The dilemma of whether and how to disclose a diagnosis of cancer or of any other terminal illness continues to be a subject of worldwide interest. We present the case of a 62-year-old Japanese woman afflicted with advanced gall bladder cancer who had previously expressed a preference not to be told a diagnosis of cancer. The treating physician revealed the diagnosis to the family first, and then told the patient: "You don't have any cancer yet, but if we don't treat (...) you, it will progress to a cancer". In our analysis, we examine the role of family consent, communication patterns (including ambiguous disclosure), and advance directives for cancer disclosure in Japan. Finally, we explore the implications for Edmund Pellegrino's proposal of "something close to autonomy" as a universal good. (shrink)

Disjunctivism about sensory experience is frequently put forward in defence of a particular conception of perception and perceptual experience known as naïve realism. In this paper, I present an argument against naïve realism that proceeds through a rejection of disjunctivism. If the naïve realist must also be a disjunctivist about the phenomenal nature of experience, then naïve realism should be abandoned.

How ought the historian to reconcile themselves philosophically with the fact of evental contingency and of its relationship to structural determination? Does the existence of contingent causation undermine the very concept of historical necessity, or do the two instead in dialectical entanglement? In this essay, I engage with the problem of historical contingency from a transcendental-materialist perspective informed by the work of Slavoj Žižek, tendering a philosophically serious response to the famous Pascalian conundrum of Cleopatra’s nose and its challenge to (...) structuralist accounts of historical causation. The position associated with Laplace – that is to say, that the course of history would be entirely predictable were one provided with a complete account of initial conditions – is firmly rejected. Instead, I revive Althusser’s attempt to craft a theory of ‘aleatory materialism’, in which the determinative power of structural forces nevertheless leave space for the radical and unpredictable transformation of a situation by the chance crystallisation of events and encounters. In this effort, I recruit conceptual architecture not only from the fields of historiography and philosophy, but also quantum physics, psychoanalysis, and mathematics. (shrink)

Drawing on ancient writers, from Aesop to Ovid, classicist and working farmer, Mark Usher compiles in this book an anthology of Greco-Roman passages illustrating how they thought about animals and illuminating they might help us to rethink our relationships with them. Not many contemporary readers will know, for example, the compelling arguments the second century AD Greek philosopher Porphyry makes for vegetarianism, long before a plant-based diet began to garner headlines. Plutarch's serio-comic exposition of the rationality and inherent dignity of (...) non-human creatures-put on the lips of one of Circe's pigs-is so fresh that it sounds like it was formulated just yesterday. The knowledge the poet Theognis derived from Greek sponge divers about the behavior of octopods rivals our contemporary fascination with the octopus. Aristotle's introduction to the scientific study of animal morphology and behavior remains unparalleled for its elegance and insight, and it represents one of the first forays into natural history writing. Seneca, employing an ingenious etymological pun on the word animal, endeavors to show that we humans are morally inferior to our animal cousins, who instinctively know and are satisfied with their place in Nature. The Greeks and Romans, amidst all their magnificent cultural achievements and reckless, destructive behavior, lived closer than most of us to the perils and prospects of their environments. This afforded them a sensitivity to their environments and, in particular, to their fellow creatures that can perhaps help to disabuse us of our disconnectedness from animal life. This small volume demonstrates how astoundingly relevant the ancients still are in this regard. (shrink)

Objective: The field of clinical ethics is relatively new and expanding. Best practices in clinical ethics against which one can benchmark performance have not been clearly articulated. The first step in developing benchmarks of clinical ethics services is to identify and understand current practices.Design and setting: Using a retrospective case study approach, the structure, activities, and resources of nine clinical ethics services in a large metropolitan centre are described, compared, and contrasted.Results: The data yielded a unique and detailed account of (...) the nature and scope of clinical ethics services across a spectrum of facilities. General themes emerged in four areas—variability, visibility, accountability, and complexity. There was a high degree of variability in the structures, activities, and resources across the clinical ethics services. Increasing visibility was identified as a significant challenge within organisations and externally. Although each service had a formal system for maintaining accountability and measuring performance, differences in the type, frequency, and content of reporting impacted service delivery. One of the most salient findings was the complexity inherent in the provision of clinical ethics services, which requires of clinical ethicists a broad and varied skill set and knowledge base. Benchmarks including the average number of consults/ethicist per year and the hospital beds/ethicist ratio are presented.Conclusion: The findings will be of interest to clinical ethicists locally, nationally, and internationally as they provide a preliminary framework from which further benchmarking measures and best practices in clinical ethics can be identified, developed, and evaluated. (shrink)

The imbalance between supply of organs for transplantation and demand for them is widening. Although the current international drive to re-establish procurement via non-heart beating organ donation/donor is founded therefore on necessity, the process may constitute a desirable outcome for patient and family when progression to brain stem death does not occur and conventional organ retrieval from the beating heart donor is thereby prevented. The literature accounts of this practice, however, raise concerns that risk jeopardising professional and public confidence in (...) the broader transplant programme. This article focuses on these clinical, ethical, and legal issues in the context of other approaches aimed at increasing donor numbers. The feasibility of introducing such an initiative will hinge on the ability to reassure patients, families, attendant staff, professional bodies, the wider public, law enforcement agencies, and the media that practitioners are working within explicit guidelines which are both ethically and legally defensible. (shrink)

In recent years, we have seen a new concern with ethics training for research and development professionals. Although ethics training has become more common, the effectiveness of the training being provided is open to question. In the present effort, a new ethics training course was developed that stresses the importance of the strategies people apply to make sense of ethical problems. The effectiveness of this training was assessed in a sample of 59 doctoral students working in the biological and social (...) sciences using a pre–post design with follow-up and a series of ethical decision-making measures serving as the outcome variable. Results showed not only that this training led to sizable gains in ethical decision making but also that these gains were maintained over time. The implications of these findings for ethics training in the sciences are discussed. (shrink)

This book studies the interfaces of ethics, economics, and politics. Public policy issues involve all three of these subjects. Although it may be seen as suggesting the nucleus of a joint university course, the book is accessible to and should interest all those concerned with political decisions. Any such decision needs a criterion for judging whether one action or outcome is better than another. Even a dictator must to some extent be concerned about the economic elfare of the citizens; and (...) a democratic government more so. But how is a person's economic welfare to be judged? Furthermore, any political decision affects the economic welfare of different people differently. How then is the welfare of a community to be judged? This is an ethical question. Underlying any coherent public policy there must be a relevant moral code. (shrink)

This book studies the interfaces of ethics, economics, and politics. Public policy issues involve all three of these subjects. Although it may be seen as suggesting the nucleus of a joint university course, the book is accessible to and should interest all those concerned with political decisions. Any such decision needs a criterion for judging whether one action or outcome is better than another. Even a dictator must to some extent be concerned about the economic welfare of the citizens; and (...) a democratic government more so. But how is a person's economic welfare to be judged? Furthermore, any political decision affects the economic welfare of different people differently. How then is the welfare of a community to be judged? This is an ethical question. Underlying any coherent public policy there must be a relevant moral code. (shrink)

Legislation that authorises controversial organ procurement strategies but ignores respect for autonomy is flawed in principle and predictably unworkable in practiceThe UK Human Tissue Act 2004,1 designed to regulate all activity involving human tissue, organs, or bodies, was introduced in the House of Commons in December 2003, received Royal Assent on 15 November 2004,2 and has been partially implemented by Commencement Orders from April 2005. The new act, which repeals and replaces the Human Tissue Act 1961, the Anatomy Act 1984, (...) and the Human Organ Transplants Act 1989, has its origins in events of serious public concern, namely the retained organs scandals at Bristol Royal Infirmary3 and the Royal Liverpool Childrens’ Hospital.4 The act is correspondingly dominated by regulation of postmortem examinations and retention of human tissue, with consistent emphasis on the need for fully informed consent. Compliance with these requirements is now mandatory with the threat of up to three years’ imprisonment and/or fines for any deviation.The impact of the original proposals within the bill on research and the clinical practice of pathology have been carefully considered and documented,5 with subsequent amendments to ameliorate professional concerns.6 The act, however, also carries significant implications for medical practice in areas where donor recruitment for transplantation can take place, and representations on these aspects during readings of the bill7 have produced neither clarification, justification, nor amendment within the final legislation.Section 43 will make it lawful for hospital authorities “to take steps for the purpose of preserving the part for use for transplantation and to retain the body for that purpose”. The original explanatory notes for the bill8 while it proceeded through parliament implied that such action, prior to consent to transplantation being sought, was then lawful, clause 44 as section 43 …. (shrink)

Ian Little has been one of the most significant British contributors to economics in the post-war era. His contributions to Welfare Economics and Development Economics have been highly influential and well-regarded throughout the world. This book is a fascinating insight into the personal and intellectual development of Professor Little, containing both the most important articles of his working life and autobiographical chapters.

In 1792 Dugald Stewart published Elements of the philosophy of the human mind. In its section on abstraction he declared himself to be a nominalist. Although a few scholars have made brief reference to this position, no sustained attention has been given to the central role that it played within Stewart’s early philosophy of mind. It is therefore the purpose of this essay to unpack Stewart’s nominalism and the intellectual context that fostered it. In the first three sections I aver (...) that his nominalism emanated from his belief that objects of the mind—qualities, ideas and words—were signs that bore no necessary relation to the external objects that they were meant to represent. More specifically, it was these signs that were arranged into systems of thought by the ‘operations of the mind’. The next three sections suggest that his treatment of words as signs most probably originated in his views on language and medicine and that his nominalistic philosophy of mind could also be extended to systems that sought to classify the natural world. I conclude by suggesting several avenues of enquiry that could be pursued by future scholars interested in excavating Stewart’s thought. (shrink)

Discusses the metaphysics of the iterative conception of set.