This study describes the results of a retrospective review of patients' charts who had an advanced directive (AD) and who were hospitalized in a tertiary, acute care teaching hospital. The purpose of the review was to understand from clinical, sociological, ethical and legal perspectives the nature and utility of ADs. Findings and implications of the review are discussed in terms of: patient demographics; diagnoses; quality of ADs; influence of ADs on clinical decisions; and legal aspects of ADs.
Objectivity in historical perspective Content Type Journal Article Category Book Symposium Pages 11-39 DOI 10.1007/s11016-011-9597-2 Authors Peter Dear, Department of History, Cornell University, 435 McGraw Hall, Ithaca, NY 14853, USA Ian Hacking, Department of Philosophy, University of Toronto, 170 St. George St., Toronto, ON M5R 2M8, Canada Matthew L. Jones, Department of History, Columbia University, 514 Fayerweather Hall, 1180 Amsterdam Ave., New York, NY 10027, USA Lorraine Daston, Max Planck Institute for the History of Science, Boltzmannstraße 22, 14195 Berlin, (...) Germany Peter Galison, Department of the History of Science, Harvard University, Science Center 371, Cambridge, MA 02138, USA Journal Metascience Online ISSN 1467-9981 Print ISSN 0815-0796 Journal Volume Volume 21 Journal Issue Volume 21, Number 1. (shrink)
We show that if κ is a weakly compact cardinal, then $\left( \matrix \kappa ^{+} \\ \kappa\endmatrix \right)\rightarrow \left(\left( \matrix \alpha \\ \kappa \endmatrix \right)_{m}\left( \matrix \kappa ^{n} \\ \kappa \endmatrix \right)_{\mu}\right)^{1,1}$ for any ordinals α < κ⁺ and µ < κ, and any finite ordinals m and n. This polarized partition relation represents the statement that for any partition $\kappa \times \kappa ^{+}=\underset i<m\to{\bigcup }K_{i}\cup \underset j<\mu \to{\bigcup }L_{j}$ of κ × κ⁺ into m + µ pieces either there (...) are A ∈ [κ]κ, B ∈ [κ⁺]α, and i < m with A × B ⊆ Ki or there are C ∈ [κ]κ, D ∈ [κ⁺]α, and j < μ with C × D ⊆ Lj. Related results for measurable and almost measurable κ are also investigated. Our proofs of these relations involve the use of elementary substructures of set models of large fragments of ZFC. (shrink)
We consider the moral and social ingredients in physicians' relationships with patients of diminished capacity by considering certain claims made about friendship and the physician's role. To assess these claims we look at the life context of two patients as elaborated examples provided in two novels: Woman on the Edge of Time (1976) by Marge Piercy, a radical feminist; and It's Hard to Leave While the Music's Playing (1977) by I. S. Cooper, a prominent physician-researcher. At issue is how the (...) doctor-patient relationship should be structured. In question is whether the physician's friendship and professional expertise, together with the diminished capacity of the patient, authorize medical paternalism. From our examination, we find compelling insights against appealing to friendship both in good doctor-patient relationships and in more typical, not-so-good ones. (shrink)
The primary purpose of this study was to examine the effects of perceptions of product harm and consumer vulnerability on ethical evaluations of target marketing strategies. We first established whether subjects are able to accurately judge the harmfulness of a product through labeling alone, and whether they could differentiate consumers who were more or less vulnerable. The results suggest that without the presence of a prime, subjects who depended on implicit memory or guess were able to detect differences in “sin” (...) and “non-sin” products and consumer vulnerability, but were far less likely to be able to distinguish among high and low levels of product harm and consumer vulnerability. The inability to accurately identify high and low levels of product harm and consumer vulnerability impacted their perceptions of the ethicality of target marketing strategies, such that only four out of 18 target marketing strategies were judged as unethical. Thus, our findings contradict previous research that found subjects judged many more of the integrated strategies as unethical [Smith and Cooper-Martin, J Market 61(1997) 1]. Our results suggest that assessing ethical evaluations of strategies varying in product harm, and consumer vulnerability may only be relevant if consumers can accurately identify product harm. (shrink)
The activities of the life sciences are essential to provide solutions for the future, for both individuals and society. Society has demanded growing accountability from the scientific community as implications of life science research rise in influence and there are concerns about the credibility, integrity and motives of science. While the scientific community has responded to concerns about its integrity in part by initiating training in research integrity and the responsible conduct of research, this approach is minimal. The scientific community (...) justifies itself by appealing to the ethos of science, claiming academic freedom, self-direction, and self-regulation, but no comprehensive codification of this foundational ethos has been forthcoming. A review of the professional norms of science and a prototype code of ethics for the life sciences provide a framework to spur discussions within the scientific community to define scientific professionalism. A formalization of implicit principles can provide guidance for recognizing divergence from the norms, place these norms within a context that would enhance education of trainees, and provide a framework for discussing externally and internally applied pressures that are influencing the practice of science. The prototype code articulates the goal for life sciences research and the responsibilities associated with the freedom of exploration, the principles for the practice of science, and the virtues of the scientists themselves. The time is ripe for scientific communities to reinvigorate professionalism and define the basis of their social contract. Codifying the basis of the social contract between science and society will sustain public trust in the scientific enterprise. (shrink)
The essays pay particular attention to tensions associated with attempts to balance the economic with the non-economic objectives of higher education, and ...
The nanomedicine field is fast evolving toward complex, “active,” and interactive formulations. Like many emerging technologies, nanomedicine raises questions of how human subjects research (HSR) should be conducted and the adequacy of current oversight, as well as how to integrate concerns over occupational, bystander, and environmental exposures. The history of oversight for HSR investigating emerging technologies is a patchwork quilt without systematic justification of when ordinary oversight for HSR is enough versus when added oversight is warranted. Nanomedicine HSR provides an (...) occasion to think systematically about appropriate oversight, especially early in the evolution of a technology, when hazard and risk information may remain incomplete. This paper presents the consensus recommendations of a multidisciplinary, NIH-funded project group, to ensure a science-based and ethically informed approach to HSR issues in nanomedicine, and to integrate HSR analysis with analysis of occupational, bystander, and environmental concerns. We recommend creating two bodies, an interagency Human Subjects Research in Nanomedicine (HSR/N) Working Group and a Secretary's Advisory Committee on Nanomedicine (SAC/N). HSR/N and SAC/N should perform 3 primary functions: (1) analysis of the attributes and subsets of nanomedicine interventions that raise HSR challenges and current gaps in oversight; (2) providing advice to relevant agencies and institutional bodies on the HSR issues, as well as federal and federal-institutional coordination; and (3) gathering and analyzing information on HSR issues as they emerge in nanomedicine. HSR/N and SAC/N will create a home for HSR analysis and coordination in DHHS (the key agency for relevant HSR oversight), optimize federal and institutional approaches, and allow HSR review to evolve with greater knowledge about nanomedicine interventions and greater clarity about attributes of concern. (shrink)
Working in ZFC, we show that for any infinite cardinal κ and ordinal $\gamma the polarized partition relation $\[\begin{pmatrix} (2^{ → $\[\begin{pmatrix}(2^{ holds. Our proof of this relation involves the use of elementary substructures of set models of large fragments of ZFC.
In this essay I argue that Rawls does not establish the priority of the right over the good, and that his notion of the original position creates more problems than it solves. I further argue that Rawls, even in his recent proposal for an overlapping consensus, misdiagnoses the problems of modern society and our capacity for justice. I suggest that what we need is not so much theories of justice or methods to abstract from conceptions of the good as discriminating (...) patterns to judge whether, and to what extent, our institutions are sustaining or corroding our social practices that might serve justice and/or make us more just people. (shrink)
By a "developed" economy, people roughly mean ones with a high, persistently-growing per-captia income which is not simply based on resource extraction (i.e., oil) or remittances or rentierism — an industrial (or, if there is such a thing, post-industrial) economy which makes most of its participants reasonably and increasingly prosperous. While there are of course differences among them --- the United States is not New Zealand, which is not Belgium, which is not Finland, which is not Japan --- they are (...) all more similar to each other than they are to the vast variety of "undeveloped", "under-developed", or (most optimistically) "developing" economies across the world. (Some people refer to the developed countries as "the North" and the others as "the South"; this drives me up the wall, if only from looking at where China and Australia are on the map.) Economies in the first category tend to stay there; so, sadly, do countries in the second. Development economics is the sub-discipline of economics which attempts to study how economies which have not attained this happy condition can be made to do so, and the factors which hold others back. (shrink)
In this essay I show that Structuralism, in order to combat the impression that it is “untenable and outmoded,” needs to be attached to a phenomenology of transcendental intersubjectivity. My argument for this conclusion is: 1) that Peter Caws is right in arguing that Structuralism needs a notion of the transcendental subject because its objects, qua intentional, presuppose such a subject; 2) the objects withwhich Structuralism is concemed are objects in the sense that Husserl speaks of objects ofthe spiritual world; (...) and, 3) the spiritual world, indeed the world in general, is constituted intersubjectively. Therefore, Structuralism needs a notion of transcendental intersubjectivity.Dans cet essai, je démontre que le structuralisme doit être rattaché à une phénoménologie de l’intersubjectivité transcendantale afin d’éviter l’impression qu’il donne d’être «intenable et démodé». J’appuie cette conclusion à l’aide des arguments suivants: 1) Peter Caws a raison d’arguer que le structuralisme a besoin d’une notion de sujet transcendantal parce que ses objets, en tant qu’intentionnels, présupposent un tel sujet; 2) les objets dont s’occupe le structuralisme sont des objets au sens oú Husserl parle d’objets du monde spirituel; et 3) le monde spirituel, enfait le monde en général, est constitué de façon intersubjective. Ainsi, le structuralisme requiert une notion d’intersubjectivité transcendantale. (shrink)
Susanna Goodin, in her article “Locke and Leibniz and the Debate over Species” , argues that Leibniz’s criticisms of Locke’s species conventionalism are inadequate as a refutation of Locke’s arguments, and if Leibniz were to buttress his criticisms by appeal to his own metaphysical commitments, he could do so only at the expense of so radically altering the nature of the debate that Locke’s original concerns would not even arise. I argue, however, that Leibniz has an argument within the Nouveaux (...) Essais which provides him with a mechanistically respectable counterproposal to Locke’s conventionalism and which demonstrates the explanatory superiority of natural kind realism. (shrink)
