When taken too far, certain well-intentioned ethical guidelines can become transformed into artificial boundaries that serve as destructive prohibitions and thereby undermine clinical effectiveness. Rigid roles and strict codified rules of conduct between therapist and client can obstruct a clinician's artistry. Those anxious conformists who go entirely by the book, and who live in constant fear of malpractice suits, are unlikely to prove significantly helpful to a broad array of clients. It is my contention that one of the worst professional/ethical (...) violations is to permit current risk-management principles to take precedence over humane interventions. (shrink)

Principa Practica is a provocative work in which author Arnold Johanson maintains that philosophers since Socrates have been asking the wrong questions, like "What is good?" and "What is right?" The reason for this, according to the author, is that moral philosophers have based their work on a logical framework more suitable to science than to ethics and politics. Striking out in a new direction, the author bases his work on the concept of requirement which he finds not only (...) has a rich logical structure but, if properly formulated, can be used to guide humanity in its struggle to find meaning in life, on one hand, and to find peace, happiness, and order, on the other. The fact that the work has an emphasis on logic may suggest that only those with a technical bent can read this work, but this is not so: much of this work—over two-thirds—is designed to be read by those without a technical background in mathematics and logic. (shrink)

This book introduces American readers to a philosophical and spiritual exemplar of dialogue. The author presents a way of thinking about ourselves, the world, and our relationship to God that is neither dualistic nor monistic. The thinkers presented in this book focus on a radical departure from objectivism and subjectivism. Kierkegaard, Feuerbach, Herman Cohen, Ferdinand Ebner, Eugen Rosenstock, Franz Rosenzweig, and Martin Buber were all trying to find a way to allow a transaction between self, the world, and God without (...) foregoing either individuality or the experience of merging. (shrink)

Advances in understanding genetic disorders have been rapid in the last few years and with them the need and desire for genetic counselling have grown. Almost simultaneously, particularly in the USA, several large screening programmes have been initiated to screen large numbers of people who may be carriers of such deleterious genes as those of Tay-Sachs disease and sickle cell anaemia. The authors of this paper, clinical medical students at University College Hospital, London, spent some time studying the ethical issues (...) raised. The first part of their study, which is not published here, relates to the biochemistry of certain genetic disorders, so leading up to the aspect of the subject which must concern readers of this journal, genetic counselling. At present genetic counselling is generally the province of the medical practitioner working with clinical biochemists, and in this paper their function is described and how programmes of screening for carriers are designed. Whether the subjects of the screening tests are found to be 'innocent' or 'guilty' psychological problems confront them, and of these the genetic counsellor must be aware. In fact the range of ethical problems raised by such counselling is wide and can only be sketched in this article. (shrink)

The idea that simplicity matters in science is as old as science itself, with the much cited example of Ockham's Razor, 'entia non sunt multiplicanda praeter necessitatem': entities are not to be multiplied beyond necessity. A problem with Ockham's razor is that nearly everybody seems to accept it, but few are able to define its exact meaning and to make it operational in a non-arbitrary way. Using a multidisciplinary perspective including philosophers, mathematicians, econometricians and economists, this 2002 monograph examines simplicity (...) by asking six questions: what is meant by simplicity? How is simplicity measured? Is there an optimum trade-off between simplicity and goodness-of-fit? What is the relation between simplicity and empirical modelling? What is the relation between simplicity and prediction? What is the connection between simplicity and convenience? The book concludes with reflections on simplicity by Nobel Laureates in Economics. (shrink)

The idea that simplicity matters in science is as old as science itself, with the much cited example of Ockham's Razor, 'entia non sunt multiplicanda praeter necessitatem': entities are not to be multiplied beyond necessity. A problem with Ockham's razor is that nearly everybody seems to accept it, but few are able to define its exact meaning and to make it operational in a non-arbitrary way. Using a multidisciplinary perspective including philosophers, mathematicians, econometricians and economists, this 2002 monograph examines simplicity (...) by asking six questions: what is meant by simplicity? How is simplicity measured? Is there an optimum trade-off between simplicity and goodness-of-fit? What is the relation between simplicity and empirical modelling? What is the relation between simplicity and prediction? What is the connection between simplicity and convenience? The book concludes with reflections on simplicity by Nobel Laureates in Economics. (shrink)

In this study we use dual process theory of self-regulation to develop a framework that outlines the mediating and moderating mechanisms explaining the relationship between leader emotional exhaustion and leadership style (transformational leadership and abusive supervision). Using Glomb et al.’s (2011) framework, we identify empathy and negative emotion as mediators that are of particular importance for leaders. In addition, we propose that leader mindfulness moderates these processes to improve leadership style. Using a time-lagged survey of leaders (N = 505) we (...) found that leader empathy and negative emotion mediated the relationships between emotional exhaustion and leadership style. Furthermore, we found that leader mindfulness significantly moderated the indirect effect of leader emotional exhaustion on leadership style through negative emotion. However, leader mindfulness did not moderate the relationship between emotional exhaustion and empathy. Theoretical and practical implications are discussed. (shrink)

Recognizing the growing interdependence of the European Union and the importance of codes of conduct in companies’ operations, this research examines the effect of a country’s culture on the implementation of a code of conduct in a European context. We examine whether the perceptions of an activity’s ethicality relates to elements found in company codes of conduct vary by country or according to Hofstede’s (1980, Culture’s Consequences (Sage Publications, Beverly Hills, CA)) cultural constructs of: Uncertainty Avoidance, Masculinity/Femininity, Individualism, and Power (...) Distance. The 294 individuals, who participated in our study, were from 8 Western European countries. Their responses to our 13 scenarios indicate that differences in the perceptions of ethicality associate primarily with the participants’ country as opposed to their employer (i.e., accounting firm), employment level, or gender. The evidence also indicates that these country differences associate with Hofstede constructs of Individualism and Masculinity. (shrink)

Studies have failed to yield definitive evidence for the existence and/or role of well-defined chaotic attractors in real brain systems. Tsuda's transients stabilized on unstable manifolds of unstable fixed points using mechanisms similar to Ott's algorithmic “control of chaos” are demonstrable. Grebogi's order in preserving “strange nonchaotic” attractor with fractal dimension but Lyapounov is suggested for neural network tasks dependent on sequence.

This is the first book published that specifically examines questions of ethics and advocacy that arise in conducting research on homelessness, exploring the issues through the deeply personal experiences of some of the field’s leading scholars. By examining the central queries from a broad range of perspectives, the authors presented here draw upon years of rich investigations to generate a framework that will be instructive for researchers across a wide spectrum of areas of inquiry.

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.

This dissertation consists in a philosophically constructive engagement with two different critiques of the Buddhist epistemological tradition stemming from Dignaga and Dharmakirti . The tradition of Dignaga and Dharmakirti, which was particularly important to the development of pan-Indian canons of reasoned argumentation, may plausibly be characterized as foundationalist. The traditions that follow the epistemologists in deploying these canons of reasoning are often taken as coextensive with or definitive of "philosophy" in classical India. Against this current, the dissertation aims at retrieving (...) and sympathetically elaborating some voices of philosophical dissent from this tradition. ;Specifically, the dissertation considers two significant but understudied critiques of the Buddhist epistemologists. First is that of one of the orthodox Brahmanical schools, viz., Purva Mimam&dotbelow;sa, whose constitutive concern is with the interpretation and authority of the earliest Vedic literature. It is argued that the characteristically Mimam&dotbelow;sa doctrine of "intrinsic validity" is best understood as a critique of the Buddhist tradition of epistemology, and that the Mimam&dotbelow;sa doctrine is analogous to contemporary "reformed epistemology." More attention is given to the critique of epistemology advanced by another Buddhist, the Madhyamika philosopher Candrakirti . Unlike that of Mimam&dotbelow;sa, Candrakirti's arguments amount to a principled refusal of epistemology. It is argued that the logically distinct character of Candrakirti's arguments is best understood by characterizing them as transcendental arguments, with this characterization of Candrakirti's thought facilitating the resolution of what have long been exegetical difficulties in his work. This characterization is meant more generally to advance the idea that there can be principled refusals of epistemological discourse which, insofar as they are based in good reasons for refusing such discourse, deserve to be taken as properly philosophical alternatives to epistemology. Thus, the arguments of these premodern Indian philosophers are not only examined and explicated, but critically assessed, such that they might be seen as representing philosophical interlocutors whose voices can be brought to bear on issues of concern to contemporary philosophers of religion. (shrink)

Empirical research pertaining to cardiopulmonary resuscitation (CPR), clinician behaviors related to do-not-resuscitate (DNR) orders and substituted judgment suggests potential contributions to medical ethics. Research quantifying the likelihood of surviving CPR points to the need for further philosophical analysis of the limitations of the patient autonomy in decision making, the nature and definition of medical futility, and the relationship between futility and professional standards. Research on DNR orders has identified barriers to the goal of patient involvement in these life and death (...) discussions. The initial data on surrogate decision making also points to the need for a reexamination of the moral basis for substituted judgment, the moral authority of proxy decision making and the second-order status of the best interests standard. These examples of empirical research suggest that an interplay between empirical research, ethical analysis and policy development may represent a new form of interdisciplinary scholarship to improve clinical medicine. (shrink)

Few residency training programmes explicitly require substantive exposure to issues in medical ethics and fewer still have a formal curriculum in this area. Traditional undergraduate medical ethics courses teach preclinical students to identify ethical issues and analyse them at a theoretical level. Residency training, however, is the ideal time to establish the critical behavioural link which makes ethics truly useful in clinical medicine. The General Internal Medicine Residency Training Program at Rhode Island Hospital has developed an integrated, three-year curriculum with (...) the goals of helping residents to perceive ethical issues in clinical practice, to utilise basic philosophical principles in resolving ethical dilemmas and to communicate these issues clearly and sensitively to patients. The curriculum has been well received by residents and has had a hospital-wide impact. We believe that training residents in medical ethics and communication skills is an effective approach to developing physicians' humane qualities. (shrink)

"The largest Ebola outbreak to date—first detected in December 2013 and still ongoing as of April 2015—has cast new light on the shortfalls of international public health systems.1 As in previous health crises, scrutiny has reemerged over the pharmaceutical industry’s ability and willingness to innovate new medicines for underserved disease areas. The public debate has intensified following revelations that promising drug candidates to treat Ebola had gone undeveloped despite compelling preclinical results.2 This lack of development is especially troubling because it (...) occurred after a recently implemented U.S. incentive scheme—the Food and Drug Administration’s (FDA) tropical disease priority review voucher program—designed to counteract exactly this problem. Taking Ebola as a case in point, it is useful to examine the short history and ongoing refinement of this voucher program, since it represents one of the most significant legislative efforts to systematically address the relative absence of com- mercial rewards for drugs targeting tropical diseases. This analysis evaluates the voucher program’s effectiveness for both stimulating private sector innovation and achieving positive health impacts among populations most severely burdened by tropical diseases. It then proposes specific recommendations for how law- makers can improve the program’s legislation to better achieve these objectives. ". (shrink)

translation of Arnold Berleant's "Engaging Dewey...".

Objective: Even when critically ill patients are almost certain to die from their illnesses, there is generally an element of prognostic uncertainty. Little is known about how physicians handle this uncertainty in conversations with surrogate decision makers. We sought to evaluate whether and how physicians discuss prognostic uncertainty with surrogate decision makers of patients who are highly likely, but not certain, to die. Design: We audiotaped and transcribed discussions between clinicians and surrogate decision makers at two major California teaching hospitals (...) from 2006 through 2008. Physicians completed a questionnaire addressing their prognostic estimates for patients' survival to hospital discharge. Participants: We included physicians and surrogates of 12 incapacitated, critically ill patients. Measurements: We analyzed transcripts of discussions in which physicians' estimates of patients' chances of hospital survival were 1% to 5%; we coded whether physicians disclosed the prognostic uncertainty and, if so, how they conveyed that death was highly likely but not certain. Results: Physicians' estimates of short-term survival were 1% to 5% for 12 of the 70 patients enrolled in the original study. In 8 of 12 cases, physicians conveyed prognostic uncertainty by using probabilistic language or by an explicit mention of uncertainty. In four cases, physicians made at least one statement that either implied or was ambiguous about whether death was certain. Conclusion: We observed variability in how physicians handle prognostic uncertainty in their discussions with surrogates of patients who are highly likely, but not certain, to die, including some circumstances in which physicians stated or implied that death was certain. (shrink)

Background: Clinical genomic implementation studies pose challenges for informed consent. Consent forms often include complex language and concepts, which can be a barrier to diverse enrollment, and these studies often blur traditional research-clinical boundaries. There is a move toward self-directed, web-based research enrollment, but more evidence is needed about how these enrollment approaches work in practice. In this study, we developed and evaluated a literacy-focused, web-based consent approach to support enrollment of diverse participants in an ongoing clinical genomic implementation study. (...) Methods: As part of the Cancer Health Assessments Reaching Many (CHARM) study, we developed a web-based consent approach that featured plain language, multimedia, and separate descriptions of clinical care and research activities. CHARM offered clinical exome sequencing to individuals at high risk of hereditary cancer. We interviewed CHARM participants about their reactions to the consent approach. We audio recorded, transcribed, and coded interviews using a deductively and inductively derived codebook. We reviewed coded excerpts as a team to identify overarching themes. Results: We conducted 32 interviews, including 12 (38%) in Spanish. Most (69%) enrolled without assistance from study staff, usually on a mobile phone. Those who completed enrollment in one day spent an average of 12 minutes on the consent portion. Interviewees found the information simple to read but comprehensive, were neutral to positive about the multimedia support, and identified increased access to testing in the study as the key difference from clinical care. Conclusions: This study showed that interviewees found our literacy-focused, web-based consent approach acceptable; did not distinguish the consent materials from other online study processes; and valued getting access to testing in the study. Overall, conducting empirical bioethics research in an ongoing clinical trial was useful to demonstrate the acceptability of our novel consent approach but posed practical challenges. (shrink)

One way of increasing the supply of vital organs without violating the dead donor rule is to declare death on cardiopulmonary criteria after withdrawing life support. The question then is how quickly death may be declared.