Few residency training programmes explicitly require substantive exposure to issues in medical ethics and fewer still have a formal curriculum in this area. Traditional undergraduate medical ethics courses teach preclinical students to identify ethical issues and analyse them at a theoretical level. Residency training, however, is the ideal time to establish the critical behavioural link which makes ethics truly useful in clinical medicine. The General Internal Medicine Residency Training Program at Rhode Island Hospital has developed an integrated, three-year curriculum with (...) the goals of helping residents to perceive ethical issues in clinical practice, to utilise basic philosophical principles in resolving ethical dilemmas and to communicate these issues clearly and sensitively to patients. The curriculum has been well received by residents and has had a hospital-wide impact. We believe that training residents in medical ethics and communication skills is an effective approach to developing physicians' humane qualities. (shrink)

Institutional ethics committees (IECs) are part of a growing phenomenon in the American health care system. Although a major force driving hospitals to establish IECs is the desire to resolve difficult clinical dilemmas in a quick and systematic way, in this paper we argue that such a goal is naive and, to some extent, misguided. We assess the growing trend of these committees, analyse the theoretical assumptions underlying their establishment, and evaluate their strengths and shortcomings. We show how the 'medical (...) consultation' model is often inappropriately applied to IECs and suggest that IECs must operate under a different framework. Finally, we argue that IECs should be valued for the process they facilitate, and not for the product that they are, often unreasonably, expected to deliver. (shrink)

Formal training in clinical ethics must become a central part of residency curricula to prepare practitioners to manage the ethical dimensions of patient care. Residency educators must ground their teaching in an understanding of the conceptual, biomedical, and psychosocial aspects of the important ethical issues that arise in that field of practice. Four aspects of professional competence in clinical ethics provide a useful framework for curricular planning. The physician should learn to: (1) recognize ethical issues as they arise in clinical (...) care and identify hidden values and unacknowledged conflicts; (2) think clearly and critically about these issues in ways that lead to ethically justifiable courses of action; (3) apply those practical skills needed to implement an ethically justifiably course of action; and (4) judge when the management of a clinical situation requires consultation with individuals or institutional bodies with additional expertise or authority. We argue that these practical goals can be accomplished with a relatively modest emphasis on the theoretical aspects of medical ethics. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

Structural equation model trees are data-driven tools for finding variables that predict group differences in SEM parameters. SEM trees build upon the decision tree paradigm by growing tree structures that divide a data set recursively into homogeneous subsets. In past research, SEM trees have been estimated predominantly with the R package semtree. The original algorithm in the semtree package selects split variables among covariates by calculating a likelihood ratio for each possible split of each covariate. Obtaining these likelihood ratios is (...) computationally demanding. As a remedy, we propose to guide the construction of SEM trees by a family of score-based tests that have recently been popularized in psychometrics. These score-based tests monitor fluctuations in case-wise derivatives of the likelihood function to detect parameter differences between groups. Compared to the likelihood-ratio approach, score-based tests are computationally efficient because they do not require refitting the model for every possible split. In this paper, we introduce score-guided SEM trees, implement them in semtree, and evaluate their performance by means of a Monte Carlo simulation. (shrink)

Julie Childers and Bob Arnold’s (2019) article, “The Inner Lives of Doctors: Physician Emotion in the Care of the Seriously Ill,” uses Kübler-Ross’s influential work on death and dying to remind us...

I present a formally explicit statement of Church's celebrated argument against Carnap's analysis of belief and defend it against well-known objections by W.V.O. Quine, R.M. Martin, and Michael Dummett.

We construct by diagonalization a non-well-founded primitive recursive tree, which is well-founded for co-r.e. sets, provable in Σ1 0. It follows that the supremum of order-types of primitive recursive well-orderings, whose well-foundedness on co-r.e. sets is provable in Σ1 0, equals the limit of all recursive ordinals ω1 ck . RID=""ID="" Mathematics Subject Classification (2000): 03B30, 03F15 RID=""ID="" Supported by the Deutschen Akademie der Naturforscher Leopoldina grant #BMBF-LPD 9801-7 with funds from the Bundesministerium für Bildung, Wissenschaft, Forschung und Technologie. RID=""ID="" (...) I would like to thank A. SETZER for his hospitality during my stay in Uppsala in December 1998 – these investigations are inspired by a discussion with him; S. BUSS for his hospitality during my stay at UCSD and for valuable remarks on a previous version of this paper; and M. MÖLLERFELD for remarks on a previous title. (shrink)

We define and study a new restricted consistency notion RCon ∗ for bounded arithmetic theories T 2 j . It is the strongest ∀ Π 1 b -statement over S 2 1 provable in T 2 j , similar to Con in Krajíček and Pudlák, 29) or RCon in Krajı́ček and Takeuti 107). The advantage of our notion over the others is that RCon ∗ can directly be used to construct models of T 2 j . We apply this by (...) proving preservation theorems for theories of bounded arithmetic of the following well-known kind: The ∀ Π 1 b -separation of bounded arithmetic theories S 2 i from T 2 j is equivalent to the existence of a model of S 2 i which does not have a Δ 0 b -elementary extension to a model of T 2 j . More specific, let M ⊨ Ω 1 nst denote that there is a nonstandard element c in M such that the function n ↦ 2 log c is total in M . Let BLΣ 1 b be the bounded collection schema for Σ 1 b -formulas. We obtain the following preservation results: the ∀ Π 1 b -separation of S 2 i from T 2 j is equivalent to the existence of 1. a model of S 2 i +Ω 1 nst which is 1 b -closed w.r.t. T 2 j , 2. a countable model of S 2 i + BLΣ 1 b without weak end extensions to models of T 2 j. (shrink)

Review of R. Goldwater and M. Treves, eds. Artists on Art, in Leonardo, l0 (l977), 78. Review of George Linden, Reflections on the Screen, and Paul Weiss, Cinematics, in Philosophy and Phenomenological Research, XXXVIII, 2 (December l977), 266 8.

Монография предназначена для преподавателей вузов, соискателей ученых степеней и студентов.

In this work, the author has fashioned out of the logical and linguistic theses of his earlier books a full-scale but readily intelligible account of moral argument.