Mr. Galanas, an eighty‐six‐year‐old man, intentionally shot himself in the chest and abdomen. Surprisingly, the bullet damaged only his distal pancreas and part of his colon, requiring a diverting colostomy to prevent leakage of bowel fluids into his abdomen. After being admitted, he lies intubated in the intensive care unit awaiting surgery to repair his colon. He is responsive but does not demonstrate clear decision‐making capacity. He grudgingly accepts pain medications but refuses antibiotics and antidepressants. He has a living will (...) that gives his wife durable power of attorney and also explicitly states a desire to refuse all medical interventions if he is permanently unconscious or in an end‐stage condition. Mrs. Galanas reports frequent conversations in which her husband said he would not want to be sustained on life support. She also says that he often mentioned he would not want an ostomy bag—a likely, albeit temporary, outcome of the proposed surgery. His physicians are nervous about withholding medical interventions when Mr. Galanas's injury is the result of a suicide attempt and his prognosis is good. Should the care team surgically repair his injured colon, regardless of the patient's capacity, his advance directive, and his wife's statement that he would not want surgery or other life‐sustaining treatment? (shrink)

Enth.: Race et histoire / Claude Lévi-Strauss. suivi de: L'oeuvre de Claude Lévi-Strauss / par Jean Pouillon.

Le but de ce texte est de mettre en évidence les équi­valences entre la façon dont le concept de conatus résout, dans l'Éthique, le problème de l'unité modale complexe. en rendant consis­tant le concept de chose singulière en tant que celle-ci doit être consi­dérée comme un légitime sujet d'attribution d'états, et la façon dont ce même concept dessine le rapport cognitif de l'esprit avec lui-même, rapport par lequel l'esprit se saisit comme sujet de ses états et qui ca­ractérise la notion (...) moderne de subjectivité. Ainsi, en éclairant cet as­pect du concept spinoziste de chose singulière. on comprendra aussi, de façon indirecte, l'une des conditions par lesquelles les choses peuvent, dans la doctrine spinoziste, devenir des objets ou des signes pour la connaissance humaine. (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)

Although the literature on social innovation has focused primarily on social enterprises, social innovation has long occurred within mainstream corporations. Drawing upon recent scholarship on social movements and institutional complexity, we analyze how movements foster corporate social innovation (CSI). Our context is the adoption of green information systems (“green IS”), which are information systems employed to transform organizations and society into more sustainable entities. We trace the historical emergence of green IS as a corporate response to increasing demands for sustainability (...) reporting, a key social innovation that environmental activists helped to create. Drawing upon extensive survey data from more than 400 U.S. firms, we then examine how managers perceived environmental activism in relation to broader field pressures for change and how their perceptions of both were related to green IS adoption. The results reveal that activists were more effective at influencing adoption indirectly by transforming organizational fields than by directly influencing corporate managers. Combined with the historical analysis, these findings suggest that CSI emerged out of ongoing interactions between activists, corporate managers, and other influential actors within a broader social innovation system. Activists helped to create conditions for social innovation, but corporations took the lead in developing new practices. (shrink)

Biologists frequently draw on ideas and terminology from engineering. Evolutionary systems biology—with its circuits, switches, and signal processing—is no exception. In parallel with the frequent links drawn between biology and engineering, there is ongoing criticism against this cross-fertilization, using the argument that over-simplistic metaphors from engineering are likely to mislead us as engineering is fundamentally different from biology. In this article, we clarify and reconfigure the link between biology and engineering, presenting it in a more favorable light. We do so (...) by, first, arguing that critics operate with a narrow and incorrect notion of how engineering actually works, and of what the reliance on ideas from engineering entails. Second, we diagnose and diffuse one significant source of concern about appeals to engineering, namely that they are inherently and problematically metaphorical. We suggest that there is plenty of fertile ground left for a continued, healthy relationship between engineering and biology. (shrink)

This work provides a reflective assessment of recent developments, social relevance and future of environmental political theory, concluding that although the alleged pacification of environmentalism is more than skin deep, it is not yet quite deep enough. This book will appeal to students and researchers of social science and philosophers with an interest in environmental issues.

In this commentary, we set out the specifics of how Glowacki's game theoretical framework for the evolution of peace could be incorporated within broader cultural evolutionary approaches. We outline a formal proposal for prisoner's dilemma games investigating raid-based conflict. We also centre an ethnographic lens to understand the norms surrounding war and peace in intergroup interactions in small-scale communities.

As the field of vascularized composite allotransplantation (VCA) continues to evolve and technological approaches improve, VCA programs must focus on promoting greater consistency in psychosocial assessment across programs to support the equitable selection of patients. Based on a summary of published reports of VCA, we address the ethical considerations raised by the present heterogeneity of approaches to psychosocial assessment, including weighing risks and benefits, informed consent and the role of decisional capacity, and potential or perceived bias in the assessment process. (...) We propose transparency of process across the field and encourage VCA programs to work collaboratively to share approaches to psychosocial assessment both pre- and posttransplant to promote health equity. (shrink)

Technoscientific developments, especially those which operate on/with human beings, are contributing to their reconfiguration in some new, unprecedented ways. Ethics too is revising radically its own field, probing its own foundations. Sensitive to both movements, bioethics is at a difficult crossroads when much is demanded of it. This paper proposes to contribute to the elucidation of the role of philosophical ethics in the area of bioethics through a critical reading of three of our major contemporary philosophers who have been attempting (...) to meet the challenges of (post)modernity. (shrink)