BackgroundSome people with progressive neurological diseases find they need additional support with eating and drinking at mealtimes, and may require artificial nutrition and hydration. Decisions concerning artificial nutrition and hydration at the end of life are ethically complex, particularly if the individual lacks decision-making capacity. Decisions may concern issues of life and death: weighing the potential for increasing morbidity and prolonging suffering, with potentially shortening life. When individuals lack decision-making capacity, the standard processes of obtaining informed consent for medical interventions (...) are disrupted. Increasingly multi-professional groups are being utilised to make difficult ethical decisions within healthcare. This paper reports upon a service evaluation which examined decision-making within a UK hospital Feeding Issues Multi-Professional Team.MethodsA three month observation of a hospital-based multi-professional team concerning feeding issues, and a one year examination of their records. The key research questions are: a) How are decisions made concerning artificial nutrition for individuals at risk of lacking decision-making capacity? b) What are the key decision-making factors that are balanced? c) Who is involved in the decision-making process?ResultsDecision-making was not a singular decision, but rather involved many different steps. Discussions involving relatives and other clinicians, often took place outside of meetings. Topics of discussion varied but the outcome relied upon balancing the information along four interdependent axes: Risks, burdens and benefits; Treatment goals; Normative ethical values; Interested parties.ConclusionsDecision-making was a dynamic ongoing process with many people involved. The multiple points of decision-making, and the number of people involved with the decision-making process, mean the question of ‘who decides’ cannot be fully answered. There is a potential for anonymity of multiple decision-makers to arise. Decisions in real world clinical practice may not fit precisely into a model of decision-making. The findings from this service evaluation illustrate that within multi-professional team decision-making; decisions may contain elements of both substituted and supported decision-making, and may be better represented as existing upon a continuum. (shrink)

Name der Zeitschrift: Semiotica Jahrgang: 2016 Heft: 208 Seiten: 79-101.

The need for a concise, comprehensive guide to the main principles and practice of psychoanalysis and psychoanalytic psychotherapy has become pressing as the psychoanalytic movement has expanded and diversified. An introductory text suitable for a wide range of courses, this lively, widely referenced account presents the core features of contemporary psychoanalytic theory and practice in an easily assimilated, but thought-provoking manner. Illustrated throughout with clinical examples, it provides an up-to-date source of reference for a wider range of mental health professionals (...) as well as those training in psychoanalysis, psychotherapy or counselling. (shrink)

The structure of traditional fiction is essentially linear or serial. No matter how complex a given work may be, it presents information to its reader successively, one element at a time, in a sequence determined by its author. By contrast, interactive fiction is parallel in structure or, more accurately, dendritic or tree-shaped. Not one, but several possible courses of action are open to the reader. Further, which one actually happens depends largely, though not exclusively, upon the reader’s own choices. To (...) be sure, the author is still in overall control, since it is she who has set up the particular nexus of events, but the route up the narrative tree, the actual sequence of events, is generally affected, if not completely determined, by the reader’s responses to that particular reader’s specific situation. In an adventure, the sequence of action frequently depends upon the reader’s decision to go in one geographical direction rather than another. In the eliza sample, the content of the “story” depends on such particulars as whether this reader has a brother or not, whether she fears her father, and why she has consulted the terminal. In general, the text presented to the eliza-reader depends on what that reader has already said and how the computer has interpreted and stored it, and this is generally true of interactive fiction.Further, interactive fiction is, in principle , open-ended—infinite. A conversation with eliza could go on for as long as one with Woody Allen’s psychoanalyst—in principle, forever. It has no necessary terminus. The program will go one writing texts and answers on the screen as long as the reader or player chooses to supply responses. Further, the computer can act as a metafictional narrator like John Barth or Thomas Pynchon who can create a story within a story or a story that generates another story within itself which generates another story within itself and so on, fictions dizzying and dazzling. One senses one’s essential humanity wobbling in the midst of the infinite paradoxes of existence and meaning. Anthony J. Niesz, assistant professor of German at Yale University, is the author of Dramaturgy in German Drama: From Gryphius to Goethe . He is interested in the phenomenon of the meta-theater, especially in seventeenth- and eighteenth-century German drama, as well as in the literature and cultural policies of the German Democratic Republic. Norman N. Holland is Milbauer Eminent Scholar at the University of Florida. He is the author of Laughing and The I. (shrink)

Santayana, whose early writings are hostile to the Faustian spirit, used a quotation from IFaust, Part IID as epigraph to IThe Realm of SpiritD. This suggest a possible affinity of late Santayana, and aspects of Goethe. The speech of the Earth-Spirit in IFaustD has an amoralism similar to passages in IThe Realm of MattesD. A certain ironical, detached spirituality links the poet-sages as well. Each uses some of the symbolism of Christian dogma (e.g., the last chapter of IThe Realm of (...) SpiritD and the end of IFaust, Part IID) to convey the religious mystery of existence, but with no strict adherence to Christianity. (shrink)

The recent genome sequencing of a non‐vertebrate deuterostome, the ascidian tunicate Ciona intestinalis, makes a substantial contribution to the fields of evolutionary and developmental biology.1 Tunicates have some of the smallest bilaterian genomes, embryos with relatively few cells, fixed lineages and early determination of cell fates. Initial analyses of the C. intestinalis genome indicate that it has been evolving rapidly. Comparisons with other bilaterians show that C. intestinalis has lost a number of genes, and that many genes linked together in (...) most other bilaterians have become uncoupled. In addition, a number of independent, lineage‐specific gene duplications have been detected. These new results, although interesting in themselves, will take on a deeper significance once the genomes of additional invertebrate deuterostomes (e.g. echinoderms, hemichordates and amphioxus) have been sequenced. With such a broadened database, comparative genomics can begin to ask pointed questions about the relationship between the evolution of genomes and the evolution of body plans. BioEssays 25:529–532, 2003. © 2003 Wiley Periodicals, Inc. (shrink)

Jakob von Uexküll’s (1864-1944) account of Umwelt has been proposed as a mediating concept to bridge the gap between ecological psychology’s realism about environmental information and enactivism’s emphasis on the organism’s active role in constructing the meaningful world it inhabits. If successful, this move would constitute a significant step towards establishing a single ecological-enactive framework for cognitive science. However, Uexküll’s thought itself contains different perspectives that are in tension with each other, and the concept of Umwelt is developed in representationalist (...) terms that conflict with the commitments of both enactivism and ecological psychology. One central issue shared by all these approaches is the problem of how a living being experiences its environment. In this paper, we will look at Uexküll’s reception in French philosophy and highlight the different ways in which the concept of Umwelt functions in the work of Georges Canguilhem, Maurice Merleau-Ponty, and Gilles Deleuze. This analysis helps clarify different aspects of Uexküll’s thought and the deeper philosophical implications of importing his concepts into embodied cognitive science. This paper is part of a recent trend in which enactivism engages with continental philosophy in a way that both deepens and transcends the traditional links to phenomenology, including most recently the thought of Georg W. F. Hegel and Gilbert Simondon. However, no more than a brief outline and introduction to the potentials and challenges of this complex conceptual intersection can be given here. Our hope is that it serves to make more explicit the philosophical issues that are at stake for cognitive science in the question of experienced environments, while charting a useful course for future research. (shrink)

-/- Following the Mental Capacity Act (MCA) becoming law in 2005, and prior to its coming into force in 2007, there was a sustained effort to train support staff in the many social care settings where this new law was applicable. This training drive was necessary because, prior to the MCA, mental capacity law had evolved in the courts through consideration of a small number of cases that concerned serious medical treatments. These included the withdrawal of artificial nutrition and hydration (...) (Airedale NHS Trust v. Bland [1993]), blood transfusion (Re T [1993]), tissue donation (Re Y [1997]) and the provision of experimental medication for terminal illness (Simms v. Simms and another (2003)). In line with the Law Commission’s recommendations, the MCA extended the application of the law to ‘all acts in connection with care or treatment’ (MCA, Section 5), meaning that, overnight, social care settings and informal family care environments immediately fell within the scope of the legislation. (shrink)

Reading the signs of the times against a background of cultural-civilization and global financial-ecological conflicts, the book explores a "new cosmology" influenced by Teilhard de Chardin. It upholds evolution as a co-creative artistic-mystical process in contrast to modern secularist-determinist perspectives. It links a global spirituality to a global ethics.

Acceptance of elderly or marginal health individuals as kidney donors is debated, with practices varying between centres. Transplant recipients, live kidney donors and health-care professionals caring for patients with renal failure were surveyed regarding their views on live donor kidney transplantation (LDKT) of marginal health (diabetes, hypertension, atherosclerosis, obesity, etc.) and elderly donors. Participants were recruited within a tertiary renal and transplant centre and invited to participate in focus groups and structured interviews. They also completed an anonymous questionnaire. Of 464 (...) participants who completed the questionnaire (36% health-care professionals and 64% patients), 49% and 64%, respectively, stated that marginal and elderly donors should be accepted for LDKT. In the structured interviews, emphasis was given to presenting to donor, recipient and their respective families a calculated risk regarding the effect that either a nephrectomy or transplant has on long-term quality of life. Participants stated that an independent third party in addition to the transplant team should discuss involved risks. Issues of ‘how desperate’ the recipient's situation is should also be considered. Health-care professionals stated that regardless of the strength of will of an individual to donate a kidney (despite age, health problems or personal risk), they should always have the right to say ‘no’ if performing a specific LDKT was against their professional and ethical values. About half of those surveyed considered that marginal health and elderly donors were acceptable for LDKT. Emphasis was given to the explanation to donors and recipients of the risks involved in such transplantation. (shrink)

In considering the debate about the meaning of ‘disease’, the positions are generally presented as falling into two categories: naturalist, e.g., Boorse, and normativist, e.g., Engelhardt and many others. This division is too coarse, and obscures much of what is going on in this debate. I therefore propose that accounts of the meaning of ‘disease’ be assessed according to Hare's (1997) taxonomy of evaluative terms. Such an analysis will allow us to better understand both individual positions and their interrelationships. Most (...) importantly, it will show that it is unlikely that there is a single unique disease-concept at issue. Rather, different authors are, for the most part, considering different concepts. (shrink)

In the UK, current policies and services for people with mental disorders, including those with intellectual disabilities (ID), presume that these men and women can, do, and should, make decisions for themselves. The new Mental Capacity Act (England and Wales) 2005 (MCA) sets this presumption into statute, and codifies how decisions relating to health and welfare should be made for those adults judged unable to make one or more such decisions autonomously. The MCA uses a procedural checklist to guide this (...) process of substitute decision-making. The personal experiences of providing direct support to seven men and women with ID living in residential care, however, showed that substitute decision-making took two forms, depending on the type of decision to be made. The first process, ‘strategic substitute decision-making’, paralleled the MCA’s legal and ethical framework, whilst the second process, ‘relational substitute decision-making’, was markedly different from these statutory procedures. In this setting, ‘relational substitute decision-making’ underpinned everyday personal and social interventions connected with residents’ daily living, and was situated within a framework of interpersonal and interdependent care relationships. The implications of these findings for residential services and the implementation of the MCA are discussed. (shrink)

Numerous social, economic and academic pressures can have a negative impact on representations of biomedical research. We review several of the forces playing an increasingly pernicious role in how health and science information is interpreted, shared and used, drawing discussions towards the role of narrative. In turn, we explore how aspects of narrative are used in different social contexts and communication environments, and present creative responses that may help counter the negative trends. As traditional methods of communication have in many (...) ways failed the public, changes in approach are required, including the creative use of narratives. (shrink)

Clinical research is a necessity if effective and safe treatments are to be developed. However, this may well include the need for research that is best described as ‘invasive’ in that it may be associated with some discomfort or inconvenience. Limitations in the undertaking of invasive research involving people with intellectual disabilities (ID) are perhaps related to anxieties within the academic community and among ethics committees; however, the consequence of this neglect is that innovative treatments specific to people with ID (...) may not be developed. Such concerns are likely to continue while there is limited published knowledge regarding the actual experiences of people with ID who have participated in invasive clinical research. As part of a pilot study trialling the novel use of a surgically inserted device to curb overeating in people with Prader–Willi syndrome (PWS) we have investigated the experience of research through semistructured qualitative interviews involving three participants and their carers. Thematic analysis revealed that the adults with PWS and their family carers rated their participation positively, seeing it as a rewarding and enriching experience. This brief report discusses findings from our interview data in order to highlight strategies which may ensure that research is acceptable to participants, meets the necessary ethical standards and is able to achieve the aims set out by the researchers. To our knowledge, this is the first study to record experiences directly from people with PWS and their carers regarding their involvement in invasive clinical research. (shrink)

Environmental ethicists have frequently criticized ancient Greek philosophy as anti-environmental for a view of philosophy that is counterproductive to environmental ethics and a view of the world that puts nature at the disposal of people. This provocative collection of original essays reexamines the views of nature and ecology found in the thought of Plato, Aristotle, the Stoics, and Plotinus. Recognizing that these thinkers were not confronted with the environmental degradation that threatens contemporary philosophers, the contributors to this book find that (...) the Greeks nevertheless provide an excellent foundation for a sound theory of environmentalism. (shrink)

This paper pr o vides an o v e r vi e w of the themes presented in Bentha m ' s w ork Scotch Reform -a n e w w ork being prepared for pu b lication from Bentha m ' s manuscripts b y Oxford Un i v ersity Press as pa r t of the Collected Works of Jeremy Bentham. Attention is focused on the relationship bet w een the system of l e g al procedure (...) proposed and the under l ying principle of utili t y . T w o issues are highlighte d , the nature of Bentha m ' s anti-nomian thesis for c i vil cou r ts and the parad o x of requiring restraint on the judicial control of c i vil procedure, w hilst simultaneous l y rem o ving all r ules of action and all o wing increased judicial discretion. (shrink)

This is the editors' introduction to a new anthology of commissioned articles covering the various branches of philosophy of physics. We introduce the articles in terms of the three pillars of modern physics: relativity theory, quantum theory and thermal physics. We end by discussing the present state, and future prospects, of fundamental physics.

Anthony Everett () argues that those who embrace the reality of fictional entities run into trouble when it comes to specifying criteria of character identity. More specifically, he argues that realists must reject natural principles governing the identity and distinctness of fictional characters due to the existence of fictions which leave it indeterminate whether certain characters are identical and the existence of fictions which say inconsistent things about the identities of their characters. Everett's critique has deservedly drawn much attention (...) and a number of defensive moves have been made by, or on the behalf of, fictional realists. My goal in this paper is to move this debate on a further step. I have three goals: to clarify the importance of Everett's discussion of identity criteria within the context of fictional realism, to reassess Everett's objections to realism in light of the resultant literature, and to develop a novel strategy for responding to Everett's concerns. On the approach to be developed, the problems emerge due to an indeterminacy inherent in the concept of a fictional character itself. (shrink)

This paper gives a technically elementary treatment of some aspects of Hamilton -Jacobi theory, especially in relation to the calculus of variations. The second half of the paper describes the application to geometric optics, the optico-mechanical analogy and the transition to quantum mechanics. Finally, I report recent work of Holland providing a Hamiltonian formulation of the pilot-wave theory.

Michael Strevens’ Depth: An Account of Scientific Explanation is an impressive recent contribution to the philosophical literature on explanation. While clearly influenced by several of the leading theories of the later twentieth century, Strevens’ account of explanation is firmly rooted in the causal tradition. His most notable intellectual debts in this regard owe to David Lewis, Wesley Salmon and James Woodward. Still, Strevens sees the work of these theorists as flawed in important respects, and his “kairetic account” of explanation (...) is meant to provide answers to problems his predecessors left unresolved (or poorly resolved, as the case may be). Before examining Strevens’ account in detail we should identify the more significant of these problems and briefly survey the contexts in which they arose. (shrink)

The impact of Beccaria's On Crimes and Punishments on English discussions of punishment in the twenty-five years following its publication is assessed, with attention being paid to Beccaria's combination of contractarian and early utilitarian thinking. It is argued that Beccaria's influence was particularly striking in England in that he stimulated two disparate strands of reform thinking. The first being exemplified in the work of William Eden, and taking the form of a contractarian, humanitarian version, which owed something to William Blackstone, (...) but was ultimately quite distinct. The second represented in Jeremy Bentham's theory of punishment with its emphasis overwhelmingly on utilitarian calculation. (shrink)

Until late in the nineteenth century, madder was the most popular natural red dye. Holland was the largest and best-known supplier. As early as the fourteenth and fifteenth centuries, the province of Zeeland and adjoining parts of the provinces of South Holland and Brabant developed into important producers. In the course of the seventeenth century these areas even succeeded in acquiring a monopoly position. Early in the nineteenth century, however, this position came under attack because France had gone (...) over to industrial production methods from around 1800, whereas Holland continued to produce with craft technologies. After 1820, as a result, a period of stagnation and decay set in. The fate of the Dutch madder industry would have been completely sealed if the production capacity of the French factories had been sufficiently large to satisfy the great increase in demand. Consequently, in Holland, after 1845, a process of revival based upon the French manufacturing methods began slowly and hesitatingly. This process started too late and was not persevered with sufficiently to regain lost markets. The Dutch producers remained strongly attached to their own out-dated, craft methods of production. (shrink)

I will begin by considering some themes from Proust's wonderful essay on Chardin, Chardin and Rembrandt. Proust speaks of the young man ‘of modest means and artistic taste’, his imagination filled with the splendour of museums, of cathedrals, of mountains, of the sea, sitting at table at the end of lunch, nauseated at the ‘traditional mundanity’ of the unaesthetic spectacle before him: the last knife left lying on the half turned-back table cloth, next to the remains of an underdone and (...) tasteless cutlet. He cannot wait to get up and leave, and if he cannot take a train to Holland or Italy, he will at least go to the Louvre to have sight of the palaces of Veronese, the princes of van Dyck and the harbours of Claude. Doing this will, of course, make his return to his home and its familiar surroundings seem yet more drab and exasperating. (shrink)

I will begin by considering some themes from Proust's wonderful essay on Chardin, Chardin and Rembrandt. Proust speaks of the young man ‘of modest means and artistic taste’, his imagination filled with the splendour of museums, of cathedrals, of mountains, of the sea, sitting at table at the end of lunch, nauseated at the ‘traditional mundanity’ of the unaesthetic spectacle before him: the last knife left lying on the half turned-back table cloth, next to the remains of an underdone and (...) tasteless cutlet. He cannot wait to get up and leave, and if he cannot take a train to Holland or Italy, he will at least go to the Louvre to have sight of the palaces of Veronese, the princes of van Dyck and the harbours of Claude. Doing this will, of course, make his return to his home and its familiar surroundings seem yet more drab and exasperating. (shrink)

Background Analysis of aphasic narratives can be a challenge for clinicians. Previous studies have mainly employed measures that categorized speech samples at the word level. They included quantification of the use and misuse of different word classes, presence and absence of narrative contents and errors, paraphasias, and perseverations, as well as morphological structures and errors within a narrative. In other words, a great amount of research has been conducted in the aphasiology literature focusing on micro-linguistic structures of oral narratives. Aspects (...) of macro- linguistic structures, such as the analysis of content information by a speaker, consistency of using cohesive devices to present information within a narrative, and order of presenting information necessary to form a coherent discourse, have not been extensively investigated. The current investigation proposes a clinical analytic system to target three aspects of macro-linguistic structures in narratives among speakers with aphasia. Specifically, (1) the presence of search events (i.e., the mentioning of key events that allow the listener to understand; Capilouto, Wright, &Wagovich, 2006) within a narrative, (2) the sequence of the mentioned events, and (3) the informativeness (i.e., the fulfillment of lexical items that allow the user to understand what the event is detailing) of the event contents, were focused in the proposed framework. Method Ten controls transcripts from were selected from the AphasiaBank (MacWhinney, Fromm, Forbes, & Holland, 2011). Three narrative tasks, including sequential picture description of ‘Refused Umbrella’, procedural narrative of making a ‘Peanut Butter and Jelly Sandwich’, and telling of ‘Cinderella’ story, were used to establish normative data for the basis of analysis. Specifically, the Search Events (e) and Informative Words (i) used by at least 70% of the speakers were listed for each genre. The sequential order of mentioning the Search Events, i.e., common order of events in 90% of the speakers, (s.total) was determined. Twelve speakers with aphasia (nine fluent and three non-fluent) were recruited and administered the Western Aphasia Battery and Object and Action Naming Battery. Their performance in the above three discourse tasks were orthographically transcribed and analyzed using the following measures: e.total, e.matched with norm, e.missed, e.irrlevant, e.extra, s.total, i.pb&j, i.umbr, i.cind, and i.total. Three samples were randomly chosen to be re-analyzed for inter- and intra-rater reliability. Results Results of an independent t-test suggested significant differences between the fluent and non-fluent subjects in sequential order of Search Events for all genres (s.total) and i.total, suggesting sensitivity of this framework to differentiate between the two fluency groups. Results of Pearson product-moment correlations revealed significant relation between Informative Words and WAB spontaneous speech scores, AQ, as well as OAB scores, for both aphasic groups. The mean value of coefficients for intra-rater reliability (0.992), with significant correlations on e.match, e.miss, and e.extra, was higher than that of inter-rater reliability (0.897). Discussion Based on our preliminary results, this objective framework allowed clinical evaluation of impairment in macro-linguistic structures present in aphasic discourse. Further extension should involve more subjects encompassing a wider range of severity with different types of aphasia. (shrink)

: The topic of organ transplantation is examined from the perspective of three authors: Robert Bellah, Jeremy Rifkin, and Margaret Jane Radin. Introduced by reflections on the development of the justification of organ transplantation within the Roman Catholic community and the various themes raised by the historical study in Richard Titmuss's The Gift Relationship, the paper examines how and in what ways the possible commodification of organs will affect our society and the impacts this may have on the supply (...) of organs. (shrink)

Freedom and the Rule of Law takes a critical look at the historical beginnings of law in the United States, and how that history has influenced current trends regarding law and freedom. Anthony Peacock has compiled articles that examine the relationship between freedom and the rule of law in America. The rule of law is fundamental to all liberal constitutional regimes whose political orders recognize the equal natural rights of all.