Objective Although patients exercise greater autonomy than in the past, and shared decision making is promoted as the preferred model for doctor-patient engagement, tensions still exist in clinical practice about the primary locus of decision-making authority for complex, scarce, and resource-intensive medical therapies: patients and their surrogates, or physicians. We assessed physicians’ attitudes toward decisional authority for adult venoarterial extracorporeal membrane oxygenation (VA-ECMO), hypothesizing they would favor a medical locus. Design, Setting, Participants A survey of resident/fellow physicians and internal medicine (...) attendings at an academic medical center, May to August 2013. Measurements We used a 24-item, internet-based survey assessing physician-respondents’ demographic characteristics, knowledge, and attitudes regarding decisional authority for adult VA-ECMO. Qualitative narratives were also collected. Main Results A total of 179 physicians completed the survey (15 percent response rate); 48 percent attendings and 52 percent residents/ fellows. Only 32 percent of the respondents indicated that a surrogate’s consent should be required to discontinue VA-ECMO; 56 percent felt that physicians should have the right to discontinue VA-ECMO over a surrogate’s objection. Those who self-reported as “knowledgeable” about VA-ECMO, compared to those who did not, more frequently replied that there should not be presumed consent for VA-ECMO (47.6 percent versus 33.3 percent, p = 0.007), that physicians should have the right to discontinue VAECMO over a surrogate’s objection (76.2 percent versus 50 percent, p = 0.02) and that, given its cost, the use of VA-ECMO should be restricted (81.0 percent versus 54.4 percent, p = 0.005). Conclusions Surveyed physicians, especially those who self-reported as knowledgeable about VA-ECMO and/or were specialists in pulmonary/ critical care, favored a medical locus of decisional authority for VA-ECMO. VA-ECMO is complex, and the data may (1) reflect physicians’ hesitance to cede authority to presumably less knowledgeable patients and surrogates, (2) stem from a stewardship of resources perspective, and/or (3) point to practical efforts to avoid futility and utility disputes. Whether these results indicate a more widespread reversion to paternalism or a more circumscribed usurping of decisional authority occasioned by VA-ECMO necessitates further study. (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)

Purpose: to characterize ethics course content, structure, resources, pedagogic methods, and opinions among academic administrators and course directors at U.S. medical schools. Method: An online questionnaire addressed to academic deans and ethics course directors identified by medical school websites was emailed to 157 Association of American Medical Colleges member medical schools in two successive waves in early 2022. Descriptive statistics were utilized to summarize responses. Results: Representatives from 61 (39%) schools responded. Thirty-two (52%) respondents were course directors; 26 (43%) were (...) deans of academic affairs, medical education, or curriculum; and 3 with other roles also completed the survey (5%). All 61 schools reported some form of formal ethics education during the first year of medical school, with most (n = 54, 89%) reporting a formal mandatory introductory course during preclinical education. Schools primarily utilized lecture and small-group teaching methods. Knowledge-based examinations, attendance, and participation were most commonly used for assessment. A large majority regarded ethics as equally or more important than other foundational courses, but fewer (n = 37, 60%) provided faculty training for teaching ethics. Conclusions: Despite a response rate of 39 percent, the authors conclude that medical schools include ethics in their curricula in small-group and lecture formats with heterogeneity regarding content taught. Preclinical curricular redesigns must innovate and implement best practices for ensuring sound delivery of ethics content in future curricula. Additional large-scale research is necessary to determine said best practices. (shrink)

The Patient Self Determination Act of 1991 brought much needed attention to the importance of advance care planning and surrogate decision-making. The purpose of this law is to ensure that a patient’s preferences for medical care are recognized and promoted, even if the patient loses decision-making capacity. In general, patients are presumed to have DMC. A patient’s DMC may come under question when distortions in thinking and understanding due to illness, delirium, depression or other psychiatric symptoms are identified or suspected. (...) Physicians and other healthcare professionals working in hospital settings where medical illness is frequently comorbid with depression, adjustment disorders, demoralization and suicidal ideation, can expect to encounter ethical tension when medically sick patients who are also depressed or suicidal request do not resuscitate orders. (shrink)

Moderate physiological or emotional arousal induced after learning modulates memory consolidation, helping to distinguish important memories from trivial ones. Yet, the contribution of subjective awareness or interpretation of arousal to this effect is uncertain. Alexithymia, which is an inability to describe or identify one’s emotional and arousal states even though physiological responses to arousal are intact, provides a tool to evaluate the role of arousal interpretation. Participants scoring high and low on alexithymia learned a list of 30 words, followed by (...) immediate recall. Participants then saw either an arousing or neutral video . Memory was tested 24-h later. Physiological response to arousal was comparable between groups, but subjective response to arousal was impaired in high alexithymia. Yet, delayed word recognition was enhanced by arousal regardless of alexithymia status. Thus, subjective response to arousal, i.e., cognitive appraisal, was not necessary for memory modulation to occur. (shrink)

Near the end of Euripides' "Helen", Helen reportedly exhorts the Greek troops to rescue her Egyptian foes: "Where is the glory of Troy ? Show it to these barbarians" . Helen's rallying cry serves as a point of departure for investigating the nature and status of kleos in a play which invites reframing her question: Where, indeed, is the glory of Troy if the report of Helen's abduction by Paris is untrue? The drama deconstructs the notion of a unitary, transcendent (...) meaning of "kleos" by demonstrating the slippage between its two root-meanings in Homer as "immortal fame," legitimated by the gods, and as mere "report" or "rumor." A diminution of the status of the proper name runs in parallel with this slippage between the two senses of "kleos": the heroic name loses its privileged status as a stable, transparent sign of character and becomes instead a signifier vulnerable to dissemination . As a vehicle of deception, Helen's phantom-twin becomes a figure for the polysemy of the signifier, both visual and linguistic. The phantom's substitution for Helen also highlights her symbolic role as a marker of men's status in a competitive system of exchange. If the play presents Helen as a continual object of men's attempts to capture her in song as well as in war, it presents heroic kleos as an equally insecure possession, insofar as it is always contingent on the "report" of others. Indeed, Helen becomes a metaphor for the duplicity inherent in the mimetic process by which fame is transmitted. That "kleos" turns out to have been a dangerously deceptive signifier is a lesson of more than literary interest for the Athenians watching Euripides' "Helen" -the forces of the Sicilian expedition had been annihilated only a year earlier. (shrink)

Recent studies indicate that the processing of an unexpected word is costly when the initial, disconfirmed prediction was strong. This penalty was suggested to stem from commitment to the strongly predicted word, requiring its inhibition when disconfirmed. Additional studies show that comprehenders rationally adapt their predictions in different situations. In the current study, we hypothesized that since the disconfirmation of strong predictions incurs costs, it would also trigger adaptation mechanisms influencing the processing of subsequent strong predictions. In two experiments, participants (...) made speeded congruency judgments on two-word phrases in which the first word was either highly constraining or not. We manipulated the proportion of disconfirmed predictions in highly constraining contexts between participants. The results provide additional evidence of the costs associated with the disconfirmation of strong predictions. Moreover, they show a reduction in these costs when participants experience a high proportion of disconfirmed strong predictions throughout the experiment, indicating that participants adjust the strength of their predictions when strong prediction is discouraged. We formulate a Bayesian adaptation model whereby prediction failure cost is weighted by the participant’s belief about the likelihood of encountering the expected word, and show that it accounts for the trial-by-trial data. (shrink)

In recent research, the concept of “media diets” has received increased attention. However, the concept remains vague and not fully developed, and rarely, if at all, do researchers ask citizens about their perceptions of their own and others’ media diets. With the ongoing transformation of the media landscape, there has never been a more pertinent time to explore these perceptions, which this research intends to do. The main goal of this paper then is to identify recommendations addressing recently voiced concerns (...) about news consumption patterns in contemporary society to relevant stakeholders. Empirically, the study is based on a series of focus group interviews with younger (18–25 years old) and older (over 55) adults in five European countries (Germany, Poland, Romania, Spain, and the UK). Our results show important cohort differences as well as cross-country similarities, which are pertinent insights for the formulation of stakeholder recommendations. (shrink)

The book introduces to readers the scope and nature of Meltzer’s contribution, and suggests the wider social context in which he saw psychoanalysis.

These essays define three significant “periods” in Derrida’s writing: his early, seemingly revolutionary phase; a middle stage, often autobiographical, that included spirited defense of his work; and his late period, when his persona ...

It is doubtless appropriate to read The Interpretation of Dreams according to the image of the journey which Sigmund Freud describes in a letter to Wilhelm Fliess:The whole thing is planned on the model of an imaginary walk. First comes the dark wood of the authorities , where there is no clear view and it is easy to go astray. Then there is a cavernous defile through which I lead my readers—my specimen dream with its peculiarities, its details, its indiscretions (...) and its bad jokes—and then, all at once, the high ground and the open prospect and the question: “Which way do you want to go?”1This walk has nothing of the nonchalant about it. Rather, it is strewn with tests and trials, as is usually the case in the “myth of the hero” or of the “conquistador,” which we know played a major role in Freud’s thought and in that of his disciples. The progress, in epic poetry, moves toward a discovery, the founding of a city, by means of difficult stages and combats. Every “discourse” capable of attaining a goal distant from its prolegomena finds its appropriate metaphor in the hero’s progress, or in the voyage of initiation. Discursivity then becomes the intellectual equivalent of the epic’s trajectory. At the time of its publication, Freud found his book insufficiently probing, and imperfect in its discursivity. He criticized himself for having failed to link properly his arguments . Doubt was momentarily cast on the achievement of the main goal…. But such severity was not to persist.But one can also read the work by discerning its framing devices. Several authors mentioned in the first chapter reappear at the work’s conclusion. Such a return is far from fortuitous; it is the result of an extremely well-calculated strategy. Another framing system which has been noticed by many readers is the one, shortly before the end of the book, which returns to a line from Virgil that Freud had placed as an epigraph on the title page: Flectere si nequeo superos, Acheronta movebo. This line, because of its repetition at two crucial points in the book, traces its message in the form of an emblem. When it breaks in, it makes explicit that the dream mechanism is the return of the repressed:In waking life the suppressed material in the mind is prevented from finding expression and is cut off from internal perception owing to the fact that the contradictions present in it are eliminated—one side being disposed of in favor of the other; but during the night, under the sway of an impetus towards the construction of compromises, this suppressed material finds methods and means of forcing its way into consciousness.Flectere si nequeo superos, Acheronta movebo.2 1. Sigmund Freud to Wilhelm Fliess, 6 Aug. 1899, Freud, The Origins of Psychoanalysis: Letters to Wilhelm Fliess, Drafts and Notes, 1887-1902, ed. Marie Bonaparte, Anna Freud, and Ernst Kris, trans. James Strachey , p. 290.2. Freud, The Interpretation of Dreams, ed. and trans. Strachey , p. 647; my emphasis. The Latin is translated in n. 1 on that page of Freud’s text: “If I cannot bend the High Powers, I will move the Infernal Regions.” All further references to this work, abbreviated I, will be included in the text. Another framing device is created by the theme of the prophetic dream, discussed at the outset of the first chapters and taken up again, with the ambivalence of denial and concession, in the final paragraph of the book. Jean Starobinski, professor emeritus at the University of Geneva, has devoted studies to Montaigne, Diderot, Rousseau, Saussure, and modern French poets. As an M.D., he is familiar with psychoanalysis and participates in the editorial board of La Nouvelle Revue de Psychanalyse . Some of his recent research deals with the history of melancholia; his most recent books are Montaigne in Motion and Rousseau . He was awarded the Balzan Prize in 1984. (shrink)

There is the famous anecdote about Freud: upon being reminded by a disciple that to smoke cigars is clearly a phallic activity, Freud, cigar in hand, is said to have responded, “Sometimes a good cigar is just a good cigar.” The anecdote demonstrates, it seems to me, a problematic central to psychoanalysis: the discipline which insists on transference and, perhaps even more significantly, on displacement as fundamental principles, ultimately must insist in turn on seeing everything as being “really” something else. (...) Such an ideology of metamorphosis is so much taken for granted that unlike the rest of the world, which generally has difficulty in being convinced that a pipe, for example, is not necessarily a pipe at all, psychoanalysis needs at times to remind itself, in a type of return to an adaequatio, that it is possible for a cigar really to be a cigar. Psychoanalysis, in other words, has not only an economy which is hydraulic , but has as well an economy of seepage: each apparent object, whether in dream, literature, or psychic narrative, splashes over onto at least one “something else.” Not only is there always a remainder, but the remainder generally proliferates, multiplies, from more than one quotient, such that the original “thing” in question becomes merely the agent for production. Its status as thing-in-the-world is easily lost.Such seepage has, of course, appeared almost everywhere. Psychoanalysis has infiltrated such diverse areas as literature , linguistics, philosophy, anthropology, history, feminism, psychology, archeology, neurology, to name some. And it is in the notion of “some,” perhaps, that lies the crux of the problem. For there is in psychoanalysis an overt conviction that it exists as the ultimate totality, of which everything else is a part. Not content to see itself as one in a number of enterprises, the psychoanalytic project has at its foundation a vision of itself as the meaning which will always lie in wait; the truth which lies covered by “the rest.” Jacques Derrida has, of course, pointed to this tendency. Psychoanalysis, he noted, wishes a peculiar logic for itself, one in which “the species would include the genus.”1 Moreover, says Derrida in the same essay, once psychoanalysis has discovered itself, what it then again proceeds to discover around it is always itself.2 What happens, then, is that psychoanalysis becomes a ubiquitous subject, assimilating every object into itself. But it is also a Subject which sees itself as omnipresent, omniscient, and without a center—precisely the terms in which God has been described. It is not then by chance that the unconscious is likened to a divinity: always present but revealing itself only obliquely and at privileged moments, the unconscious takes the place of the Judeo-Christian God. It is within every being, but inaccessible unless it “chooses” to manifest itself. And in a peculiar reversal of the notion of the partitive, psychoanalysis would have the unconscious reveal itself in fleeting moments and fragments, thereby suggesting its fullness and totality; and it would have “other” intellectual enterprises be only apparent totalities which are revealed through psychoanalysis alone to be “really” incomplete because they exist without recognizing the unconscious and its mother, psychoanalysis itself. 1. Jacques Derrida, “Graphesis,” “The Purveyor of Truth,” trans. Willis Dominggo et al., Yale French Studies 52 : 32.2. See the syllogism with which Derrida opens his “Purveyor of Truth,” p. 31. Part of what I am calling the “syllogism” appears at the beginning of Stephen Melville’s article in the present issue. (shrink)

The federal regulations that govern biomedical research, most notably those enshrined in the Common Rule, express a protectionist ethos aimed at safeguarding subjects of human experimentation from the potential harms of research participation. In at least one critical way, however, the regulations have always fallen short of this promise: if a subject suffers a research-related injury, then neither the investigator nor the sponsor has any legal obligation under the regulations to care for or compensate the subject. Because very few subjects (...) with research-related injuries can meet the financial or evidentiary requirements associated with a successful legal claim to recover the costs associated with their injuries, most injured subjects must shoulder the burden of those expenses alone. For 40 years, national advisory panels have concluded that this result is out of step with the Common Rule's otherwise protectionist promise. When the Department of Health and Human Services released an Advance Notice of Proposed Rulemaking (ANPRM) in 2011, suggesting potential changes to the Common Rule, the time seemed ripe to address research-related injuries. The ANPRM, however, makes no mention of compensation for research-related injuries, and the federal government once again seems poised to stop short of addressing what has arguably become the most longstanding, frequent, and consistent plea for regulatory reform of research: protections for injured subjects. This article asks why, despite decades of federal-level panels recommending no-fault compensation for research-related injuries, the United States has so strongly resisted change. I suggest that a central reason for our current impasse is that, despite consensus among federal advisory committees that there is an obligation to compensate injured subjects, the committees have not coalesced around a moral justification for that duty. Although multiple justifications can support and even strengthen a single ethical obligation, the reverse has occurred in this context. I demonstrate that the committees' articulation of multiple ethical principles – including humanitarianism, professional beneficence, and compensatory justice – results in incongruent obligations that favor different kinds of compensation systems. This outcome, which I call “moral gridlock,” makes it extremely difficult to determine what kind of compensation scheme to implement. Recognizing that each moral argument for compensation creates a slightly different trajectory is, however, an important first step in moving toward a more systematic approach to compensating injured research subjects. (shrink)

This infamous book has enjoyed a lively underground reputation since its first publication in 1970. Richard Meltzer (a.k.a. R. Meltzer) took his training as a young philosopher and applied it with unalloyed enthusiasm to the lyrics, sound, and culture of rock and roll. Never before had anyone noticed the relationship between the philosophy of Heidegger and a tune by Little Anthony and the Imperials, heard the cries of agony in the Shangri Las' “Remember (Walkin' in the Sand)”, or (...) transcribed every "papa-ooma-mow-mow" in the Trashmen's “Surfin' Bird.”From Dionne Warwick to Plato, Jim Morrison to Bert Brecht, Conway Twitty to Miguel de Unamuno, Meltzer subverts high and low culture in his search for meaning, emotion, and codes in popular music. At once an earnest investigation and a crypto put-on, the book can be read for its nuggets of information and insights or for its humor. Here with Greil Marcus's new introduction, yet another generation of readers can be outraged and inspired. (shrink)

The prominence and peculiarity of color in French symbolist verse have often been noted. Yet the dominance of color in symbolism is not the result of aesthetic preference or mere poetic technique, as has been previously argued; rather, color functions, with the synaesthetic poetic context of which it is an integral part, as the direct manifestation of a particular metaphysical stance. Color leads to the heart of what symbolism is, for it is the paradigmatic literary expression of a general spiritual (...) crisis—a crisis in epistemology. The nineteenth century extended seventeenth-century empiricism—an empiricism which had invented mathematical measurement as the gauge of reality and which resulted in a predilection to see most authentic knowledge as quantifiable. The logical corollary of such a predilection is that all sensory experience is regarded as suspect. Newtonian physics had rationalized the laws of the universe in reducing its properties to atomical structures and laws of motion. Nothing, it seemed, was left unexplained. Those areas of perception which remained unquantifiable were dispelled as illusion or attributed to the necessary limitations of the human mind. The theories of John Locke act as a kind of historical watershed in this regard: they are the classic philosophic expression of the disjunction between sensory experience and knowledge which, in its nineteenth-century versions, would lead to the symbolist revolt. Françoise Meltzer is a professor of French literature and of comparative literature at the University of Chicago. Her previous contribution to Critical Inquiry is the translation of Christian Metz's "Trucage and the Film" . She is the author of The Trial of Psychoanalysis, Salome and the Dance of Writing, and Hot Property: The Stakes and Claims of Literary Originality. (shrink)

The role of the reader is central to the epistolary genre because the letters anticipate a reader within the novel's framework. There is the letter's intended recipient , the occasional interceptor, the invented publisher and/or editor who organize the collected correspondence, and the extrafictional reader who reads the collection in its entirety, including the disclaiming or condemning prefaces which precede it. The epistolary form, however, with so many layers of readers, considerably complicates the issue of reader response. If we share, (...) for example, Stanley Fish's assumption that "literature is in the reader," the epistolary novel apparently reverses the formula: the reader is in the literature.And yet it is in the novel of letters that the reader, the fictional reader, most clearly creates the text. Let us return to Merteuil's admonishment to Cécile: "Voyez donc à soigner davantage votre style…. Vous voyez bien que, quand vous écrivez à quelqu'un, c'est pur lui et non pas pour vous: vous devez donc moins chercher à lui dire ce que vous pensez, que ce qui lui plaît davantage."2 If a reader's response to a given sentence is colored by the previous one, the epistolary novel achieves the same effect within a larger unit: each letter is determined by the one which precedes it. In this sense the letter is a grammatical unit, a larger sentence. Moreover, a letter-novel presents the possibility of an architectural as well as conceptual interruption. That is, whereas insufficiencies in a first-or third-person narrative must consist of circumlocutions, repetitions, and exclusions of information, the letter-novel can create a concrete insufficiency by a lost, suppressed, stolen, or interrupted letter. In such cases the letter must function without its precedent since the destinataire remains empty-handed. Thus, the epistolary novel has a great capacity for mise en abîme.Both inside and outside the narrative, there always is a destinataire; and even if he is the wrong one in the context of the récit he is the intended one for the histoire.3 In any case, the extrafictional reader is the final destinataire and holds a privileged position. And yet, he too is subject to interruptions: here the editor rears his head by claiming in footnotes that a letter is lost, too damaged to decipher, or so boring or obscene that he has seen fit to exclude it; these footnotes are the only "letters" addressed to and meant for us. At this point the editor removes his mask but remains on stage. Apart from such tricks, however, we do read every letter available, each of which is addressed to another reader, a system of the once removed or of the "letter in suffrance." Or, loosely interpreting Jacques Lacan, a purloined letter means that a letter always arrives at its destination.42. Choderlos de Laclos, Les Liasons dangereuses , letter 105, p. 247; all subsequent quotations are taken from this edition and will be identified by letter and page number in the text. "Therefore attend more to your style....You must well know that, when you write to someone, it is for him and not for you: you must therefore seek less to tell him what you think, than what pleases him more"; here and elsewhere my translation.3. I am using the French terms of Gérard Genette to avoid confusion caused by English equivalents. "Récit is often translated as discourse, plot, narrative, subject, narration; histoire as story, events, myth, and so forth.4. See Jacques Lacan, "Seminar on'The Purloined Letter,'" trans. Jeffrey Mehlman, Yale French Studies 48 : 38-72; all further references to this work, abbreviated as "SPL," will be included in the text. The final sentence reads as follows: "Thus it is that what the 'purloined letter,' nay, the 'letter in suffrance' means is that a letter always arrives at its destination." What Lacan means by this statement has to do with the language of the unconscious, or of unconscious Desire. Each individual sends his own message of "truth" of identity. Earlier in this passage Lacan says: "The sender, we tell you , receives from the receiver his own message in reverse form." Françoise Meltzer is an associate professor of Romance language and literatures and of comparative literature at the University of Chicago. Her previous contributions to Critical Inquiry are "Color as Cognition in Symbolist Verse" and the translation of Christian Metz's "Trucage and the Film" . She is presently working on the relationship between rhetoric and psychoanalytic terminology. (shrink)

The U.S. regulations for the protection of humans in biomedical and behavioral research were "born in scandal and reared in protectionism." This paper discusses the evolution of these regulations and the gaps that still persist in the ongoing effort to strike a balance between protecting vulnerable populations from research risks and providing all individuals and groups with an equal opportunity to benefit from research. In particular, this paper focuses on racial, social, and economic inequities in the selection of research participants; (...) the exclusion and underrepresentation of the elderly in research, and controversies about U.S. clinical trials conducted in developing countries. (shrink)

U.S. researchers and scholars often point to two legal factors as significant obstacles to the inclusion of pregnant women in clinical research: the Department of Health and Human Services’ regulatory limitations specific to pregnant women's research participation and the fear of liability for potential harm to children born following a pregnant woman's research participation. This article offers a more nuanced view of the potential legal complexities that can impede research with pregnant women than has previously been reflected in the literature. (...) It reveals new insights into the role of legal professionals throughout the research pathway, from product conception to market, and it highlights a variety of legal factors influencing decision-making that may slow or halt research involving pregnant women. Our conclusion is that closing the evidence gap created by the underrepresentation and exclusion of pregnant women in research will require targeted attention to the role of legal professionals and the legal factors that influence their decisions. (shrink)

This introduction to the basic ideas of structural proof theory contains a thorough discussion and comparison of various types of formalization of first-order logic. Examples are given of several areas of application, namely: the metamathematics of pure first-order logic (intuitionistic as well as classical); the theory of logic programming; category theory; modal logic; linear logic; first-order arithmetic and second-order logic. In each case the aim is to illustrate the methods in relatively simple situations and then apply them elsewhere in much (...) more complex settings. There are numerous exercises throughout the text. In general, the only prerequisite is a standard course in first-order logic, making the book ideal for graduate students and beginning researchers in mathematical logic, theoretical computer science and artificial intelligence. For the new edition, many sections have been rewritten to improve clarity, new sections have been added on cut elimination, and solutions to selected exercises have been included. (shrink)

Open theists argue that God's relationship to time, as conceived in classical theism, is erroneous. They explain that it is contradictory for an atemporal being to act in a temporal universe, including experiencing its temporal successions. Contrary to the atemporalists, redemptive history has shown that God interacts with humans in time. This relational nature of God nullifies the classical notion of God as timelessly eternal. Therefore, it lacks a philosophical and theological basis. Because God is in time, He does not (...) know all future contingencies and, therefore, changes. This study examines open theism's appropriation of the A and B theories of time to the divine-human relationship. The study argues that divine temporality does not solve the tension of divine-human relationships, especially in relation to the future. Further, historical divine temporality does not negate the fact of divine atemporality. It mainly stems from God's choice to create temporal creatures and His relationship with them. Furthermore, if it is not logically and metaphysically contradictory for an omnipresent being to act in space, then it follows that an atemporal being can act in time. Whether time is understood from the metric or psychological point of view, it does not transcend God, and therefore, the limitation it places on human creatures with respect to the future does not apply to God. Lastly, although a few philosophers reject the notion of eternity as timelessly eternal, the doctrine has a philosophical and theological basis in the Scripture. (shrink)

Research collaboration beyond national jurisdiction is one aspect of the globalisation of health research. It has potential to complement researchers in terms of research skills, equipment and lack of adequate numbers of potential research subjects. Collaboration at an equal level of partnership though desirable, may not be practicable. Sometimes, human research specimens must be transported from one country to other. Where this occurs, there should be clear understanding between the collaborating research institutions regarding issues of access and control of the (...) specimens as well as the duration of storage of specimens. The researchers have the duty to inform the research participants about specimen storage and transport across national boundaries. While obtaining informed consent from study subjects if specimens are to be stored beyond the life of the present study could be the ideal, there still remains significant challenges in a multi-cultural world. (shrink)