Many medical ethicists accept the thesis that there is no moral difference between withholding and withdrawing life-sustaining therapy. In this paper, we offer an interesting counterexample which shows that this thesis is not always true. Withholding is distinguished from withdrawing by the simple fact that therapy must have already been initiated in order to speak coherently about withdrawal. Provided that there is a genuine need and that therapy is biomedically effective, the historical fact that therapy has been initiated entails a (...) claim to continue therapy that cannot be attributed to patients who have not yet received therapy. This intrinsic difference between withholding and withdrawing therapy is of moral importance. In many instances, patients will waive this claim. But when one considers withdrawing therapy from one patient to help another in a setting of scarce resources, this intrinsic moral difference comes into sharp focus. In an era of shrinking medical resources, this difference cannot be ignored. (shrink)

In 1885, during initial discussions of J. C. Maxwell's celebrated thermodynamic demon, Whiting (1) observed that the demon-like velocity selection of molecules can occur in a gravitationally bound gas. Recently, a gravitational Maxwell demon has been proposed which makes use of this observation [D. P. Sheehan, J. Glick, and J. D. Means, Found. Phys. 30, 1227 (2000)]. Here we report on numerical simulations that detail its microscopic phase space structure. Results verify the previously hypothesized mechanism of its paradoxical behavior. This (...) system appears to be the only example of a fully classical mechanical Maxwell demon that has not been resolved in favor of the second law of thermodynamics. (shrink)

Recent studies in semantics of modal and superintuitionistic predicate logics provided many examples of incompleteness, especially for Kripke semantics. So there is a problem: to find an appropriate possible- world semantics which is equivalent to Kripke semantics at the propositional level and which is strong enough to prove general completeness results. The present paper introduces a new semantics of Kripke metaframes' generalizing some earlier notions. The main innovation is in considering "n"-tuples of individuals as abstract "n"-dimensional vectors', together with some (...) transformations of these vectors. Soundness of the semantics is proved to be equivalent to some non- logical properties of metaframes; and thus we describe the maximal semantics of Kripke- type. (shrink)

A laboratory-testable, solid-state Maxwell demon is proposed that utilizes the electric field energy of an open-gap p-n junction. Numerical results from a commercial semiconductor device simulator (Silvaco International–Atlas) verify primary results from a 1-D analytic model. Present day fabrication techniques appear adequate for laboratory tests of principle.

OBJECTIVE: To examine the long-term effects of an innovative curriculum on medical house officers' (HOs') knowledge, confidence, and attitudes regarding medical ethics. DESIGN: Long term cohort study. The two-year curriculum, implemented by a single physician ethicist with assistance from other faculty, was fully integrated into the programme. It consisted of monthly sessions: ethics morning report alternating with didactic conferences. The content included topics such as ethics vocabulary and principles, withdrawing life support, informed consent, and justice. Identical content was offered simultaneously (...) at the largest affiliated community hospital. SETTING: A multi-hospital university training programme from July, 1992 to June, 1994. PARTICIPANTS: Thirty-nine HOs responded in 92. Thirty HOs from the same cohort responded in 94 (response rates = 83% v 71%; P = 0.19). RESULTS: The curriculum was well received, with 96% of HOs finding the sessions stimulating. Previously validated scales of knowledge and confidence were administered at baseline and at follow-up. The average knowledge score improved 14% (P < 0.001). Confidence also improved, rising from 3.3 to 3.8 on a 5-point Likert scale (P < 0.001). These findings were independent of age, gender, religion, and prior education. The only attitudinal change was an increase in the proportion of residents who thought that ethics should be a required part of residency training (57% v 80%, P = 0.05). CONCLUSION: This curriculum appears practical, popular, and effective. It should be readily transferable to other institutions. (shrink)

In 2000, a simple, foundational thermodynamic paradox was proposed: a sealed blackbody cavity contains a diatomic gas and a radiometer whose apposing vane surfaces dissociate and recombine the gas to different degrees (A $_{2} \rightleftharpoons $ 2A). As a result of differing desorption rates for A and A $_{2}$ , there arise between the vane faces permanent pressure and temperature differences, either of which can be harnessed to perform work, in apparent conflict with the second law of thermodynamics. Here we (...) report on the first experimental realization of this paradox, involving the dissociation of low-pressure hydrogen gas on high-temperature refractory metals (tungsten and rhenium) under blackbody cavity conditions. The results, corroborated by other laboratory studies and supported by theory, confirm the paradoxical temperature difference and point to physics beyond the traditional understanding of the second law. (shrink)

We report the results of a randomized trial to assess the impact of an innovative ethics curriculum on the knowledge and confidence of 85 medical house officers in a university hospital programme, as well as their responses to a simulated clinical case. Twenty-five per cent of the house officers received a lecture series, 25 per cent received lectures and case conferences, with an ethicist in attendance, and 50 per cent served as controls. A post-intervention questionnaire was administered. Knowledge scores did (...) not differ among the groups. Confidence regarding ethical issues was significantly greater in the aggregate intervention group compared to the control group. Confidence regarding procedural issues related to ethics was significantly higher for the EI group than for the controls. Responses to a simulated case showed that significantly fewer house officers in the EI group would intubate a patient for whom such therapy would be futile. We conclude that ethics education can have an impact on house officers' confidence and their responses to a simulated case, and that the EI was more effective than the LI. Such results have implications regarding the implementation of ethics education during residency. (shrink)

Assessments of the acceptability of new transplantation practices require a pinpointing of not only the meaning of death, but also the timing of death. They typically perceive elective ventilation as occurring just prior to death and non-heart-beating donor protocols as operative just after death. However, such practices in fact highlight the general vagueness and ambiguity surrounding these issues in both law and ethics. Supply-side dilemmas in transplantation lend real urgency to this "life or death" debate.

In a recent article in this journal our unit was accused of a number of errors of judgment in applying covert video surveillance (CVS) to infants and children suspected of life-threatening abuse. The article implied, that on moving from the Royal Brompton Hospital in London to North Staffordshire Hospital, we failed to present our work to the Research Ethics Committee (REC). We did send our protocol to the REC though we did not consider that, after a total of 16 patients (...) had been documented as being the subject of life-threatening abuse, this was research. The REC in Staffordshire agreed with us. We were also accused of undertaking work that should be pursued by the Police. We agree with this. However, unlike the Metropolitan Police the Staffordshire Police would not undertake CVS. We fail to agree that 'working together' with parents is necessarily practical or safe when trying to protect children from life-threatening abuse of this kind. (shrink)

In any competition for monuments of wasted labour the collection of accidental acrostics in Latin poets published by I. Hilberg would stand a good chance of a prize. But amongst his examples of ‘neckische Spiele des Zufalls’ is one I am gullible enough to believe may be more significant. In Aeneid 7. 601–15 Vergil describes the custom of opening the gates of war in a long anacoluthic sentence, the first four lines of which run: Mos erat Hesperio in Latio, quern (...) protinus urbes Albanae coluere sacrum, nunc maxima rerum Roma colit, cum prima movent in proelia Mortem, Sive Getis inferre manu lacrimabile bellum…. (shrink)

Originally published in 1936, this book presents the ancient Greek text of the paraphrases and quotations of Zeno's philosophical arguments, together with a facing-page English translation and editorial commentary. Detailed notes are incorporated throughout and a bibliography is also included. This book will be of value to anyone with an interest in Zeno and ancient philosophy.

Two categories of life are currently recognized—chemosynthetic and photosynthetic—indicating their principal free energy resource as either chemicals or electromagnetic radiation. Building on recent developments in thermodynamics, we posit a third category of life—thermosynthetic life (TL)—which relies on environmental heat rather than traditional free energy sources. Since thermal energy is more abundant than chemicals or light in many settings, thermosynthesis offers compelling evolutionary possibilities for new life forms. Based on variants of standard cellular machinery, a physical model is proposed for the (...) conversion of thermal energy into biochemical work. Conditions favorable to thermosynthetic life and prospects for its discovery are assessed. Terrestrially, deep-subsurface unicellular anaerobic superthermophiles are deduced to be likely TL candidates. (shrink)

First published in 1966. Professor Dryer has furnished a highly illuminating account of Kant’s _Critique of Pure Reason _by unfolding its central argument. _Kant’s Solution for Verification in Metaphysics _brings out the light which Kant has to throw on central topics of philosophy. It takes its place as an indispensable guide to every student of the _Critique of Pure Reason. _.

First published in 1966. Professor Dryer has furnished a highly illuminating account of Kant’s _Critique of Pure Reason _by unfolding its central argument. _Kant’s Solution for Verification in Metaphysics _brings out the light which Kant has to throw on central topics of philosophy. It takes its place as an indispensable guide to every student of the _Critique of Pure Reason. _.

In any competition for monuments of wasted labour the collection of accidental acrostics in Latin poets published by I. Hilberg would stand a good chance of a prize. But amongst his examples of ‘neckische Spiele des Zufalls’ is one I am gullible enough to believe may be more significant. In Aeneid 7. 601–15 Vergil describes the custom of opening the gates of war in a long anacoluthic sentence, the first four lines of which run: Mos erat Hesperio in Latio, quern (...) protinus urbes Albanae coluere sacrum, nunc maxima rerum Roma colit, cum prima movent in proelia Mortem, Sive Getis inferre manu lacrimabile bellum…. (shrink)

OBJECTIVES: To study the accuracy of reviewing ward notes (chart review) as a measure of the quality of care rendered to patients with "Do Not Resuscitate" (DNR) orders. DESIGN: We reviewed the charts of 19 consecutive, competent inpatients with DNR orders for evidence that the staff addressed a broad range of patient care needs called Concurrent Care Concerns (CCCs), such as withholding treatments other than resuscitation itself, and attention to patient comfort needs. We then interviewed the patient, consultant physician, house (...) officer, and primary nurse and compared the ward notes with the understandings of these staff members. SETTING: The medical service of an urban university medical centre. RESULTS: The average number of documented CCCs addressed per DNR order was 1.1. The ward notes generally agreed with the perceptions of patients, house officers, and nurses (% agreement with notes = 79%, 77%, and 82%; kappa = 0.43, 0.40, 0.50). Consultant physicians' understandings were poorly reflected in the ward notes (% agreement = 59%; kappa = 0.18). They overestimated attention to CCCs compared with the notes (P < 0.0001) and with other observers (P < 0.0001). CONCLUSION: Chart review for attention to CCCs accurately reflects the understandings of patients, house officers, and nurses, but consultant physicians report more attention to CCCs than is recorded in the ward notes or understood by other observers. Better communication regarding end-of-life care plans should be encouraged. (shrink)

A recently formulated concept of stochastic localizability is shown to be consistent with a concept of stochastic microcausality, which avoids the conclusions of Hegerfeldt's no-go theorem as to the inconsistency of sharp localizability of quantum particles and Einstein causality. The proposed localizability on quantum space-time is shown to lead to strict asymptotic causality. For finite time evolutions, upper bounds on propagation to the exterior of stochastic light cones are derived which show that the resulting probabilities are too small to be (...) actually observable in a realistic context. (shrink)