culture. In this volume, Joe Sachs (translator of Aristotle's _Physics, Metaphysics,_ and the _Nicomachean Ethics _)also supplements his excellent translation with well-chosen notes and glossary of important terms. Focus Philosophical Library translations are close to and are non-interpretative of the original text, with the notes and a (...) glossary intending to provide the reader with some sense of the terms and the concepts as they were understood by Aristotle’s immediate audience. (shrink)

This paper challenges the long-standing and widely accepted view that medical ethics is nothing more than common morality applied to clinical matters. It argues against Tom Beauchamp and James Childress’s four principles; Bernard Gert, K. Danner Clouser and Charles Culver’s ten rules; and Albert Jonsen, Mark Siegler, and William Winslade’s four topics approaches to medical ethics. First, a negative argument shows that common morality does not provide an account of medical ethics and then a positive argument demonstrates why the medical (...) profession requires its own distinctive ethics. The paper also provides a way to distinguish roles and professions and an account of the distinctive duties of medical ethics. It concludes by emphasizing ways in which the uncommon morality approach to medical ethics is markedly different from the common morality approach. (shrink)

Explores the nature and types of mystical experience and discusses the value of mysticism for humanity.

In lieu of an abstract, here is a brief excerpt of the content:Reviewed by:Dialectic and Dialogue: Plato's Practice of Philosophical Inquiry (SPEP Studies in Historical Philosophy)Rosamond Kent SpragueFrancisco J. Gonzalez. Dialectic and Dialogue: Plato's Practice of Philosophical Inquiry (SPEP Studies in Historical Philosophy). Evanston, IL: Northwestern University Press, 1998. Pp. 418. Paper, $29.95.What this rich and independent-minded book asks us to do is to give serious consideration to the question, "What, in Plato's view, are we doing when we philosophize?" (...) (1) If we employ our own conceptions of philosophy as the models for formulating and discussing specific Platonic questions, we may be imposing upon him ways of thinking that are foreign to his thought. To do this is particularly distorting in the case of dialectic.Gonzalez has chosen to confine himself to the early and middle dialogues, so that his book is a direct challenge to the work of Richard Robinson. Of the important views that have more recently arisen, Gonzalez allies himself most nearly with the non-doctrinal approach, but not to the extent of embracing scepticism. There is much philosophical knowledge in the dialogues, but such knowledge is primarily non-propositional. As for the esotericist and the developmentalist, both are misguided in proceeding on the assumption that Plato is attempting to formulate definitions and to arrive at a systematic philosophy; they regard the dialogues as treatises, which they are not. As Gonzalez quite justly inquires, "can there be any form of writing less suited to presenting a systematic philosophy than Plato's dramatic dialogues?" (4)In contrast to Robinson, who relies on the analysis of passages taken out of context, Gonzalez focusses mainly on whole dialogues, taking them to be dramatic portrayals of dialectic at work. He begins with detailed studies of the Laches and Charmides. In both cases, Socrates starts with ordinary knowledge (in the persons of the title characters), but "clearly intends to transcend it" (20). Neither will he accept "the 'sophistic' understanding that attempts to substitute definitions for this experience" (21) on the part of Nicias and Critias. The knowledge sought by Socrates by means of the dialectical method is shown to thave three characteristics: it is "knowledge how," it is "self-knowledge," and it is "non-propositional" (61).The next chapters consider three presuppositions of Plato's dialectic: words (in the Cratylus), arguments (in the Euthydemus), and images (in Republic X). All three are necessary to the dialectical enterprise, but, like ordinary knowledge in the aporetic dialogues, are transcended.Gonzalez' confrontation with Robinson naturally requires that he address the topic [End Page 113] of the method of hypothesis in the Meno, Phaedo, and Republic. This is a method that does yield propositional results, but it remains at the level of poion ti and fails to provide similar knowledge of the ti. Gonzalez' interpretation of the divided line is of particular interest here: as he sees it, dialectic is not intended as simply an extension continuous with the method of hypothesis. To take it this way is, with Robinson, to collapse dialectic into mathematics, making the former as deductive as the latter. The good (which "is not for Plato an exclusively moral term" 216) is "already there before the inquiry as the ground of its possibility" (236); this is what "unhypothesized" means. The movement of thought is circular, but not with a vicious circularity; "reflexivity" is the term preferred.To my mind the most rewarding and most convincing section of the book is the concluding chapter on the philosophical digression in the Seventh Letter. (The issue of authenticity is not significant, since, if the Letter is a forgery, "this forger had a better understanding of Plato than many other scholars, both ancient and contemporary" (246). Although "the subject of this wisdom simply cannot be expressed in words" (252) (and here Gonzalez emphasizes that Plato means spoken as much as written words), there is no contradiction in being able to talk or write about it. If "our only means of attaining true knowledge of a thing have the defect of being unable to express this nature" (263), Plato suggests an up and down movement which transcends this defect. The nature of this movement he describes as tribein, a process... (shrink)

Human microbiome research has revealed that legions of bacteria, viruses, and fungi live on our skin and within the cavities of our bodies. New knowledge from these recent studies shows that humans are superorganisms and that the microbiome is indispensible to our lives and our health. This volume explores some of the science on the human microbiome and considers the ethical, legal, and social concerns that are raised by this research.

Name der Zeitschrift: Paragrana Jahrgang: 25 Heft: 2 Seiten: 112-124.