In this expanded edition, an accomplished physician and teacher of medicine discusses the importance of being a caring doctor, especially now that the focus of medicine is increasingly on technological innovation and health care costs. With wisdom and compassion, Dr. Jerome Lowenstein tells stories about relationships between medical students and their teachers, physicians and their patients. He reflects on what doctors learn from treating chronic illness; how they respond to patients' needs for reassurance; how they bear the burden of (...) treating patients with life-threatening or degenerative disease; whether the distinction between traditional and "alternative" medical treatment is ultimately beneficial or destructive; and many other issues. Dr. Lowenstein's ruminations on humanistic approaches to learning and practicing medicine will be treasured by physicians, medical students, and patients alike. (shrink)
Continuous recordings of brain electrical activity were obtained from a group of 176 patients throughout surgical procedures using general anesthesia. Artifact-free data from the 19 electrodes of the International 10/20 System were subjected to quantitative analysis of the electroencephalogram (QEEG). Induction was variously accomplished with etomidate, propofol or thiopental. Anesthesia was maintained throughout the procedures by isoflurane, desflurane or sevoflurane (N = 68), total intravenous anesthesia using propofol (N = 49), or nitrous oxide plus narcotics (N = 59). A set (...) of QEEG measures were found which reversibly displayed high heterogeneity of variance between four states as follows: (1) during induction; (2) just after loss of consciousness (LOC); (3) just before return of consciousness (ROC); (4) just after ROC. Homogeneity of variance across all agents within states was found. Topographic statistical probability images were compared between states. At LOC, power increased in all frequency bands in the power spectrum with the exception of a decrease in gamma activity, and there was a marked anteriorization of power. Additionally, a significant change occurred in hemispheric relationships, with prefrontal and frontal regions of each hemisphere becoming more closely coupled, and anterior and posterior regions on each hemisphere, as well as homologous regions between the two hemispheres, uncoupling. All of these changes reversed upon ROC. Variable resolution electromagnetic tomography (VARETA) was performed to localize salient features of power anteriorization in three dimensions. A common set of neuroanatomical regions appeared to be the locus of the most probable generators of the observed EEG changes. (shrink)
State universities have grown to become monumental enterprises generating revenues of more than $124 billion a year in the sale and delivery of education and other services. They compete in a marketplace composed of private secular, nonsecular and for-profit higher education institutions. In addition, state universities in their own right engage in a number of traditionally for-profit "business" enterprises competing with the private sector. However, as the enterprise aspect of state universities grows; so too does the impact of a unique (...) competitive advantage enjoyed solely by state universities--that is, the ability of state universities to immune themselves from lawsuit in federal court under the guise of "sovereign immunity" for disputes arising under federal employment laws. Indeed, as a consequence of recent Supreme Court rulings, state agencies, including universities, are the only entities in the United States that are effectively exempt from the enforcement of federal employment laws in federal or state courts. This article reviews the condition of the "two faces" of the state university regarding federal employment law and the apparent new barriers to federal court access of employees to judicial review of employment disputes. (shrink)
Voyeurism seems creepy. This paper considers whether these feelings are well-founded. It identifies a variety of ethically troubling features, including harmful consequences, deceit, and the violation of various religious, legal, and conventional norms. Voyeurism is something of a moral misdemeanor that seems worrisome when associated with these other failings. However, because voyeurism remains troubling even in the absence of harm or deceit, we must pay special attention to the ways complex social conventions can be used to show disrespect for others. (...) The discussion centers on the famous case of Lady Godiva and Peeping Tom, but much of the analysis applies to voyeurism more generally. (shrink)
Tom Kelly argues that instrumentalist aeeounts of epistemie rationality fail beeause what a person has reason to believe does not depend upon the eontent of his or her goals. However, his argument fails to distinguish questions about what the evidence supports from questions about what a person ought to believe. Once these are distinguished, the instrumentalist ean avoid Kelly’s objeetions. The paperconcludes by sketehing what I take to be the most defensible version of the instrumentalist view.
A recently published book, 'The Economics of Health Reconsidered' by Tom Rice, provides a strong critique of the role of markets in health care. Many of the issues of 'market failure' raised by Rice, however, have been, to varying extents, recognised previously in the health economics literature (at least outside the U.S.). What perhaps sets Rice's book apart from previous attempts to document such issues is its elegance and the methodical manner in which this critique is delivered. Significantly the critique (...) is based solely on conventional economic arguments. There has, however, been an emerging strand of the health economics literature not acknowledged in Rice's book which has approached some of these issues of market failure from a different perspective. Notably this research has involved, in part, borrowing from the ideas and methodological traditions of other disciplines. The emphasis in this work has been to expand the scope and the concerns of economic analysis in health care. (shrink)
Since its publication in 1976, Tom Paine and Revolutionary America has been recognized as a classic study of the career of the foremost political pamphleteer of the Age of Revolution, and a model of how to integrate the political, intellectual, and social history of the struggle for American independence. Foner skillfully brings together an account of Paine's remarkable career with a careful examination of the social worlds within which he operated, in Great Britain, France, and especially the United States. He (...) explores Paine's political and social ideas and the way he popularized them by pioneering a new form of political writing, using simple, direct language and addressing himself to a reading public far broader than previous writers had commanded. He shows which of Paine's views remained essentially fixed throughout his career, while directing attention to the ways his stance on social questions evolved under the pressure of events. This enduring work makes clear the tremendous impact Paine's writing exerted on the American Revolution, and suggests why he failed to have a similar impact during his career in revolutionary France. And it offers new insights into the nature and internal tensions of the republican outlook that helped to shape the Revolution. In a new preface, Foner discusses the origins of this book and the influences of the 1960s and 1970s on its writing. He also looks at how Paine has been adopted by scholars and politicians of many stripes, and has even been called the patron saint of the Internet. (shrink)
Tom Regan (this issue) criticizes my thesis that obligation toward the environment is grounded in a world view and thereby has a moral overridingness which mere interests and desires do not have. He holds that my approach is too subjectivistic. I counter, first, by explaining that phenomenology, which I use in my analysis of moral obligation, is not subjectivistic in the way emotivism or prescriptivism inethics is subjectivistic. Second, I argue that world views are products of learning and experience of (...) one shared world, that most world views share large areas of agreement, and that they can be argued for and criticized. (shrink)
This is an extremely thorough revision of the leading textbook of bioethics. The authors have made many improvements in style, organization, argument and content. These changes reflect advances in the bioethics literature over the past five years. The most dramatic expansions of the text are in the comprehensiveness with which the authors treat different currents in ethical theory and the greater breadth and depth of their discussion of public policy and public health issues. In every chapter, readers will find new (...) material and refinements of old discussions. This is evident in the many new sections on topics like communitarianism, ethics of care, relationship-based accounts, casuistry, case-based reasoning, principle-based common-morality theories, the justification of assistance in dying, rationing through priorities in the health care budget, and virtues in professional roles. The most extensive revisions are in chapters 1, 2 and 8. (shrink)
In this article, I seek to make sense of the oft-invoked idea of 'public emergency' and of some of its (supposedly) radical moral implications. I challenge controversial claims by Tom Sorell, Michael Walzer, and Giorgio Agamben, and argue for a more discriminating understanding of the category and its moral force.
Wesley Salmon and John Earman have presented influential Bayesian reconstructions of Thomas Kuhn’s account of theory-change. In this paper I argue that all attempts to give a Bayesian reading of Kuhn’s philosophy of science are fundamentally misguided due to the fact that Bayesian confirmation theory is in fact inconsistent with Kuhn’s account. The reasons for this inconsistency are traced to the role the concept of incommensurability plays with reference to the ‘observational vocabulary’ within Kuhn’s picture of scientific theories. The upshot (...) of the discussion is that it is impossible to integrate both Kuhn’s claims and Bayesianism within a coherent account of theory-change. (shrink)
