Academic health centres have historically treated patients with the most complex of diseases, served as training grounds to teach the next generations of physicians and fostered an innovative environment for research and discovery. The physicians who hold faculty positions at these institutions have long understood how these key academic goals are critical to serve their patient community effectively. Recent healthcare reforms, however, have led many academic health centres to recruit physicians without these same academic expectations and to partner with non-faculty (...) physicians at other health systems. There has been limited transparency in regard to the expertise among the physicians and the academic faculty within these larger entities. Such lack of transparency may lead to confusion among patients regarding the qualifications of who is actually treating them. This could threaten the ethical principles of patient autonomy, benevolence and non-maleficence as patients risk making uninformed decisions that might lead to poorer outcomes. Furthermore, this lack of transparency unjustly devalues the achievements of physician faculty members as well as potentially the university they represent. In this paper, it is suggested that academic health centres have an obligation to foster total transparency regarding what if any role a physician has at a university or medical school when university or other academic monikers are used at a hospital. (shrink)

The ethical obligation to provide a reasonably safe discharge option from the inpatient setting is often confounded by the context of homelessness. Living without the security of stable housing is a known determinant of poor health, often complicating the safety of discharge and causing unnecessary readmission. But clinicians do not have significant control over unjust distributions of resources or inadequate societal investment in social services. While physicians may stretch inpatient stays beyond acute care need in the interest of their patients (...) who are experiencing homelessness, they must also consider the implications of using an inpatient hospital bed for someone without the attendant level of medical need. Caring for patients in an inpatient setting when they no longer require acute care means fewer beds for acute care patients. And when a patient who is experiencing homelessness declines a medically safer option such as a skilled nursing facility, then clinicians may be faced with the sole option of discharge to the street, which raises troubling questions of nonmaleficence and social justice. Here we investigate the different forms of injustice that play out when patients are discharged to the street, and offer a map of the interwoven ethical responsibilities of clinicians, hospitals, and skilled nursing facilities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Philosophy and Rhetoric 34.4 (2001) 355-363 [Access article in PDF] Plato on Power, Moral Responsibility and the Alleged Neutrality of Gorgias' Art of Rhetoric (Gorgias 456c-457b) James Stuart Murray 1. Introduction You are sitting in your office on a quiet Thursday afternoon when an agitated university administrator enters with news that the students in your "Plato class" have just been interviewed on the city's largest radio station. According (...) to them, their professor claimed that the demise of their university is a direct result of the fact that senior administrative positions are held by a motley assortment of business-oriented, academically cynical, "renewal"-promoting "innovators" whose main preoccupation is "government funding opportunities" in areas of dubious academic importance.Your response might be: "That's not what I taught them." Or perhaps you might say, "That's not exactly what I taught them--I didn't say it was a 'motley' assortment." In either case, you would be relying on some form of what Robert Wardy (170, n.r 20) has dubbed the "blame students, not teachers defence." He asserts, perhaps correctly, that this defense gained the status of topos within the ancient rhetorical tradition. A version of it certainly does seem to show up in Isocrates' Antidosis (250-52) and perhaps in his Nicocles (3-4), and it is suggested by remarks in both Aristotle's Rhetoric (1355b) and Quintilian's Institutio Oratoria (II,16,5). On this occasion, however, I am concerned with only one rendition, probably its earliest extant instance in Greek literature. In Plato's Gorgias, the eponymous sophist argues as follows: Imagine someone who after attending wrestling school, 1 getting his body into good shape and becoming a boxer, went on to strike his father and mother or any other family member or friend. By Zeus, that's no reason to hate physical trainers... and to exile them from their cities! For while these people imparted their skills to be used justly against enemies and wrongdoers, and in [End Page 355] defense, not aggression, their pupils pervert their strength and skill and misuse them. So it's not their teachers who are wicked, nor is this a reason why the craft should be a cause of wickedness; the ones who misuse it are supposedly the wicked ones. And the same is true for oratory as well. The orator has the ability to speak against everyone on every subject, so as in gatherings to be more persuasive, in short, about anything he likes, but the fact that he has the ability to rob doctors or other craftsmen of their reputations doesn't give him any more of a reason to do it. He should use oratory justly, as he would any competitive skill. And I suppose that if a person who has become an orator goes on with this ability and this craft to commit wrongdoing, we shouldn't hate his teacher and exile him from our cities. For while the teacher imparted it to be used justly, the pupil is making the opposite use of it. So it's the misuser whom it's just to hate and exile or put to death, not the teacher. (Gorgias 456d, 457a-b) 2Change "exile from our cities" to "fire from our universities" and this makes a good passage to remember when confronted by that agitated administrator mentioned above. Blame the students, not the teachers.Not much comment has been provoked by this defense of Gorgianic rhetoric and its underlying rhetor/boxer analogy, except over the question of whether we should read the passage as an accurate reflection of the words of the historical Gorgias or as a Platonic invention. In a previous generation, E. R. Dodds (212) reckoned that this defense was "probably the standpoint of the historical Gorgias," while E. A. Havelock (195) cautioned that "there is little--very little--that he [i.e., Plato] lets Gorgias say in the Gorgias." In our own day, and on a more general level, Thomas Cole (151) states that "Plato's... (shrink)

Virtue epistemology is new in one sense but old in another. The new tradition starts with figures such as Code, Greco, Montmarquet, and Zagzebski. The old tradition has its pedigree in Plato, Aristotle, Aquinas, and their modern interpreters such as Anscombe and MacIntyre. Virtue epistemology recognizes that knowledge is something we value and that propositional knowledge requires intellectual virtues, that is to say, virtues as applied to the intellect. Although much pioneering work in the new tradition has been done on (...) propositional knowledge, comparatively little in it has been done on know-how. This is surprising, because one might naturally think of know-how as something to be refined into a skill, and virtues may be thought of as skills. In the modern epistemological tradition that does not take its direction from virtue ethics, propositional knowledge, as opposed to know-how, has received by far the bulk of the discussion, although since Ryle first argued that knowhow is not always propositional knowledge, there has been a fairly recent resurgence of interest in know-how.We value intellectual virtues because they are skills that promote our flourishing, both as individuals and as members of a community. The intellectual virtues are truth- seeking virtues and stem from a love of the truth. Since love is itself a virtue - indeed it was what Tyndale called the greatest Christian virtue before the King James translation renamed it as charity—it may be seen as the virtue that motivates all other intellectual virtues. A commitment to the truth is presupposed by any intellectual virtue. For example, logic is important to a community, and in particular to the intellectual community, not only because there are rules governing the activity of logic but also because there are those within the community who are trustworthy in following the activity and because there are publically accepted standards of accountability in the way the activity of logic is practiced. Here is how we will proceed. In section 2 we sketch a metaphysics of natural purposes that supports the claim that there are objective goods that beings need qua the kinds of being they are in order to flourish. In section 3 we argue that flourishing includes the acquisition of virtues. We give a general account of virtue, roughly as a stable disposition to act upon a habit elevated to a skill of putting one’s know-how into practice that springs from one’s motivation to pursue what one perceives as good. In section 4 we give a general sketch of intellectual virtues as truth-seeking virtues that stem from a love of the truth that are the skills to flourish intellectually. In section 5 we discuss connaturality, namely those specific metaphysical accidents readily acquired by beings due to their first nature. We make an original distinction between ontological connaturality, namely the connaturality that belongs to animals qua beings of a certain kind, and habitual connaturality, namely our first natures suffused with virtues—or vices, although we will concentrate only on virtues. Habitual connaturality is acquired through the practice of virtue and involves perceptiveness awakened by the possession of the virtue in question. The knowledge arising from this form of connaturality may be a form of know-how. In section 6 we give an account of connatural apprehension and connatural propositional knowledge. In section 7 we discuss connatural know-how and argue that it makes certain virtues possible. At this point we will have shown that intellectual and moral virtues are informed by know-how. In sections 8 and 9 we give analyses of know-how and skill in terms of counterfactual success. We show how skill is a refined form of know-how and how both know-how and skill are informed by moral and intellectual virtues. We conclude in section 10 that know-how informs intellectual and moral virtues in the sense that virtue is to be elucidated in terms of skill, which is in turn to be elucidated in terms of know-how. Moreover, virtues inform know-how in the sense that know-how is to be elucidated in terms of intellectual and moral virtues. No circularity arises because different virtues and different forms of know-how are involved. (shrink)

The study reports on the results of an empirical investigation of the education and recruitment processes used in HIV vaccine trials conducted in South Africa. Interviews were conducted with 21 key informants involved in HIV vaccine research in South Africa and three focus groups of community advisory board members. Data analysis identified seven major themes on the relationship between education and recruitment: the process of recruitment, the combined dual role of educators and recruiters, conflicts perceived by field staff, pressure to (...) achieve recruitment targets, problems in achieving comprehension, accountability and education as capacity building. The results raise ethical concerns about the adequacy of current informed consent processes in these settings. The study findings bear directly on current debates about issues of exploitation and the scope of moral responsibilities of researchers and funding agencies to assure that HIV clinical prevention research is conducted ethically. (shrink)

In this paper we offer a new argument for the existence of God. We contend that the laws of logic are metaphysically dependent on the existence of God, understood as a necessarily existent, personal, spiritual being; thus anyone who grants that there are laws of logic should also accept that there is a God. We argue that if our most natural intuitions about them are correct, and if they are to play the role in our intellectual activities that we take (...) them to play, then the laws of logic are best construed as necessarily existent thoughts -- more specifically, as divine thoughts about divine thoughts. We conclude by highlighting some implications for both theistic arguments and antitheistic arguments. (shrink)

In Paradox in Christian Theology I argued that the Christian doctrines of the Trinity and the Incarnation are paradoxical—that is, they appear to involve implicit contradictions—yet Christians can still be rational in affirming and believing those doctrines. Dale Tuggy has characterized my theory of theological paradox as a form of “positive mysterianism” and argues that the theory “faces steep epistemic problems, and is at best a temporarily reasonable but ultimately unsustainable stance.” After summarizing my proposed model for the rational affirmation (...) of theological paradox and considering whether my proposal is indeed a form of “positive mysterianism” as Tuggy defines the term, I address the two main criticisms raised in Tuggy’s paper: first, that the doctrine of divine incomprehensibility cannot bear the weight required by my defense of paradox; and second, that my proposed model is afflicted with epistemic instability. I conclude that Tuggy has failed to show that a mysterian stance with respect to paradoxical Christian doctrines is in principle unreasonable, unnatural, or unsustainable. (shrink)

This article discusses the representation of AIDS in Guibert's posthumously published novel Le Paradis. The novel is situated in relation to Guibert's better known previous AIDS writings. The article proposes that Guibert's AIDS works fall in to three related categories: writings about other peoples' AIDS; autobiographical writings about AIDS, and, in the third, terminal stage in which Le Paradis fits, writing AIDS. As such the article suggests that Le Paradis manages to reflect and communicate some of the trauma of living (...) with AIDS by specifically trying not to write about it. The article raises issues related to constructions of sexualized and AIDS identities in fiction, and presents the novel as a form which represents a loss of self. The novel, it is argued, becomes a self-mourning for a healthy past which is memorialized in a fictional present, itself always-already haunted by the nostalgia for a lost future. (shrink)

The sounds that make up spoken words are heard in a series and must be mapped rapidly onto words in memory because their elements, unlike those of visual words, cannot simultaneously exist or persist in time. Although theories agree that the dynamics of spoken word recognition are important, they differ in how they treat the nature of the competitor set—precisely which words are activated as an auditory word form unfolds in real time. This study used eye tracking to measure the (...) impact over time of word frequency and 2 partially overlapping competitor set definitions: onset density and neighborhood density. Time course measures revealed early and continuous effects of frequency (facilitatory) and on set based similarity (inhibitory). Neighborhood density appears to have early facilitatory effects and late inhibitory effects. The late inhibitory effects are due to differences in the temporal distribution of similarity within neighborhoods. The early facilitatory effects are due to subphonemic cues that inform the listener about word length before the entire word is heard. The results support a new conception of lexical competition neighborhoods in which recognition occurs against a background of activated competitors that changes over time based on fine-grained goodness-of-fit and competition dynamics. (shrink)

The sounds that make up spoken words are heard in a series and must be mapped rapidly onto words in memory because their elements, unlike those of visual words, cannot simultaneously exist or persist in time. Although theories agree that the dynamics of spoken word recognition are important, they differ in how they treat the nature of the competitor set—precisely which words are activated as an auditory word form unfolds in real time. This study used eye tracking to measure the (...) impact over time of word frequency and 2 partially overlapping competitor set definitions: onset density and neighborhood density. Time course measures revealed early and continuous effects of frequency (facilitatory) and on set based similarity (inhibitory). Neighborhood density appears to have early facilitatory effects and late inhibitory effects. The late inhibitory effects are due to differences in the temporal distribution of similarity within neighborhoods. The early facilitatory effects are due to subphonemic cues that inform the listener about word length before the entire word is heard. The results support a new conception of lexical competition neighborhoods in which recognition occurs against a background of activated competitors that changes over time based on fine‐grained goodness‐of‐fit and competition dynamics. (shrink)

In 2012, a U.S. Institute of Medicine report called for a different approach to health care: “Left unchanged, health care will continue to underperform; cause unnecessary harm; and strain national, state, and family budgets.” The answer, they suggested, would be a “continuously learning” health system. Ethicists and researchers urged the creation of “learning health organizations” that would integrate knowledge from patient‐care data to continuously improve the quality of care. Our experience with an ongoing research study on atrial fibrillation—a trial known (...) as IMPACT‐AFib—gave us some insight into one of the challenges that will have to be dealt with in creating these organizations. Although the proposed educational intervention study placed no restrictions on what providers and health plans could do, the oversight team argued that the ethical principle of beneficence did not allow the researchers to be “bystanders” in relation to a control group receiving suboptimal care. In response, the researchers designed a “workaround” that allowed the project to go forward. We believe the experience suggests that what we call “bystander ethics” will create challenges for the kinds of quality improvement research that LHOs are designed to do. (shrink)

There are two women called Salpe who are said to have written books in antiquity: one is described by Athenaeus as the name or pseudonym of a writer of ‘Paignia’ the other is cited by Pliny the Elder who calls her at one point Salpe obstetrix. Salpe is a rare name in antiquity—I know of no other examples—and few ancient books were ascribed to women. That two of these rare female writers should be called by the same name is something (...) of a coincidence. That the name they shared was the very rare Salpe is a priori distinctly unlikely. It is much more plausible that they were one and the same. (shrink)

The effectiveness of case-based learning in ethics education varies widely regarding how cases are presented. Case process instruction may impact case-based ethics education to promote sensemaking processes, ethical sensemaking strategy use, and ethical decision making (EDM) quality. This study examined two teaching techniques, notes and review, and participants completed note-taking and review activities examining a case-based scenario during an ethics education course. Results suggest that providing case notes in outline form improves sensemaking processes, strategy use, and EDM quality. In addition, (...) combining processes of provided notes and passive review results in incremental, additive performance via certain ethical sensemaking strategies and EDM quality. (shrink)

Girard discusses "homosexuality" on three occasions in his oeuvre. Late in the first chapter of Deceit, Desire, & the Novel he discusses the relationship between Veltchaninov and Troussotsky, characters in Dostoyevsky's The Eternal Husband. Then in Part III of Things Hidden since the Foundation of the World the sections entitled "Homosexuality" and "Mimetic Latency and Rivalry" are dedicated to the subject. Indeed, in the latter of these Girard reproduces his discussion of Veltchaninov and Troussotsky from the earlier book. Finally, he (...) touches on the matter in Chapter 4 of A Theater of Envy: William Shakespeare, dedicated to... (shrink)

This book introduces the study of Biblical studies, theology, religion and philosophy from an African perspective. The book comprises twenty six chapters divided into four sections.

Highly creative and interactive, this apologetics resource helps readers identify and evaluate 21 different worldviews through engaging yes-or-no questions and easy-to-understand descriptions. Appendices include answers to common questions and suggestions for further reading.

Taber and Lodge offer a powerful case for the prevalence of directional reasoning that aims not at truth, but at the vindication of prior opinions. Taber and Lodge's results have far-reaching implications for empirical scholarship and normative theory; indeed, the very citizens often seen as performing “best” on tests of political knowledge, sophistication, and ideological constraint appear to be the ones who are the most susceptible to directional reasoning. However, Taber and Lodge's study, while internally beyond reproach, may substantially overstate (...) the presence of motivated reasoning in political settings. That said, focusing on the accuracy motivation has the potential to bring together two models of opinion formation that many treat as competitors, and to offer a basis for assessing citizen competence. (shrink)

Taber and Lodge offer a powerful case for the prevalence of directional reasoning that aims not at truth, but at the vindication of prior opinions. Taber and Lodge's results have far-reaching implications for empirical scholarship and normative theory; indeed, the very citizens often seen as performing “best” on tests of political knowledge, sophistication, and ideological constraint appear to be the ones who are the most susceptible to directional reasoning. However, Taber and Lodge's study, while internally beyond reproach, may substantially overstate (...) the presence of motivated reasoning in political settings. That said, focusing on the accuracy motivation has the potential to bring together two models of opinion formation that many treat as competitors, and to offer a basis for assessing citizen competence. (shrink)

The question of when and how bottom‐up input is integrated with top‐down knowledge has been debated extensively within cognition and perception, and particularly within language processing. A long running debate about the architecture of the spoken‐word recognition system has centered on the locus of lexical effects on phonemic processing: does lexical knowledge influence phoneme perception through feedback, or post‐perceptually in a purely feedforward system? Elman and McClelland (1988) reported that lexically restored ambiguous phonemes influenced the perception of the following phoneme, (...) supporting models with feedback from lexical to phonemic representations. Subsequently, several authors have argued that these results can be fully accounted for by diphone transitional probabilities in a feedforward system (Cairns et al., 1995; Pitt & McQueen, 1998). We report results strongly favoring the original lexical feedback explanation: lexical effects were present even when transitional probability biases were opposite to those of lexical biases. (shrink)

A single protein molecule with one or more cysteine residues can occupy a plurality of unique residue and oxidation‐chemotype specified proteoforms that I term oxiforms. In binary reduced or oxidised terms, one molecule with three cysteines will adopt one of eight unique oxiforms. Residue‐defined sulfur chemistry endows specific oxiforms with distinct functionally‐relevant biophysical properties (e.g., steric effects). Their emergent complexity means a functionally‐relevant effect may only manifest when multiple cysteines are oxidised. Like how mixing colours makes new shades, combining discrete (...) redox chemistries—colours—can create a kaleidoscope of oxiform hues. The sheer diversity of oxiforms co‐existing within the human body provides a biological basis for redox heterogeneity. Of evolutionary significance, oxiforms may enable individual cells to mount a broad spectrum of responses to the same stimulus. Their biological significance, however plausible, is speculative because protein‐specific oxiforms remain essentially unexplored. Excitingly, pioneering new techniques can push the field into uncharted territory by quantifying oxiforms. The oxiform concept can advance our understanding of redox‐regulation in health and disease. (shrink)

No overarching hypotheses tie the basic mechanisms of mitochondrial reactive oxygen species (ROS) production to activity dependent synapse pruning—a fundamental biological process in health and disease. Neuronal activity divergently regulates mitochondrial ROS: activity decreases whereas inactivity increases their production, respectively. Placing mitochondrial ROS as innate synaptic activity sentinels informs the novel hypothesis that: (1) at an inactive synapse, increased mitochondrial ROS production initiates intrinsic apoptosis dependent pruning; and (2) at an active synapse, decreased mitochondrial ROS production masks intrinsic apoptosis dependent (...) pruning. Immature antioxidant defense may enable the developing brain to harness mitochondrial ROS to prune weak synapses. Beyond development, endogenous antioxidant defense constrains mitochondrial (ROS) to mask pruning. Unwanted age‐related synapse loss may arise when mitochondrial ROS aberrantly recapitulate developmental pruning. Placing mitochondrial ROS with their hands on the shears is beneficial in early but deleterious in later life. (shrink)

Here I propose to undertake a brief survey of the statements of the argument given by these proponents, formulating and qualifying as I go what seems to me a sound version of it, capable of withstanding both Ayer's criticism and others that I have developed. There must be additional ways in which the same or similar points can be expressed. Another review of Kant, Paton, Taylor, and Kenner would no doubt produce a somewhat different result. All that is claimed here (...) is that the argument advanced in this paper is sound and that it was suggested by certain statements of theirs. (shrink)

It is said there are only two things in life that are certain: death and taxes … maybe only taxes.

Natural ecosystems perform fundamental life-support services upon which human civilization depends. However, many people believe that nature provides these services for free and therefore, they are of little or no value. One nearly forgotten ecosystem service is ecotherapy – the ability of interaction with nature to enhance healing and growth. While we do not pay for this service, we pay significantly for its loss resulting in slower recovery times, greater distress, reduced well-being and losses in those images of nature that (...) contribute to our basic happiness. Little is understood about the ecotherapy benefits of the natural environment and its ecosystem services. The complex and interactive relationship of ecosystems, their services and human well-being is poorly acknowledged in the broad social, philosophical and economic well-being literature. In this article, we examine the role of nature and its ecosystem services in ecotherapy and its associated enhancement of recovery from physical and mental illness. (shrink)

This copiously illustrated volume is the first systematic general work to do justice to the fruits of recent scholarship in the history of natural history. Public interest in this lively field has been stimulated by environmental concerns and through links with the histories of art, collecting and gardening. The centrality of the development of natural history for other branches of history - medical, colonial, gender, economic, ecological - is increasingly recognized. Twenty-four specially commissioned essays cover the period from the sixteenth (...) century, when the first institutions of natural history were created, to its late nineteenth-century transformation by practitioners of the new biological sciences. An introduction discusses novel approaches that have made this a major focus for research in cultural history. The essays, which include suggestions for further reading, offer a coherent and accessible overview of a fascinating subject. An epilogue highlights the relevance of this wide-ranging survey for current debates on museum practice, the display of ecological diversity and concerns about the environment. (shrink)