William of Malmesbury's Regesta Regum Anglorum is one of the great histories of England, and one of the most important historical works of the European Middle Ages. Although its focus is national, its scope encompasses most of Western Europe and beyond, providing a full-scale account of the First Crusade. Apart from its formidable learning, it is characterized by narrative skill and entertainment value - with topics including unpowered flight and Henry I's zoo. This edition in the Oxford Medieval Texts series (...) is the first modern translation and edition. A full historical introduction is supplied in Volume II. (shrink)

William of Malmesbury's Regesta Regum Anglorum is one of the great histories of England, and one of the most important historical works of the European Middle Ages. Although its focus is national, its scope encompasses most of Western Europe and beyond, providing a full-scale account of the First Crusade. Apart from its formidable learning, it is characterized by narrative skill and entertainment value - with topics including unpowered flight and Henry I's zoo. This edition in the Oxford Medieval Texts series (...) is the first modern translation and edition. A full historical introduction is supplied in Volume II. (shrink)

In the years 1878 and 1879 the American physicist Alfred Marshall Mayer published his experiments with floating magnets as a didactic illustration of molecular actions and forms. A number of physicists made use of this analogy of molecular structure. For William Thomson they were a mechanical illustration of the kinetic equilibrium of groups of columnar vortices revolving in circles round their common centre of gravity . A number of modifications of Mayer's experiments were described, which gave configurations which were (...) more or less analogous to Mayer's arrangements. It was Joseph John Thomson who, in publications between 1897 and 1907, used Mayer's results to obtain a good deal of insight into the general laws which govern the configuration of the electrons in his atomic model. This article is mainly concerned with Mayer's experiments with floating magnets and their use by a number of physicists. Through his experiments Mayer made a significant, although small, contribution to the theory of atomic structure. (shrink)

This paper begins with a discussion of the current legal definition of sex laid down in Corbett v Corbett. The implications of this test for three areas of the law, marriage, birth certificates and employment are then examined. Solutions from the United States of America and West Germany are studied and the suitability of similar solutions being transplanted into British law discussed.

Organ donation after a circulatory determination of death is possible in selected patients where consent is given to support donation and the patient has been legally declared dead by two doctors. The National Health Act (61 of 2003) and regulations provide strict controls for the certification of death and the donation of organs and tissues after death. Although the National Health Act expressly recognises that brain death is death, it does not prescribe the medical standards of testing for the determination (...) of brain death (neurological determination of death), circulatory death (circulatory determination of death) or for determination of death based on somatic criteria. However, in all cases of organ donation, including after circulatory death, the National Health Act mandates that two doctors certify the death, with one doctor possessing more than 5 years of experience. Additionally, both doctors must be independent from the transplant team. The standard for such determination, as for brain death, aligns with accepted medical standards. The Critical Care Society of Southern Africa has published South African (SA) Guidelines on Death Determination that outline rigorous standards for death determination in hospital settings by either a neurological or circulatory method. Legislation and the Health Professions Council of SA’s (HPCSA) professional guidance direct clinicians on obtaining informed consent for donation either from the patient or in cases of incapacity from their surrogate decision maker. Collectively, the legislation, regulations and professional guidelines in SA provide a robust ethical framework that supports organ donation after circulatory death. (shrink)

This second volume contains commentaries on the Latin Aristotle from the University Library, the Fitzwilliam Museum, and the college libraries of the University of Cambridge. This is the second of a projected series of four volumes describing manuscripts and fragments in British libraries containing commentaries on the Latin Aristotle. This volume covers the University Library, the Fitzwilliam Museum, and the college libraries of the University of Cambridge. It lists 152 items , dating from the tenth century until c. 1500. While (...) a few of these manuscripts came to Cambridge after the Reformation, the majority were already in use in the medieval University. Not many have been adequately described before, while most of the anonymous commentaries have not been listed anywhere. Four indexes are provided to facilitate searching the main text. (shrink)

The late eleventh and twelfth centuries were Europe's first age of pamphlet warfare, of invective and satire. The perceived failure, or at least hypocrisy, of its new institutions-the new monastic orders and the reformed papacy-gave rise to the phenomenon, and it was shaped by the study of grammar and rhetoric in the new Schools. The central figures in the texts in the present book are Bernard of Clairvaux, the powerful ostensible founder of the Cistercian order, and the popular and influential (...) teacher Peter Abelard, leader of the radical faction in the Schools of Paris. The event which sparked this controversy was the Church council at Sens in 1141 which had led to the condemnation of Abelard's doctrines. Abelard proposed to use reason to explain the mysteries of faith, and this had led him into all kinds of difficulties with established church doctrine. The leading light in the atttack on his ideas was Bernard, the famous abbot of Clairvaux, a group of whose letters, written to gather support for it before and after the Council, are presented here. A little while later Abelard was defended by the vituperative but otherwise unknown Berengar, who wrote an outrageous Apology attacking Bernard; we also edit his remaining polemical works: his Letter to the Carthusians, and his Letter to the Bishop of Mende. None of Berengar's works has been translated before. An extensive introductory essay describes the course of the debate and the personnel, and analyses the invective employed by both Bernard and Berengar. There is full annotation identifying the writers' sources and clarifying the issues."-- Back cover. (shrink)

Research is increasingly recognised as a key component of medical curricula, offering a range of benefits including development of skills in evidence-based medicine. The literature indicates that experienced academic supervision or mentoring is important in any research activity and positively influences research output. The aim of this project was to investigate the human research ethics experiences and knowledge of three groups: medical students, and university academic staff and clinicians eligible to supervise medical student research projects; at two Australian universities. Training (...) in research ethics was low amongst academic staff and clinicians eligible to supervise medical student research. Only two-thirds of academic staff and students and less than half of clinicians surveyed indicated that specific patient consent was required for a doctor to include patient medical records within a research publication. There was limited awareness of requirements for participant information and consent forms amongst all groups. In the case of clinical trials, fewer clinicians and students than academics indicated there was a requirement to obtain consent. Awareness of the ethics committee focus on respect was low across all groups. This project has identified significant gaps in human research ethics understanding among medical students, and university academic staff and clinicians. The incorporation of research within medical curricula provides the impetus for medical schools and their institutions to ensure that academic staff and clinicians who are eligible and qualified to supervise students’ research projects are appropriately trained in human research ethics. (shrink)

ABSTRACT In establishing National Bioethics Organisations (NBOs), liberal democracies seek to acknowledge the diversity of strongly held ethical positions and the imperative to engage in public debate about important bioethical decisions. NBOs are typically given a range of responsibilities, including contributing to and stimulating public debate; providing expert opinion on relevant issues for policy deliberations; and developing public policy. The state is now found to have an interest in areas previously thought to be a matter of individual choice. NBOs can (...) provide one way of opening up public debate to allow the diversity of views to be heard in a manner that is well‐informed, articulate and responsive to both expert and ‘lay’ public views. We draw on debates in political theory about democratic decision‐making and on the policy making roles of some key NBOs. We are particularly interested in examining the capacity of NBOs to meet the democratic ideal of effective participation by the public, or citizenry, especially by those who are directly affected by the policies, in the development of effective public policy. We provide a basic framework for policy development involving NBOs that can begin to meet this ideal, a process of ‘contested deliberation’. (shrink)

κάτοπτρον, which is in all the manuscripts, was emended by Canter to κάτοπτον, and this emendation, or Headlam's κατόπτην, has been received by subsequent editors. Those who read κάτοπτον have been in the habit of taking the word to mean here ‘looking down upon’, and in support of this interpretation they sometimes adduce a scholium in M, κατόψιον. This does seem to prove that the scholar, whose note is copied in our scholium, found κάτοπτον in his text. Presumably he took (...) Σαρωνικο πορθμο κάτοπτον to signify ‘descried from the Saronic gulf’, having very possibly in his mind the phrase in Euripides, Hippolytus 30, where the temple of Cypris is said to be κατόψιον γς τσδε, visible from Troezen. At least we ought not without proof to lay to his account what appears to be the solecism of regarding κάτοπτον as if it meant ‘looking down upon’. Headlam's κατόπτην has at least an active force, but I cannot find that it means ‘one who looks down upon’, if that is the sense desired; it is a ‘spy’ or an ‘inspector’. And, at the end of all discussion, when one asks what in fact is this peak or headland that ‘looks down upon the Saronic crossing’, then commentators take refuge in silence or tend to contradict one another. An emendation that nobody can be sure he understands can hardly be regarded as satisfactory. It may be feared that what has happened is this. In order to get rid of κάτοπτρον, which appeared to them devoid of meaning, editors have introduced into the text a word which does not mean what they want it to mean, and which, if it had that meaning, would still present us with a picture which no man can recognize. (shrink)

There are differences in caregivers’ literacy and health literacy levels that may affect their ability to consent to children participating in clinical research trials. This study aimed to explore the effectiveness, and caregivers’ understandings, of the process of informed consent that accompanied their child’s participation in a dental randomized control trial (RCT). Telephone interviews were conducted with a convenience sample of ten caregivers who each had a child participating in the RCT. Pre-tested closed and open-ended questions were used, and the (...) findings were produced from an inductive analysis of the latter and a descriptive analysis of the former. Participants had limited understanding of the purpose of the RCT and rated the readability of the consent form more highly than they rated their understanding of the research. All felt that informed consent was vital, but some caregivers had not read the consent documents. Some caregivers enrolled their child in the RCT because they trusted the researchers, and the majority wanted to improve dental care for children. The informed consent process was not always effective despite high readability of the informed consent documents. Researchers must consider the health literacy of the study group, and actively engaging with caregivers to achieve meaningful informed consent may be challenging. Future research could explore participants’ perspectives of informed consent in populations with low health literacy and assess whether an underlying expectation not to comprehend health-related information may be a barrier to informed consent. (shrink)

Investigation of neural and cognitive processes underlying individual variation in moral preferences is underway, with notable similarities emerging between moral- and risk-based decision-making. Here we specifically assessed moral distributive justice preferences and non-moral financial gambling preferences in the same individuals, and report an association between these seemingly disparate forms of decision-making. Moreover, we find this association between distributive justice and risky decision-making exists primarily when the latter is assessed with the Iowa Gambling Task. These findings are consistent with neuroimaging studies (...) of brain function during moral and risky decision-making. This research also constitutes the first replication of a novel experimental measure of distributive justice decision-making, for which individual variation in performance was found. Further examination of decision-making processes across different contexts may lead to an improved understanding of the factors affecting moral behaviour. (shrink)

we always get to this difficult conversation one way or another when I'm talking to friends who have kids with disabilities. It goes like this: "If there had been a test for autism when my wife was pregnant with our son," my close friend tells me, "she would definitely have had an abortion." He tells me this with candor because he knows I know that this does not mean that he regrets having the son, grown up now, that they do (...) have. Parents with disabled children are usually rightfully wary about engaging in such conversations, but perhaps because I have a significant congenital genetic disability myself, we talk together about this with intimacy and mutual understanding. With his reflection about what we now... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Ethical, Legal, and Social Implications Research Program at the National Human Genome Research InstituteEric M. Meslin (bio), Elizabeth J. Thomson (bio), and Joy T. Boyer (bio)Organizers of the Human Genome Project (HGP) understood from the beginning that the scientific activities of mapping and sequencing the human genome would raise ethical, legal, and social issues that would require careful attention by scientists, health care professionals, government officials, and (...) the public. The establishment of the ELSI (ethical, legal, and social implications) programs at the National Human Genome Research Institute (NHGRI) and the Department of Energy (DOE) was thought to be vital to the success of the HGP in the United States. It also provided a novel approach to the simultaneous study of ethical, legal, and social issues and basic scientific issues. Eric Juengst, the first director of the ELSI program, described its origins in a previous issue of the Kennedy Institute of Ethics Journal (Juengst 1991). Now in its seventh year, the ELSI program has accomplished much. This article summarizes the evolution and goals of the ELSI program at NHGRI, outlines the program’s current research priorities with examples of activities within each priority area, and provides a look to the future, including the initiation of a strategic planning process.Evolution and Goals of the ELSI Research ProgramThe HGP’s “genomic” goals are unique: to map and sequence the entire human genome—some 3 billion base pairs that make up approximately 80–100,000 genes—and the genomes of related model organisms by the year 2005. This goal was particularly ambitious since, when it was proposed, the technologies for mapping and sequencing had yet to be developed. When the HGP was first established, its organizers also elaborated a set of ELSI goals, which they saw as vital to the success of the genome project. The original ELSI goals were: (1) to anticipate and address the implications of the HGP for individuals and society and (2) to examine the ELSI consequences of mapping and sequencing the human genome in order to stimulate public discussion. To meet these goals, the NHGRI created its ELSI research program in 1990. Along with mapping, sequencing, [End Page 291] and mammalian genetics, ELSI was one of four original branches in the NHGRI Division of Extramural Research that funded research in those areas. Although the individual “branches” no longer exist, the mechanisms for funding research remain much the same. While the overall goals of the program have not changed, the specific ways of achieving the goals have continued to evolve. The importance of the ELSI program lies not in the collection of a full set of data that will be valuable in and of itself, but in the value of using and interpreting this new set of information.Early on, the NHGRI described a set of somewhat more specific goals: (1) to develop a program to help understand the ethical, legal, and social implications of the human genome project and (2) to identify and define the major issues of concern and develop policy options to address them. These more specific goals have been largely met. As the most recent biennial NHGRI Progress Report notes, “a robust ELSI research and education program has been established, many of the most urgent ELSI issues have been identified, and many policy options to address these issues have been proposed” (NCHGR 1995, p. 21). Between 1990 and 1996, ELSI provided more than $32.5 million in funding through 128 research and education grants in more than 30 states and in Canada (Table 1). The ELSI research budget is unique in that when originally created, it was specifically tied to the amount of money provided for the overall NHGRI budget. The NHGRI originally devoted 3 percent of its extramural budget to fund ELSI projects, but in FY 1991, it increased the ELSI budget to 5 percent, a figure that remains today. Table 2 lists the expenditures for each fiscal year since 1990 and the cumulative expenditures to date. The ELSI research budget at NHGRI this year will be about $7 million. When other sources of funding—e.g., co-funding arrangements with other institutes and agencies and the funding of ELSI... (shrink)

Few figures of the Middle Ages command the attention of so many modern disciplines as Robert Grosseteste (c. 1170-1253). Theology, Philosophy, History, and Science are all areas which his life and thought continue to have significance and to inspire re-interpretation. Accompanied by a series of original commentaries, this new edition of Grosseteste's work, with English translation, draws together the perspectives of modern scientists and medieval specialists. Volume I of a six volume series, Knowing and Speaking presents two of the earliest (...) of Grosseteste's works, the treatises On the Liberal Arts and On the Generation of Sounds. These are accompanied by a significant Middle English treatise on the Seven Liberal Arts whose anonymous fifteenth-century author translated and excerpted passages from Grosseteste's treatises in a re-imagining of their structure and function.0Each work is treated separately within the volume, which is constructed in three parts. On the Liberal Arts sets Grosseteste's thoughts on the arts subjects and emphasises moral concerns about the purpose of learning. On the Generation of Sounds builds on the theories and statements of On the Liberal Arts in connection to the production of sound, elaborating the earlier position, relating the generation of sounds to human vocal and speech production. (shrink)

Richard Cartwright's impact on other philosophers has been as much a product of his own personal contact with students and colleagues as the result of his written work. The essays in this book demonstrate the deep influence he has had, not only by his thinking but equally by his style and manner and, above all, by his clarity and purity of intention. All of the essays are concerned with the questions of logic, language, and metaphysics that have been at the (...) core of Cartwright's own work. The chapters and their authors are: The Consistency of Frege's Foundations of Arithmetic, George Boolos. Russell's "No-Classes" Theory of Classes, Leonard Linsky. Quine's Indeterminacy, Charles S. Chihara. Justifying Symbolizations, Harold Levin. Substitutivity, Scott Soames. Moore-Paradox, Sincerity Conditions, and Epistemic Qualification, Charles E. Caton. Matching Illocutionary Act Types, William P. Alston. Scattered Objects, Roderick M. Chisholm. Parts and Places, Helen Morris Cartwright. Ruminations on an Account of Personal Identity, Judith Jarvis Thomson. G_del's Ontological Proof, Jordan Howard Sobel. "The Concept of the Subject Contains the Concept of the Predicate," David Wiggins. Judith Jarvis Thomson is Professor of Philosophy at MIT. Philosophical Essays, the first collection of Richard Cartwright's work, is being published simultaneously by The MIT Press. (shrink)

After a chapter which is an introduction to and summary of the rest of the book, chapter 2 begins by criticizing various attempts to do away with theories, such as the Reichenbach-Salmon conception of theoretical truth in terms of observational consequences, and the Ramsey strategy of replacing first-order theoretical sentences by second-order nontheoretical ones; it then argues against hypothetico-deductivist theories of confirmation on the grounds that they are unable to handle the relevance of evidence to theory, whether or not other (...) formal constraints or even nonformal ones such as simplicity and explanatory power are added to those theories; it ends with an exposition of the Reichenbach-Carnap conventionalist thesis that the confirmation of hypotheses with evidence presupposes analytic principles connecting hypothetical and empirical concepts. Chapter 3 criticizes Bayesian theories of confirmation on such grounds as that the a priori arguments for Bayesian restrictions on beliefs are insufficient; that the Bayesian explanations of notions like variety of evidence, ad hocness, and simplicity are inadequate; and that they cannot account, without drastic revisions, for the relevance of evidence to theory, especially old evidence to new theory. Chapter 4 is an unsympathetic account of historically oriented philosophies of science; Lakatos’s notion of progressive research programs and Laudan’s theory of problem-solving effectiveness are found to be insufficiently precise and dubbed examples of "new fuzziness", while the Sneed-Stegmüller dynamics of theories is regarded as "a paradigm of misplaced rigor" ; and all three are criticized as unable to explicate the concept of evidential relevance. Chapter 5 is a formal and informal elaboration of the basic idea in Glymour’s account of theory and evidence, namely that confirmation or support is a three-term relation among evidence, hypothesis, and theory, so that evidence confirms an hypothesis only relative to a theory, and such that evidence e confirms hypothesis h relative to T if T with e implies, but T without e does not imply, an instance of h, and T with e does not imply a comparable hypothesis h’ different from h; the most interesting part of this chapter is a series of discussions showing how such an idea makes sense of the "methodological truisms" that it is possible selectively to test certain parts of a theory but not others, that a theory is supported better by a greater variety of evidence, that redundant or physically meaningless quantities are an undesirable feature of theories, that there are no inviolable rules, that a "white shoe" does not confirm "all ravens are black," that a theory is more useful and better supported than the set of its observational consequences, and that the hypothetico-deductive method often works. Since Glymour claims no originality for the conception of this general account, but only for its description, he plausibly thinks it necessary to apply it to some important historical cases of actual science; he does so in the next chapter by discussing at some length the structure and merits of Ptolemaic and Copernican astronomy, of Newton’s universal gravitation, of nineteenth century atomism, of Freud’s Rat Man, and of general relativity. For example, he argues convincingly that Copernicanism was better supported by the evidence available even before the telescope because it alone, and not the Ptolemaic theory, can determine some planetary properties which are presupposed by both theories, can test and confirm some common hypotheses, and can be confirmed in an essential rather than incidental manner; and though Glymour admits that the Copernicans tended to argue in terms of explanatory rather than confirmatory superiority, he sketches an interesting account of the relation between explanation and confirmation which strengthens his case. He also analyzes the text at the beginning of book 3 of Newton’s Principia and compiles a reconstruction of the intricate details of the inferential structure of the argument to universal gravitation; his impressive reconstruction clearly shows that Newton’s method is neither the inductivist one he himself thought he was following, nor the one attributed to him by Pierre Duhem, but rather one in accordance with Glymour’s so-called "bootstrap strategy" of repeatedly using the evidence from Kepler’s second and third laws, from lunar data, and from falling bodies, together with the theory consisting of the second and third laws of motion, to arrive at increasingly general instances of the principle of universal gravitation. Glymour’s account of arguments for and against the atomic theory from Thomson to Cannizzaro is his longest historical example, but he himself admits that this illustration of the bootstrap strategy is "certainly not the neatest", and rather "diffuse, and perhaps disconnected". Chapter 7 is a detailed application of the same principles to the technique known among social scientists as "causal modeling"; since such "causal models" are essentially systems of algebraic equations, Glymour’s account shows indirectly that the bootstrap strategy is applicable to any scientific theory presented as a set of algebraic equations; this, of course is not surprising, since the formal considerations with which Glymour begins the exposition of his theory in chapter 5 involve systems of algebraic equations. Chapter 8 is an attempt to apply Glymour’s theory of evidence to the very common scientific practice of curve-fitting, where one measures values of two or more quantities and then infers a functional relationship; Glymour argues that simpler polynomials are preferred because they are tested more frequently and more severely by the data and because they are more informative; but then he criticizes his own explanation and concludes that "the bootstrap procedures of chapter 5 do not seem to help the problem much more than a whit" ; this is admirably honest, but if one wants an additional logical or methodological rationale, then one would perhaps have to go to the meta-level and say that Glymour is here testing his own theory, and he is more interested in a further illustration of the bootstrap methodology even with a failed test, than he is to claim universal or exclusive validity for it. In chapter 9 Glymour uses his bootstrap theory of confirmation to criticize geometrical conventionalism; he considers the alternative theories of space or space-time proposed by conventionalists to show the radical undetermination of geometries by evidence, for example, a non-Euclidean geometry with no universal force instead of Newtonian gravitation with Euclidean geometry; he argues that such alternatives are simply not as well tested as the originals and that their equivalence to the originals is questionable. The last chapter is a brief discussion of further problems worthy of future investigation. (shrink)

Iain I remember reading Thomas Jefferson in high school; he wrote so eloquently about our human need for freedom that I got choked up just reading him. When I found out he'd had slaves I was stunned, traumatized intellectually, but I lacked the resources to work through it very far at the time. Reading Heidegger a few years later I had a similar experience, only magnified and more complicated. As I read Heidegger's later work in Hubert Dreyfus's wonderful "later Heidegger" (...) course at UC Berkeley, I had that strange experience Emerson describes as our own ideas returning to us with "alienated majesty"; here, I thought, was someone who had eloquently expressed ideas that I felt were at the core of my own thinking but that I had never managed to articulate adequately. I was deeply moved by Heidegger's critique of our increasingly nihilistic treatment of our world and each other as meaningless resources to be optimized and I was inspired by his vision of poetic thinking as a way out of this historical nihilism. Then I found out he'd been a Nazi. I was intellectually traumatized once again. But this time I didn't let the question go: How could the greatest thinker of the twentieth century have thrown the weight of his thinking behind its most horrible political regime? That's something I've been struggling with for almost twenty years now. I believe I made some real progress in understanding this difficult and controversial issue in Heidegger on Ontotheology: Technology and the Politics of Education, and I hope to disseminate the view I presented there to a broader audience in a book I'm working on now, an intellectual biography of Heidegger. (shrink)

In an interesting paper read some time ago to the Cambridge Philological Society , H. J. M. Milne analysed the first Ode of Sappho and showed that it is constructed according to those principles of poetical form which we should expect to find in the work of so delicate a Greek artist. If more of these lyrics had survived in their entirety, the task of expounding the technique of Greek poetry would be simpler than it is, because naturally the principles (...) are more easily grasped in a short lyric than in epic or drama. (shrink)

In “Imposing Risks,” Judith Thomson gives a case in which, by turning on her stove, she accidentally causes her neighbor’s death. She claims that both the following are true: (1) she ought not to have caused her neighbor’s death; (2) it was permissible for her to turn her stove on. In this paper it is argued that it cannot be that both (1) and (2) are true, that (2) is true, and that therefore (1) is false. How this is (...) so is explained, and the implications of this position regarding the relation between rights and duties is explored. (shrink)

The ArgumentThe societal context within which science is pursued generally acts as a productive force in the generation of knowledge. To analyze this action it is helpful to consider particular modes of mediation through which societal concerns are projected into the very local and esoteric concerns of a particular domain of research. One such mode of mediation occurs through material systems. Here I treat two such systems – the steam engine and the electric telegraph – in the natural philosophy of (...) William Thomson (Lord Kelvin).The steam engine illustratesconceptualmediation. It simultaneously instantiates “labor value” in political economy and “work” in engineering mechanics, thereby identifying the two concepts in the region of their common reference. The partial identification carries with it a structural analogy between a network of concepts from political economy and a similar network in natural philosophy, providing a potent heuristic for the reformulation and further development of dynamics.The electric telegraph illustratesmethodologicalmediation. It projects the interests of engineering and industry into the interests of electromagnetic theory and vice versa, thereby establishing, in Thomson's view, a Baconian unity of truth and utility. As the common reference of theory and practice, the telegraph locates the truth of theoretical knowledge in its utility and the utility of practical knowledge in its truth.These particular cases of conceptual and methodological mediation indicate how the local practices, concepts, and interests of a research specialty, or subculture, draw on and are adapted to those of the larger culture within which they develop. Thus the analysis of mediation leads to an ecological model of the social construction of scientific knowledge. (shrink)

Patients in a vegetative state/ unresponsive wakefulness syndrome (VS/UWS) pose ethical dilemmas to those involved. Many conflicts occur between professionals and families of these patients. In the Netherlands physicians are supposed to withdraw life sustaining treatment once recovery is not to be expected. Yet these patients have shown to survive sometimes for decades. The role of the families is thought to be important. The aim of this study was to make an inventory of the professional perspective on conflicts in long-term (...) care of patients in VS/UWS. A qualitative study of transcripts on 2 Moral Deliberations (MD’s) in 2 cases of patients in VS/UWS in long-term care facilities. Six themes emerged: 1) Vision on VS/UWS; 2) Treatment and care plan; 3) Impact on relationships; 4) Feelings/attitude; 5) Communication; 6) Organizational aspects. These themes are related to professionals and to what families had expressed to the professionals. We found conflicts as well as contradictory feelings and thoughts to be a general feature in 4 of these themes, both in professionals and families. Conflicts were found in several actors: within families concerning all 6 themes, in nurse teams concerning the theme treatment and care plan, and between physicians concerning all 6 themes. Different visions, different expectations and hope on recovery, deviating goals and contradictory feelings/thoughts in families and professionals can lead to conflicts over a patient with VS/UWS. Key factors to prevent or solve such conflicts are a carefully established diagnosis, clarity upon visions, uniformity in treatment goals and plans, an open and empathic communication, expertise and understanding the importance of contradictory feelings/thoughts. Management should bridge conflicts and support their staff, by developing expertise, by creating stability and by facilitating medical ethical discourses. Shared compassion for the patient might be a key to gain trust and bridge the differences from non-shared to shared decision making. (shrink)