Clinical decision making is a challenging task that requires practical wisdom—the practised ability to help patients choose wisely among available diagnostic and treatment options. But practical wisdom is not a concept one typically hears mentioned in medical training and practice. Instead, emphasis is placed on clinical judgement. The author draws from Aristotle and Aquinas to describe the virtue of practical wisdom and compare it with clinical judgement. From this comparison, the author suggests that a more complete understanding of clinical judgement (...) requires its explicit integration with goals of care and ethical values. Although clinicians may be justified in assuming that goals of care and ethical values are implicit in routine decision making, it remains important for training purposes to encourage habits of clinical judgement that are consciously goal-directed and ethically informed. By connecting clinical judgement to patients' goals and values, clinical decisions are more likely to stay focused on the particular interests of individual patients. To cultivate wise clinical judgement among trainees, educational efforts should aim at the integration of clinical judgement, communication with patients about goals of care, and ethical reasoning. But ultimately, training in wise clinical judgement will take years of practice in the company of experienced clinicians who are able to demonstrate practical wisdom by example. By helping trainees develop clinical judgement that incorporates patients' goals of care and ethical reasoning, we may help lessen the risk that ‘clinical judgement’ will merely express ‘the clinician's judgement.’. (shrink)

Now in his 89th year, Viscount Samuel, who with advancing age has had progressively to restrict the activities of his many-sided life, has reluctantly decided not to stand this year for election to the Presidency of The Royal Institute of Philosophy. It is but fitting, before he vacates the Presidential Chair in June, that PHILOSOPHY, as the official organ of the Institute, should pay a small tribute to one who has served its interests so devotedly, and whose claims on its (...) gratitude cannot be exaggerated. (shrink)

The research presented in this volume demonstrates that it is no longer reasonable to ask whether or not synesthesia is real--we must now ask how we can account ...

This article explores egg freezing experiences of women in Turkey. Since 2014, it has been legal in Turkey to use egg freezing technology for ageing women, while it was previously allowed only for disease-related purposes. In cooperation with a private fertility clinic in Istanbul, the authors conducted 21 interviews with older, single women who held either professional or managerial positions and who were undergoing or had undergone the procedure. Drawing on a qualitative analysis of these interviews, the authors explore the (...) social context in which women postpone motherhood and decide to freeze their eggs. The study also looks at the women’s emotional responses to ageing that were triggered by the experience of egg freezing and their narratives of empowerment as a result of the procedure. (shrink)

Objective: To describe the frequency of support for terminal sedation among internists, determine whether support for terminal sedation is accompanied by support for physician assisted suicide , and explore characteristics of internists who support terminal sedation but not assisted suicide.Design: A statewide, anonymous postal survey.Setting: Connecticut, USA.Participants: 677 Connecticut members of the American College of Physicians.Measurements: Attitudes toward terminal sedation and assisted suicide; experience providing primary care to terminally ill patients; demographic and religious characteristics.Results: 78% of respondents believed that if (...) a terminally ill patient has intractable pain despite aggressive analgesia, it is ethically appropriate to provide terminal sedation . Of those who favoured terminal sedation, 38% also agreed that PAS is ethically appropriate in some circumstances. Along a three point spectrum of aggressiveness in end of life care, the plurality of respondents were in the middle, agreeing with terminal sedation but not with PAS. Compared with respondents who were less aggressive or more aggressive, physicians in this middle group were more likely to report having more experience providing primary care to terminally ill patients and attending religious services more frequently .Conclusions: Support for terminal sedation was widespread in this population of physicians, and most who agreed with terminal sedation did not support PAS. Most internists who support aggressive palliation appear likely to draw an ethical line between terminal sedation and assisted suicide. (shrink)

Success in sport can provide a source of national pride for a society, and vast financial and personal rewards for an individual athlete. It is therefore not surprising that many athletes will go to great lengths in pursuit of success. The provision of healthcare for elite sports people has the potential to create many ethical issues for sports doctors; however there has been little discussion of them to date. This study highlights these issues. Respondents to a questionnaire identified many ethical (...) matters, common to other areas of medicine. However they also raised problems unique to sports medicine. Some of these ethical difficulties arise out of the place of the sports doctor within the hierarchy of sport. Yet others arise out of the special relationship between sports doctors and individual players/athletes. This study raises some important questions regarding the governance of healthcare in sport, and what support and guidance is available to sports doctors. As medical and scientific intervention in sport escalates, there is a risk that demands for enhanced performance may compromise the health of the athlete, and the role the sports doctor plays remains a critical question. (shrink)

Self-monitoring theory explains the individual differences in using interpersonal adjustment techniques like self-control, self-regulation, and self-presentation. Self-monitoring plays a key role for understanding the social life. Therefore, it has been one of most popular research topics in social psychology. The aim of this study is to find out if there is a meaningful relationship between religious orientation and self-monitoring, and to determine the direction of the relationship if it exists. Besides, examining the effect of religious group membership on self-monitoring is (...) another aim of this study. In accordance with this purpose, Religious Orientation Scale and Revised Self-Monitoring Scale are applied to sample group which consists of 437 female and 369 male participants aged16 to 65+ living in Bursa. The results has revealed that there is a meaningful positive correlation between intrinsic religious orientation and self-monitoring. In addition, no meaningful relationship between religious group membership and self-monitoring has been confirmed.Summary: The adaptation process of the human being as a social creature starts in a mother's womb and becomes more complicated in consequence of coming into the world which is full of stimulus. In the beginning, this process has only a physical aspect, but with the inclusion of emotional, cognitive, and social factors over time turns into developmental tasks that people will struggle throughout their lives. The social development involves the process of becoming of the individual as an organic part of the society. As the individual realizes the existence of the other, he/she develops similar patterns of behavior that can be approved by the other. Because the meaningful relationships that form the backbone of social development constitute an important part of the self. Belonging is one of the main needs, that the individual shapes his emotions, actions, and decisions more or less in line with this need in order not to encounter the possibility of social exclusion. While belonging is a universal need for every healthy individual, there are differences between individuals in terms of directing the course of the relationship, role sharing, and using situational clues. Individual differences in how people construct interpersonal processes led Mark Snyder to systematize and theorize the concept of self-monitoring. Self-monitoring is a concept that expresses individuals' control of self-presentation, expressive behavior, and non-verbal emotional expression and their regulation. Accordingly, individuals with a high tendency to shape their behavior according to the context are classified as high self-monitors and those with low tendency are classified as low self-monitors. It can be said that adherence to religion, which is one of the determinants of social behavior, is related to self-monitoring. In this context, the main subject of this study is the relationship between self-monitoring and religiosity. The study aims to examine the effect of intrinsic-extrinsic religiosity on individuals' self-monitoring levels. Besides, as a form of religiosity, to reveal whether religious group religiosity affects self-monitoring, the study examines also self-monitoring levels of individuals belonging to the religious group and those who are not.The sample of the study was selected by a simple random sampling method and it consists of 806 participants aged 16 to 65+ living in Bursa in 2017. 437 (54.2%) of the participants in the research are women and 369 (45.8%) are men. In this study, a relational screening model was used for determining the presence, direction, and degree of the relationship between the variables. The questionnaire technique was preferred as the method of gathering information. The questionnaire was arranged in a way that does not require asking the participant any other questions apart from the questions on the form. The questionnaire form used in this research consists of 43 items. At the beginning of the questionnaire, there is a 9-item personal information form that includes demographic items consisting of age, gender, educational status, marital status, occupation, place of residence, socio-economic status, levels of subjective religious involvement, and religious group membership. For the measurement of self-monitoring, a 12-item "Self-Monitoring Scale", which was developed by Mark Snyder, revised by Richard Lennox and Raymond Wolfe and adapted by İlknur Özalp Türetgen and Sevim Cesur to Turkish (α =.80) was used. For the measurement of religious orientation, a 22-item “Religious Orientation Scale” developed by Gordon Allport and Michael Ross and adapted to Turkish by Fatma Gül Cirhinlioğlu was used (α =.90). Data collected through scales were processed by One Way Variance Analysis (ANOVA), t-Test, Pearson Correlation Analysis, and Simple Linear Regression Analysis and turned into research findings.According to the results of the simple linear correlation analysis conducted to reveal whether there is a relationship between the self-monitoring scores of the participants and the intrinsic religious orientation scores, there is a positive and significant relationship between the variables (r = 0.102, p = 0.004 0.05). The result of the correlation analysis between self-monitoring and the level of subjective religious involvement shows that no significant relationship is found (r = 0.051, p = 0.146> 0.05).This research expected that there was a negative relationship between self-monitoring and intrinsic religious orientation. However, the analyses has not reported anticipated results as addressed in the previous research. Therefore, this study opens the door for asking new questions about the subject. Religious groups, by their very nature, can refer the individual to self-presentation control, obedience, to act as deemed appropriate by the group, to adapt to the group, to change behavior without attitude change, and therefore, to attitude-behavior inconsistency. It can be argued that not only religious groups but, by their nature, all social groups create harmony-oriented pressure on the individual. Therefore, it can be predicted that belonging to a group, in general, may have a significant effect on the level of self-monitoring. The high self-monitoring scores of the participants, whether religious or non-religious group members of this study may have reduced the observability of the difference between the two groups. Therefore, repeating the study on a different sample may produce different results. (shrink)

Background and objective: Code status discussions may fail to address patients’ treatment-related goals and their knowledge of cardiopulmonary resuscitation (CPR). This study aimed to investigate patients’ resuscitation preferences, knowledge of CPR and goals of care. Design, setting, patients and measurements: 135 adults were interviewed within 48 h of admission to a general medical service in an academic medical centre, querying code status preferences, knowledge about CPR and its outcome probabilities and goals of care. Medical records were reviewed for clinical information (...) and code status documentation. Results: 41 (30.4%) patients had discussed CPR with their doctor, 116 (85.9%) patients preferred full code status and 11 (8.1%) patients expressed code status preferences different from the code status documented in their medical record. When queried about seven possible goals of care, patients affirmed an average of 4.9 goals; their single most important goals were broadly distributed, ranging from being cured (n = 36; 26.7%) to being comfortable (n = 8; 5.9%). Patients’ mean estimate of survival to discharge after CPR was 60.4%. Most patients believed it was helpful to discuss goals of care (n = 95; 70.4%) and the chances of surviving inhospital CPR (n = 112; 83.0%). Some patients expressed a desire to change their code status after receiving information about survival following inhospital CPR (n = 11; 8.1%) or after discussing goals of care (n = 2; 1.5%). Conclusions: Doctors need to address patients’ knowledge about CPR and take steps to avoid discrepancies between treatment orders and patients’ preferences. Addressing CPR outcome probabilities and goals of care during code status discussions may improve patients’ knowledge and influence their preferences. (shrink)

The Objective Of This Highly Rewarding Book Indian Philosophy Of Knowledge Is To Highlight The Main Purpose Of Gaining Knowledge. The Highest Knowledge In Vedas And Upanisads Is The Knowledge Of Brahman Which Leads To Liberation. The Sankhya System Promises Complete Cessation Of All Sorrows. The Yoga Is Entirely Devoted To The Attainment Of Kaivalya. Gautama, In His Nyayasutra Asserts That Their Knowledge Would Lead To The Attainment Of The Liberation. The Vaisesika And Mimamsa Begins With The Interpretation Of Dharma (...) As The Means For Attainment Of The Worldly As Well As Transcendental Well-Being. The Buddhists Aim Of Knowledge Is To Remove Passions And To Show The Path Of Nirvana. The Removal Of Karmic Matter Is The Main Theme Of Knowledge In Jaina Philosophy. (shrink)

L. C. Holborow; V*—Blame, Praise and Credit, Proceedings of the Aristotelian Society, Volume 72, Issue 1, 1 June 1972, Pages 85–100, https://doi.org/10.1093/ari.

Background Professional autonomy, which directly affects the quality of professional nursing in patient care, and cognitive flexibility, which is an important factor for adaptation to change and developing nursing roles, are important concepts for nursing. Research objectives This research was carried out to determine the effect of cognitive flexibility on attitudes towards professional autonomy in nurses. Research design This was a descriptive study. Participants and research context The research was conducted with 415 nurses working in a city hospital of a (...) province, meeting the inclusion criteria and agreeing to participate in the study. A questionnaire form, The Cognitive Flexibility Inventory (CFI), and the Attitude Toward Professional Autonomy Scale for Nurses (APASN) were used to collect data. Ethical considerations Ethical approval was obtained from the university ethics committee before starting the study. Institutional permission was obtained from the city hospital where the study was conducted. Electronic informed consent was obtained from the nurses included in the study. Findings In the study, the mean CFI score was 80.62 ± 11.55 and the mean APASN score was 70.42 ± 18.79. There was a weak positive correlation (r = 0.270; p < 0.05) between CFI and APASN scores. Moreover, the effect of the CFI mean score on the APASN mean score was found to be statistically significant (β = 0.278; p < 0.001). Furthermore, CFI explains 7.7% of APASN. Conclusion In the study, nurses’ attitudes towards professional autonomy and cognitive flexibility scores were found to be at a good level. Cognitive flexibility has a positive effect on attitudes towards professional autonomy. Interventional studies that will increase the level of cognitive flexibility are recommended in the development of nurses' attitudes towards professional autonomy. (shrink)

Starting from simple topological arguments due to Dirac on the classical rotational properties of extended rigid bodies, we abstract the concept of a finite-size spinor (FSS). The FSS is a concept distinct from both point spinors (e.g., electrons) and composite spinors (e.g., nuclei), and suggests a new model for baryons. The FSS offers a natural explanation of “threeness” for the quarks, excludes the existence of free quarks, denies the operational definition of quark spin statistics, and, moreover, leads to the dual (...) model of hadronic interactions. (shrink)

Background: Discussions about medical errors facilitate professional learning for physicians and may provide emotional support after an error, but little is known about physicians’ attitudes and practices regarding error discussions with colleagues.Methods: Survey of faculty and resident physicians in generalist specialties in Midwest, Mid-Atlantic and Northeast regions of the US to investigate attitudes and practices regarding error discussions, likelihood of discussing hypothetical errors, experience role-modelling error discussions and demographic variables.Results: Responses were received from 338 participants . In all, 73% of (...) respondents indicated they usually discuss their mistakes with colleagues, 70% believed discussing mistakes strengthens professional relationships and 89% knew at least one colleague who would be a supportive listener. Motivations for error discussions included wanting to learn whether a colleague would have made the same decision , wanting colleagues to learn from the mistake and wanting to receive support . Given hypothetical scenarios, most respondents indicated they would likely discuss an error resulting in no harm , minor harm or major harm . Fifty-seven percent of physicians had tried to serve as a role model by discussing an error and role-modelling was more likely among those who had previously observed an error discussion .Conclusions: Most generalist physicians in teaching hospitals report that they usually discuss their errors with colleagues, and more than half have tried to role-model discussions. However, a significant number of these physicians report that they do not usually discuss their errors and some do not know colleagues who would be supportive listeners. (shrink)