Background: Despite the expansion of ethics consultation services, questions remain about the aims of clinical ethics consultation, its methods and the expertise of those who provide such services.Objective: To describe physicians’ expectations regarding the training and skills necessary for ethics consultants to contribute effectively to the care of patients in intensive care unit .Design: Mailed survey.Participants: Physicians responsible for the care of at least 10 patients in ICU over a 6-month period at a 921-bed private teaching hospital with an established (...) ethics consultation service. 69 of 92 eligible physicians responded.Measurements: Importance of specialised knowledge and skills for ethics consultants contributing to the care of patients in ICU; need for advanced disciplinary training; expectations regarding formal-training programmes for ethics consultants.Results: Expertise in ethics was described most often as important for ethics consultants taking part in the care of patients in ICU, compared with expertise in law , religious traditions , medicine and conflict-mediation techniques . When asked about the formal training consultants should possess, however, physicians involved in the care of patients in ICU most often identified advanced medical training as important.Conclusions: Although many physicians caring for patients in ICU believe ethics consultants must possess non-medical expertise in ethics and law if they are to contribute effectively to patient care, these physicians place a very high value on medical training as well, suggesting a “medicine plus one” view of the training of an ideal ethics consultant. As ethics consultation services expand, clear expectations regarding the training of ethics consultants should be established. (shrink)

Following up on a 1989 paper on the subject, this essay revisits the question of ethical expertise in the court room. Informed by recent developments in the use of ethics experts, the authors argue 1) that the adversarial nature of court proceedings challenges the integrity of the ethicist's pedagogical role; 2) that the use of ethics experts as normative authorities remains dubious; 3) that clarification of the State's interest in “protecting the ethical integrity of the medical profession” is urgently required; (...) and 4) that the expertise of the ethicist may be more appropriately used in advising the legislature than in influencing the court. (shrink)

Large-scale sequencing tests, including whole-exome and whole-genome sequencing, are rapidly moving into clinical use. Sequencing is already being used clinically to identify therapeutic opportunities for cancer patients who have run out of conventional treatment options, to help diagnose children with puzzling neurodevelopmental conditions, and to clarify appropriate drug choices and dosing in individuals. To evaluate and support clinical applications of these technologies, the National Human Genome Research Institute and National Cancer Institute have funded studies on clinical and research sequencing under (...) the Clinical Sequencing Exploratory Research program as well as studies on return of results. Most of these studies use sequencing in real-world clinical settings and collect data on both the application of sequencing and the impact of receiving genomic findings on study participants. They are occurring in the context of controversy over how to obtain consent for exome and genome sequencing. (shrink)

A recently formulated concept of stochastic localizability is shown to be consistent with a concept of stochastic microcausality, which avoids the conclusions of Hegerfeldt's no-go theorem as to the inconsistency of sharp localizability of quantum particles and Einstein causality. The proposed localizability on quantum space-time is shown to lead to strict asymptotic causality. For finite time evolutions, upper bounds on propagation to the exterior of stochastic light cones are derived which show that the resulting probabilities are too small to (...) be actually observable in a realistic context. (shrink)

Carol Gilligan has identified two orientations to moral understanding; the dominant justice orientation and the under-valued care orientation. Based on her discernment of a voice of care, Gilligan challenges the adequacy of a deontological liberal framework for moral development and moral theory. This paper examines how the orientations of justice and care are played out in medical ethical theory. Specifically, I question whether the medical moral domain is adequately described by the norms of impartiality, universality, and equality that characterize the (...) liberal ideal. My analysis of justice -oriented medical ethics, focuses on the libertarian theory of H.T. Engelhardt and the contractarian theory of R.M. Veatch. I suggest that in the work of E.D. Pellegrino and D.C. Thomasma we find not only a more authentic representation of medical morality but also a project that is compatible with the care orientation's emphasis on human need and responsiveness to particular others. (shrink)

Chefs have been recognized as potentially important partners in efforts to promote local food systems. Drawing on the diffusion of innovation framework we (a) examine the characteristics of chefs and restaurants that have adopted local foods; (b) identified local food attributes valued by restaurants; (c) examine how restaurants function as opinion leaders promoting local foods; (d) explored network linkages between culinary and production organizations; and (e) finally, we consider some of the barriers to more widespread adoption of local foods in (...) the culinary community. Analyzing quantitative and qualitative data collected from interviews with individuals from 71 restaurants, we compare and contrast restaurants that utilize relatively large amounts of locally-produced ingredients with restaurants using few, if any, local products. Results reveal that chefs are most interested in intrinsic food qualities, such as taste and freshness, and less interested in production standards. As opinion leaders, chefs utilize signage, wait staff, and cooking classes to promote local foods; however, the diffusion process across restaurants, and between restaurants and producers, is limited by network associations. Structural barriers such as distribution problems and lack of convenience were identified as limiting more widespread use of locally-grown foods. We offer several implications of this research for further work that seeks to engage chefs as opinion leaders who are important to building greater support for local food systems. (shrink)

The lines come from the messenger's speech describing the attack of the Delphians on Neoptolemus, a passage which I have discussed elsewhere in connexion with the tradition of Neoptolemus as inventor of the armed Pyrrhic dance. LSJ seem to be in several minds about the meaning and connexion of some of the words describing the missiles used by the Delphians. S.v. ‘σφαγεύς’, they give ‘sacrificial knife, spit’ uniquely of a word elsewhere meaning ‘slayer, murderer’, etc.. S.v. ‘βουπόρος’, they cite ἀμφωβόλοι (...) σφαγῆς … βουπόροι ‘spitst fit to pierce an ox's throat’—i.e. taking σφαγῆς as gen. sing., rather oddly dependent on βουπόροι. S.v. ‘ἔκλυτος’, they quote this passage, again uniquely, in the sense ‘easy to let go, light, buoyant, of missiles’. This last seems even less likely than Wecklein's ohne Riemen or the Budé's doubles dards sans poignée, which presumably invoke a rather frigid contrast of the true javelins fitted with thongs and the spits, sharp at both ends, which were pressed into service of a similar sort, but of course had to be thrown without this attachment: but these implements could hardly be described as ἔκλυτοι of thongs which they never had at all in the first place!With Murray's punctuation, since a combination of a, b, c τε, d is scarcely credible, σφαγῆς βουπόροι is presumably not to be taken as the description of a separate type of weapon, but as an explanatory appositional phrase with ἀμφώβολοι. This interpretation is found in the schol, ὀβελίσκοι σφάττειν δυνάμενοι and followed by Hermann and Paley. (shrink)

Political decision theory provides a framework for evaluating three approaches to military research and development: offensive weaponry intended for deterrence, the Strategic Defense Initiative and other weaponry intended fordefense, and cutbacks designed to slow the research and development treadmill. Large-scale R&D does not protect against most of the risks facing national security. Nor does an R&D-intensive approach provide the flexibility necessary to adjust military policy in light of rapidly changing international conditions. Considering all factors together, there is a strong theoretical (...) case for placing sharp constraints on military innovation, not just on the quantities of weapons deployed. (shrink)

Inside What Would Plato Do?, you'll find the basics of philosophy, written in an easy, digestible way we can all understand, along with questions to help you apply these important theories to your own life. So, after you've learned about a philosophical concept, you'll then be challenged to test yourself and see how the results can impact your daily life. For instance, after learning about Kant's theory of morality and the importance of intention you're challenged with questions like: Can good (...) people do bad things? Was there a time when you intended to do something helpful that ended up being hurtful? Does that make you a good person (because you intended to do good) or a bad person (because the results were bad)? What Would Plato Do? will not only help you better understand some of the greatest thinkers ever but will also help you think of the world around you in a whole new way! (shrink)

In its aim to radicalize the basis of objectivity, Husserl's phenomenological inquiries resemble the "new science" of Vico. But Husserl's renewal of that aim is animated by a peculiarly modern sense of antidogmatism and rigor, and its special problem is to criticize knowledge by starting with the existential a priori of the life-world. The antidogmatism of phenomenology is seen to be a consequence of its antisubjectivism. Semerari's interpretation of Husserl is provocative but sketchy; his appreciations and criticisms of Kant, several (...) analytically-oriented thinkers, Wittgenstein, Sartre, and Heidegger are very sharp, but usually left as ideas for the reader to test and work out.--C. D. (shrink)

In this paper I offer a counterexample to the so called vagueness argument against restricted composition. This will be done in the lines of a recent suggestion by Trenton Merricks, namely by challenging the claim that there cannot be a sharp cut-off point in a composition sequence. It will be suggested that causal powers which emerge when composition occurs can serve as an indicator of such sharp cut-off points. The main example will be the case of a heap. (...) It seems that heaps might provide a very plausible counterexample to the vagueness argument if we accept the idea that four grains of sand is the least number required to compose a heap—the case has been supported by W. D. Hart. My purpose here is not to put forward a new theory of composition, I only wish to refute the vagueness argument and point out that we should be wary of arguments of its form. (shrink)

Some of the objections to life-extension stem from a concern with overpopulation. I will show that whether or not the overpopulation threat is realistic, arguments from overpopulation cannot ethically demand halting the quest for, nor access to, life-extension. The reason for this is that we have a right to life, which entitles us not to have meaningful life denied to us against our will and which does not allow discrimination solely on the grounds of age. If the threat of overpopulation (...) creates a rights conflict between the right to come into existence, the right to reproduce, the right to more opportunities and space , and the right to life, the latter ought to be given precedence. (shrink)

I welcome Mr Kennedy's general approach, but query whether the concept of consumerism is so closely applicable to medical care as he maintains. However, in particular aspects, especially the handling of complaints, his criticisms echo those made by the Patients Association. Finally, I detect some ground for hope in the more enlightened attitude creeping in to the eduction of the medical student.