This introduction to moral philosophy treats a wide range of theoretical questions and a number of contemporary moral problems. The first chapter discusses the noncognitivism of many analytic ethicians [[sic]], and insists on the possibility of providing correct and interpersonally valid answers to a number of disputed moral issues. Chapter two treats basic issues concerning freedom and moral responsibility; and the third chapter discusses the difficulties raised by the naturalistic fallacy argument. Chapters four and five distinguish the author's "reflective naturalism" (...) from other moral positions. While there is some appeal to Dewey and others in the American naturalist tradition, the author is a naturalist more in the realistic tradition of Thomism. There is some lack of clarity in the exposition of his own basic position because of a desire to associate too closely the naturalism of Thomas with that of Dewey. The practical issues treated are those of sexual morality, of economic life, and political life. These questions are treated intelligently, and enter into lively debate with some leading opponents of a sophisticated and liberal Christian ethical position. But the arguments do not succeed so clearly in presenting themselves as decisively valid answers flowing out of the basic principles of his fundamental position. The final chapter is a critique of the closed, anti-theistic elements of Dewey's naturalism, and an appeal for a naturalism open to theistic influence.--R. D. L. (shrink)

Charvet presents a "critical reconstruction" of Rousseau’s argument in the Second Discourse, Emile, and the Social Contract, in order to elucidate the French philosopher’s thought about the problem of "the individual’s relation to others in society." While the book is devoid of reference to other works of Rousseau scholarship, this seeming lack helps to give Charvet’s critical work a refreshing clarity and directness.

BackgroundIn research ethics, the most basic question would always be, “which is an ethical issue, which is not?” Interestingly, depending on which ethics guideline we consult, we may have various answers to this question. Though we already have several international ethics guidelines for biomedical research involving human participants, ironically, we do not have a harmonized document which tells us what these various guidelines say and shows us the areas of consensus. In this manuscript, we attempted to do just that.MethodsWe extracted (...) the imperatives from five internationally-known ethics guidelines and took note where the imperatives came from. In doing so, we gathered data on how many guidelines support a specific imperative.ResultsWe found that there is no consensus on the majority of the imperatives and that in only 8.2 % of the imperatives were there at least moderate consensus. Of the 12 clusters, Informed Consent has the highest level of consensus and Research Collaboration and Regulatory Sanctions have the least.ConclusionThere was a lack of consensus in the majority of imperatives from the five internationally-known ethics guidelines. This may be partly explained by the differences among the guidelines in terms of their levels of specification as well as conceptual/ideological differences. (shrink)

Few studies in sub-Saharan Africa evaluate Institutional Review Boards (IRBs) capacity. The study aims to explore the composition of IRBs, training, and challenges experienced in the ethics review processes by members of research institutions and universities in Addis Ababa, Ethiopia. Our findings indicate that most IRBs members were trained on research ethics and good clinical practice. However, majority perceived the trainings as basic. IRB members faced several challenges including: investigators wanting rapid review; time pressure; investigators not following checklists; limited expertise (...) in reviewing clinical trials, studies on genetics, and traditional medicine; lack of IRB offices for administrative work; competing tasks; limited staffing and the lack of a standardized review system. There is need for advanced training on research ethics to meet the evolving research needs. In addition, investments in IRBs are needed in terms of funding, and physical and human resources in Addis Ababa and Ethiopia in general. (shrink)

Few studies in sub-Saharan Africa evaluate Institutional Review Boards (IRBs) capacity. The study aims to explore the composition of IRBs, training, and challenges experienced in the ethics review processes by members of research institutions and universities in Addis Ababa, Ethiopia. Our findings indicate that most IRBs members were trained on research ethics and good clinical practice. However, majority perceived the trainings as basic. IRB members faced several challenges including: investigators wanting rapid review; time pressure; investigators not following checklists; limited expertise (...) in reviewing clinical trials, studies on genetics, and traditional medicine; lack of IRB offices for administrative work; competing tasks; limited staffing and the lack of a standardized review system. There is need for advanced training on research ethics to meet the evolving research needs. In addition, investments in IRBs are needed in terms of funding, and physical and human resources in Addis Ababa and Ethiopia in general. (shrink)

Background: Demand for organisational ethics capacity is growing in health organisations, particularly among managers. The role of clinical ethicists in, and perspective on, organisational ethics has not been well described or documented in the literature. Objective: To describe clinical ethicists’ perspectives on organisational ethics issues in their hospitals, their institutional role in relation to organisational ethics, and their perceived effectiveness in helping to address organisational ethics issues. Design and Setting: Qualitative case study involving semi-structured interviews with 18 clinical ethicists across (...) 13 health organisations in Toronto, Canada. Results: From the clinical ethicists’ perspective, the most pressing organisational ethics issues in their organisations are: resource allocation, staff moral distress linked to the organisation’s moral climate, conflicts of interest, and clinical issues with a significant organisational dimension. Clinical ethicists were consulted in particular on issues related to staff moral distress and clinical issues with an organisational dimension. Some ethicists described being increasingly consulted on resource allocation, conflicts of interest, and other corporate decisions. Many clinical ethicists felt they lacked sufficient knowledge and understanding of organisational decision-making processes, training in organisational ethics, and access to organisational ethics tools to deal effectively with the increasing demand for organisational ethics support. Conclusion: Growing demand for organisational ethics expertise in healthcare institutions is reshaping the role of clinical ethicists. Effectiveness in organisational ethics entails a re-evaluation of clinical ethics training to include capacity building in organisational ethics and organisational decision-making processes as a complement to traditional clinical ethics education. (shrink)

It is commonly held that early career experiences influence ethical behavior. One way early career experiences might operate is to influence the decisions people make when presented with problems that raise ethical concerns. To test this proposition, 102 first-year doctoral students were asked to complete a series of measures examining ethical decision making along with a series of measures examining environmental experiences and climate perceptions. Factoring of the environmental measure yielded five dimensions: professional leadership, poor coping, lack of rewards, (...) limited competitive pressure, and poor career direction. Factoring of the climate inventory yielded four dimensions: equity, interpersonal conflict, occupational engagement, and work commitment. When these dimensions were used to predict performance on the ethical decision-making task, it was found that the environmental dimensions were better predictors than the climate dimensions. The implications of these findings for research on ethical conduct are discussed. (shrink)

Recognition that the Principle of Respect for Autonomy fails to work in family-centric societies such as Singapore has recently led to the promotion of relational autonomy as a suitable framework within which to place healthcare decision making. However, empirical data, relating to patient and family opinions and the practices of healthcare professionals in Confucian-inspired Singapore, demonstrate clear limitations on the ability of a relational autonomy framework to provide the anticipated compromise between prevailing family decision-making norms and adopted Western led atomistic (...) concepts of autonomy. Evidence suggests that despite a growing infusion of Western influence, there is still little to indicate any major shift to individual decision making, particularly in light of the way society and healthcare are structured. Similarly, the lack of employing a shared decision-making model and data that discredit the notion that the complex psychosocial and cultural factors that affect the decision making may be considered “content neutral” not only prevents the application of relational autonomy but questions the viability of the values behind the Principle of Respect for Autonomy. Taking into account local data and drawing upon a wider concept of personhood that extends beyond prevailing family-centric ideals along with the complex interests that are focused upon the preservation of the unique nature of personhood that arises from the Ring Theory of Personhood, we propose and “operationalize” the employing of an authoritative welfare-based approach, within the confines of best interest decision making, to better meet the current care needs within Singapore. (shrink)

The child was 2 years, 8 months old and weighed 25 pounds, one-fifth the weight of her mother, for whom she was to be the bone marrow donor. The mother had suffered a relapse of acute myelogenous leukemia; her physicians recommended a bone marrow transplant. The child was the closest human leukocyte antigen match and thus the best donor candidate for her mother's transplant.

The bioethical principle of autonomy is problematic regarding the future of the embryo who lacks the ability to self-advocate but will develop this defining human capacity in time. Recent experiments explore the use of clustered regularly interspaced short palindromic repeats /Cas9 for germline engineering in the embryo, which alters future generations. The embryo’s inability to express an autonomous decision is an obvious bioethical challenge of germline engineering. The philosopher Joel Feinberg acknowledged that autonomy is developing in children. He advocated that (...) to reserve this future autonomy, parents should be guided to make ethical decisions that provide children with open futures. Here, Feinberg’s 1980 open future theory is extended to the human embryo in the context of CRISPR germline engineering. Although the embryo does not possess the autonomous decision-making capacity at the time of germline engineering, the parental decision to permanently change the unique genetic fabric of the embryo and subsequent generations disregards future autonomy. Therefore, germline engineering in many instances is objectionable considering Feinberg’s open future theory. (shrink)

Current models of autobiographical memory suggest that self-identity guides autobiographical memory retrieval. Further, the capacity to recall the past and imagine one’s self in the future can influence social problem solving. We examined whether manipulating self-identity, through an induction task in which students were led to believe they possessed high or low self-efficacy, impacted episodic specificity and content of retrieved and imagined events, as well as social problem solving. Compared to individuals in the low self efficacy group, individuals in the (...) high self efficacy group generated past and future events with greater specificity, positive words, and self-efficacious statements, and also performed better on social problem solving indices. A lack of episodic detail for future events predicted poorer performance on social problem solving tasks. Strategies that increase perceived self-efficacy may help individuals to selectively construct a past and future that aids in negotiating social problems. (shrink)

Wicked problems’ are tricky to solve because of their many interconnected components and a lack of any single optimal solution. At the science–policy interface, all problems can look wicked: research exposes the complexity that is relevant to designing, executing and implementing policy fit for ambitious human needs. Expertise in philosophical research can help to navigate that complexity.

Requirements for business ethics education and organizational ethics trainings mark an important step in encouraging ethical behavior among business students and professionals. However, the lack of specificity in these guidelines as to how, what, and where business ethics should be taught has led to stark differences in approaches and content. The present effort uses meta-analytic procedures to examine the effectiveness of current approaches across organizational ethics trainings and business school courses. to provide practical suggestions for business ethics interventions and (...) research. Thus, the primary questions driving this research are as follows: what course characteristics moderate the effectiveness of ethics instruction?, and have ethics education and training efforts improved? Findings suggest that professional, focused, and workshop-based training programs are especially effective for improving business ethics. However, results also reveal considerable problems with many of the criteria used to evaluate the effectiveness of business ethics interventions. Practical suggestions for course design and evaluation in business ethics efforts are discussed along with future research needs. (shrink)

© 2015 NATCO, The Organization for Transplant Professionals.Despite the known benefits of kidney transplant, less than 30% of the 615 000 patients living with end-stage renal disease in the United States have received a transplant. More than 100 000 people are presently on the transplant waiting list. Although the shortage of kidneys for transplant remains a critical factor in explaining lower transplant rates, another important and modifiable factor is patients' lack of comprehensive education about transplant. The purpose of this (...) article is to provide an overview of known best practices from the broader literature that can be used as an evidence base to design improved education for ESRD patients pursuing a kidney transplant. Best practices in chronic disease education generally reveal that education that is individually tailored, understandable for patients with low health literacy, and culturally competent is most beneficial. Effective education helps patients navigate the complex health care process successfully. Recommendations for how to incorporate these best practices into transplant education design are described. Providing more ESRD patients with transplant education that encompasses these best practices may improve their ability to make informed health care decisions and increase the numbers of patients interested in pursuing transplant. (shrink)

The aim of this exploratory study was to examine client demographics and expectations, reasons for use, sensations during treatment, and perceived outcomes of Pranic Healing, an energy healing system lacking in scientific documentation but whose use in the general population is becoming more widespread internationally. This study consisted of a cross-sectional survey of adults (18+ years of age) receiving care from 12 Pranic Healing practices in four different states in the U.S. (N = 179) completing online questionnaires. Closed-ended response sets (...) were analyzed descriptively, while qualitative data were analyzed using content analysis. Reasons to use the therapy included physical, mental/emotional, and metaphysical issues, dissatisfaction with conventional care, and overall well-being. Expectations of care included enhanced abilities, cure or relief, or unsure. Respondents were more likely to cite a specific problem from which they needed alleviation than to cite overall health or wellness as their goal. Sensations experienced were reported to be of a relaxing nature and not, as was hypothesized, of an energizing nature. Results show that those who use Pranic Healing fit the sociodemographic profile of CAM (complementary and alternative medicine) users in the United States, that their reasons for use are not homogeneous, and that preliminary descriptive data from a selective subsample of respondents indicated that some respondents are experiencing positive outcomes attributed to this modality. (shrink)

It is predicted that the rapid acquisition of new genetic knowledge and related applications during the next decade will have significant implications for virtually all members of society. Currently, most people get exposed to information about genes and genetics only through stories publicized in the media. We sought to understand how individuals in the general population used and understood the concepts of ???genetics??? and ???genes.??? During in-depth one-on-one telephone interviews with adults in the United States, we asked questions exploring their (...) basic understanding of these terms, as well as their belief as to the location of genes in the human body. A wide range of responses was received. Despite conversational familiarity with genetic terminology, many noted frustration or were hesitant when trying to answer these questions. In addition, some responses reflected a lack of understanding about basic genetic science that may have significant implications for broader public education measures in genetic literacy, genetic counseling, public health practices, and even routine health care. (shrink)

Tool use research has suffered from a lack of consistent theoretical frameworks. There is a plethora of tool use definitions and the most widespread ones are so inclusive that the behaviors that fall under them arguably do not have much in common. The situation is aggravated by the prevalence of anecdotes, which have played an undue role in the literature. In order to provide a more rigorous foundation for research and to advance our understanding of the interrelation between tool (...) use and cognition, we suggest the adoption of Fragaszy and Mangalam's (2018) tooling framework, which is characterized by the creation of a body-plus-object system that manages a mechanical interface between tool and surface. Tooling is limited to a narrower suite of behaviors than tool use, which might facilitate its neurocognitive investigation. Indeed, evidence in the literature indicates that tooling has distinct neurocognitive underpinnings not shared by other activities typically classified as tool use, at least in primates. In order to understand the extent of tooling incidences in previous research, we systematically surveyed the comprehensive tool use catalog by Shumaker et al. (2011). We identified 201 tool use submodes, of which only 81 could be classified as tooling, and the majority of the tool use examples across species were poorly supported by evidence. Furthermore, tooling appears to be phylogenetically less widespread than tool use, with the greatest variability found in the primate order. However, in order to confirm these findings and to understand the evolution and neurocognitive mechanisms of tooling, more systematic research will be required in the future, particularly with currently underrepresented taxa. (shrink)

Many adoptees face a number of challenges relating to separation from biological parents during the adoption process, including issues concerning identity, intimacy, attachment, and trust, as well as language and other cultural challenges. One common health challenge faced by adoptees involves lack of access to genetic-relative family health history. Lack of GRFHx represents a disadvantage due to a reduced capacity to identify diseases and recommend appropriate screening for conditions for which the adopted person may be at increased risk. (...) In this article, we draw out common features of traditionally understood “health disparities” in order to identify analogous features in the context of adoptees’ lack of GRFHx. (shrink)

Discussions of research involving vulnerable populations have left the homeless comparatively ignored. Participation by these subjects in drug studies has the potential to be upsetting, inconvenient, or unpleasant. Participation occasionally produces injury, health emergencies, and chronic health problems. Nonetheless, no ethical justification exists for the categorical exclusion of homeless persons from research. The appropriate framework for informed consent for these subjects of pharmaceutical research is not a single event of oral or written consent, but a multi-staged arrangement of disclosure, dialogue, (...) and permission-giving. Payments and other rewards in biomedical research raise issues of whether it is ethical to offer inducements to the homeless in exchange for participation in drug studies. Such inducements can influence desperate persons who are seriously lacking in resources. The key is to strike a balance between a rate of payment high enough that it does not exploit subjects by underpayment and low enough that it does not create an irresistible inducement. This proposal does not underestimate the risks of research, which are often overestimated and need to be appraised in light of the relevant empirical literature. (shrink)

Can the institutional systems that prepare Black nurse researchers question the ways their systemic pathways have impacted health equity knowledge development in nursing? We invite our readers to keep this question in mind and engage with our conversation as Black nurse researchers, scholars, educators, and clinicians. The purpose of our conversation, and this article, is to explore the transactional impact of knowledge development pathways and Black faculty retention pathways on the state of health equity knowledge in nursing today. Over a (...) series of conversations, we discuss the research exploitation of communities of color, deficit research funding, knowledge capitalization, the marginalization of diversity as a continuous process, a lack of sociocultural authority, and our thoughts on solutions. We conclude by using the wisdom of a generation to answer our initial question. (shrink)

Background Regulations on research ethics in France have evolved considerably over the past four years: the implementation of the Jardé law and of the General Data Protection Regulations have changed the landscape of research ethics for research involving or not involving human persons. In a context of creation of an Institutional Review Board at the University of Bordeaux, France, we sought to explore research ethics practices and perceptions in the medical community of our University Hospital. Methods A short questionnaire was (...) sent to all physicians of the University Hospital of Bordeaux. The questionnaire included closed questions and main topics were: physicians’ education in research ethics, ethics practices concerning researches non implying human persons, and physicians’ perceptions about current regulations. Results 86 questionnaires were sent back. If a majority of physicians have validated Good Clinical Practices trainings, there was a low rate of specific training on fundamental references in research ethics and a high proportion of responders do not consider themselves as educated in research ethics after completion of GCPs. Regulations on research ethics have many implications on medical research, especially by inducing changes in protocols in order to alleviate ethical requirements. Malpractices were acknowledged like false mention of positive opinion from an ethics committee. If If a majority of responders considers regulations as a positive answer to research ethics, a large majority considers it as a constraint and a complexification of research process. For 58%, regulations in research ethics are perceived as a hindrance for research initiatives. Conclusion Because of their impact on research process, regulations seem to constitute a scarecrow for physicians. Lack of training, bad representations and questionable practices highlight the need to improve education and to propose concrete guidance for medical researchers. (shrink)

Objectives The objectives of the study are to understand the current practice of informed consent in medical research in public hospitals in Shanghai, and to share our views with other countries, especially developing countries. Methods In the study, 145 consent forms (CFs) of the selected research projects in eight public hospitals with ethics committees in Shanghai were audited, and the principle investigators (PIs) of these research projects and 40 student subjects who had participated in clinical drug tests were surveyed by (...) questionnaires. Results The CFs of medical researches in public hospitals with ethics committees in Shanghai were generally acceptable. However, there were some defects in the CFs. Although most of the surveyed PIs had correct recognition of informed consent, some processes of informed consent were not in accordance with generally accepted requirements. A large number of the PIs considered the greatest difficulty with informal consent was lack of correct recognition of subjects or legally authorised representatives on medical research. Discussion Informed consent in medical research should consider the research ethics, the background of potential subjects, the local resources and culture of medical research. In addition, special protection is needed for student subjects in informed consent as well as efforts for building and restoring the public's trust in biomedical research. Conclusion The informed consent in Shanghai's public hospitals with ethics committees was generally acceptable and the achievement of adequate informed consent is influenced by many factors. (shrink)

In many research studies, tumor biopsies are an unavoidable requirement for achieving key scientific aims. Yet some commentators view mandatory research biopsies as coercive and suggest they should be optional, or at least optional until further data are obtained regarding their scientific usefulness. Further complicating the ethical picture is the fact that some research biopsies offer a potential for clinical benefit to trial participants. We interviewed and surveyed a convenience sample of participants in phase I clinical trials at a single (...) institution. Our primary aim was to describe phase I participants’ understanding of whether a research biopsy offered them the prospect of medical benefit. We also endeavored to describe participants’ views about biopsies—specifically, the benefits of biopsies, if any, and whether biopsies were acceptable, risky, or discouraged trial participation. Finally, we collected data on demographics and attitudes to see if any strong correlations with misunderstanding, acceptability, or riskiness existed. Overall, the respondents tended to view research biopsies as acceptable, though they did not succeed in identifying the lack of benefit of a research biopsy. These findings call for renewed efforts in consent conversations and documents to carefully describe the benefits, or lack thereof, of research biopsies. (shrink)

Requirements for business ethics education and organizational ethics trainings mark an important step in encouraging ethical behavior among business students and professionals. However, the lack of specificity in these guidelines as to how, what, and where business ethics should be taught has led to stark differences in approaches and content. The present effort uses meta-analytic procedures to examine the effectiveness of current approaches across organizational ethics trainings and business school courses. to provide practical suggestions for business ethics interventions and (...) research. Thus, the primary questions driving this research are as follows: what course characteristics moderate the effectiveness of ethics instruction?, and have ethics education and training efforts improved? Findings suggest that professional, focused, and workshop-based training programs are especially effective for improving business ethics. However, results also reveal considerable problems with many of the criteria used to evaluate the effectiveness of business ethics interventions. Practical suggestions for course design and evaluation in business ethics efforts are discussed along with future research needs. (shrink)

Several studies have explored differences between North American and European doctor patient relationships. They have focused primarily on differences in philosophical traditions and historic and socioeconomic factors between these two regions that might lead to differences in behaviour, as well as divergent concepts in and justifications of medical practice. However, few empirical intercultural studies have been carried out to identify in practice these cultural differences. This lack of standard comparative empirical studies led us to compare differences between France and (...) the USA regarding end-of-life decision-making. We tested certain assertions put forward by bioethicists concerning the impact of culture on the acceptance of advance directives in such decisions. In particular, we compared North American and French intensive care professional's attitudes toward: (1) advance directives, and (2) the role of the family in decisions to withhold or withdraw life-support. (shrink)

Development of the knowledge base for a profession depends on research and scholarship that builds on the insights and work of scholars within the discipline and is disseminated through the literature. The purpose of this study was to examine a unique collection of 79 articles selected by editors as representative of their nursing journals. Articles were assessed for congruence with long‐standing values and conceptual definitions of nursing, and the extent to which they built on prior literature published in nursing. Articles (...) were scored based on whether they reflected four characteristics of nursing as a discipline (holism, social context, goal of health, and consistency with common definitions of nursing); an abstract score on the extent to which the title, abstract, or keywords indicated a general focus on nursing; and a distinction score based on whether the article distinguished nurses or nursing from other providers. Fifty of the articles received an article score of 4, indicating all four disciplinary characteristics were present in the article's content. While the majority of the articles were congruent with fundamental nursing values and perspectives, only 28% of the sources cited were from nursing sources. The lack of citations to nursing literature, coupled with an assessment that reveals gaps in substantive content that builds on nursing knowledge, raises questions about the future of nursing perspectives in the literature. (shrink)

Researchers are required to seek consent from Indigenous communities prior to conducting research but there is inadequate information about how Indigenous people understand and become fully engaged with this consent process. Few studies evaluate the preference or understanding of the consent process for research with Indigenous populations. Lack of informed consent can impact on research findings. The Picture Talk Project was initiated with senior Aboriginal leaders of the Fitzroy Valley community situated in the far north of Western Australia. Aboriginal (...) people were interviewed about their understanding and experiences of research and consent processes. Transcripts were analysed using NVivo10 software with an integrated method of inductive and deductive coding and based in grounded theory. Local Aboriginal interpreters validated coding. Major themes were defined and supporting quotes sourced. Interviews with Aboriginal leaders were facilitated by a local Aboriginal Community Navigator who could interpret if necessary and provide cultural guidance. Participants were from all four major local language groups of the Fitzroy Valley; aged 31 years and above; and half were male. Themes emerging from these discussions included Research—finding knowledge; Being respectful of Aboriginal people, Working on country, and Being flexible with time; Working together with good communication; Reciprocity—two-way learning; and Reaching consent. The project revealed how much more there is to be learned about how research with remote Aboriginal communities should be conducted such that it is both culturally respectful and, importantly, meaningful for participants. We identify important elements in community consultation about research and seeking consent. (shrink)

BackgroundThe outbreak of novel coronavirus disease 2019 has caused a global panic and public concern due to its mortality ratio and lack of treatments/vaccines. Reduced levels of physical activity have been reported during the outbreak, affecting the normal daily pattern.ObjectiveTo investigate the relationship of physical activity level with sleep quality and the effects of reduction physical activity levels on sleep quality.MethodsA Google form was used to address personal information, COVID-19 personal care, physical activity, and mental health of 1,907 adult (...) volunteers. Binary logistic regression was used to verify the association of physical activity parameters and sleep quality.ResultsInsufficient physical activity levels were a risk factor to have disturbed sleep pattern [OR: 1.28, 95% CI ]; however, when the BMI was added to the analysis, there was no more statistical difference [OR: 1.23, 95% CI ]. On the other hand, we found that the reduction of physical activity levels was associated with negative changes in sleep quality [OR: 1.73, 95% CI ], regardless all the confounders [OR: 1.30, 95% CI ], unless when feeling of depression was added in Model 6 [OR: 1.28, 95% CI ].ConclusionDisruption in daily physical activity routine, rather than physical activity level, negatively influences sleep quality during the COVID-19 quarantine. (shrink)

In Wrong Medicine, Lawrence J. Schneiderman, M.D., and Nancy S. Jecker, Ph.D., address issues that have occupied the media and the courts since the time of Karen Ann Quinlan. The authors examine the ethics of cases in which medical treatment is offered--or mandated--even if a patient lacks the capacity to appreciate its benefit or if the treatment will still leave a patient totally dependent on intensive medical care. In exploring these timely issues Schneiderman and Jecker reexamine the doctor-patient relationship and (...) call for a restoration of common sense and reality to what we expect from medicine. They discuss economic, historical, and demographic factors that affect medical care and offer clear definitions of what constitutes futile medical treatment. And they address such topics as the limits on unwanted treatment, the shift from the "Age of Physician Paternalism" to the "Age of Patient Autonomy," health care rationing, and the adoption of new ethical standards. (shrink)

The present contribution tackle the question of which kind of philosophy is apt to thinking contemporary Europe. In order to thematize this problem, the philosophy of Roberto Esposito is analyzed in detail. The central idea of the paper is that contemporary politics cannot be founded upon classical metaphysical instances, such as God, a teleological structur, or some other moral good. The foundation of contemporary politics must rely in politics itself. Esposito’s philosophy of the “impolitico” can help us in thiking this. (...) Following his path, we claim that Europe is to be conceived as a political structure that has its origin in its own “outside”: Europe must take responsibility for its constitute lack of identity, for its own fragility. In this fragility and in the community of death lies the potential for an immanent foundation of European politics. (shrink)

βρυχεδανς : πολυφγος, ο δ μακρς. For μακρς read μργος. ζγγος· τν μελισσν χος, κα τν μοων. L. and S. translate literally, ‘humming of bees, etc.’; but to buzz or hum is not a common property of insects, it is peculiar to a few. For τν μοων I suggest τν μυιν. ζγγος refers especially to the buzz, or ‘ping’, of a mosquito , LL. zanzara; cf. Cassiodorus ‘Ciniphes genus est culicum, fixis aculeis permolestum, quas vulgus consuevit vocare zinzalas’; and in (...) the Appendix, De Wit adds: ‘zinzala; parva musca, id est culex; unde zinzalarium, conopeum ad eas arcendas, Gloss. Ugut. ’—i.e. a mosquito-net. Culex, by the way, is an interesting and a homely word; we lack mosquitoes in Scotland, but we know the angry bite of a ‘horse-fly’ and call it a ‘cleg’. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Franz Brentano and Intentional Inexistence LINDA L. McALISTER FRANZBRnrCrXr~O,in his important early work Psychologie vom empirischen Stand, punkt (1874), maintains that all human experience is divided into two classes: mental phenomena and physical phenomena,x It is then incumbent upon him to show how these two classes of phenomena are to be distinguished one from another. In Book II, Chapter 1, of the Psychologie, he devotes him.self to this task, (...) and in the course of the chapter he surveys several different ways of making out the distinction. After enumerating examples of men~l phenomena and of physical phenomena, he searches for defining characteristics of mental phenomena. He finds several charac, teristics which he thinks all mental phenomena have and all physical phenomena lack or vice versa, but far and away the most important of these, in Brentano's estimation, and the one whdch has aroused the most interest on the part of later philosophers, is what he calls "intentional inexistence," 2 (or merely "intentional existence"; the prefix "in-" does not indicate negation but rathor location, indicating existence in the mind). As examples of mental phenomena Brentano lists first ideas or presentations (Vorstellungen), whether sensory or issuing from the imagination, and by this he meam not the objects which are presented or which one has before one's mind, but rather the condition or, what Brentano; broadly speaking, calls the act of having such an idea or presentation.3 Thus the acts of hearing something, or seeing or perceiving something would be mental phenomena regardless of whether the object which is, e. g., seen, ds perceived through the visual organs or seen in the mind's eye, so to speak. Other examples are acts of judgment, amongwhich Brentano includes ~:emembering, inferring, believing, doubting; and emotions.such as being happy or sad, lovi~,g and hating, along with which Brentano includes such things as willing, intending, choosing, etc.4 i Oskar Kraus, e.d.,2nd ed. (Leipzig,1924),I, 109. Psych. I, 137. Psych. I, 111. " Psych. I, 112. [423] 424 HISTORY OF PHILOSOPHY ExamFles of physical phenomena which Brentano mentions are "a color, a figure, a landscape which I see, a chord which I hear, warmth, cold, odor which I perceive; as well as similar images which appear in the imagination." s It appears from the examFles, then, that mental phenomena are all mental acts, in a broad sense, while physical phenomena are, strictly speaking, all instances of sensible qualities, the inclusion of "a landscape" being, apparently, a slip on Brentano's part, as his student, friend and editor Oskar Kraus points out. 6 As mentioned above, Brentano thought that there is one partieula~ mark of mental phenomena which characterizes them better than any other: Every mental phenomenon is characterized by what the Scholastics of the Middle Ages called the intentional (or mental) inexistence of an object, and what we might call, though not wholly unambiguously, reference to a content, direction toward an object (by which you should not take me to mean a thing), or immanent objectivity. Every mental phenomenon includes something in itself as an object, though they do not all do so in the same way. In presentation something is presented, in judgment something is affmned or denied, in love loved, in hate hated, in desire desired and so on.7 Commentators, perhaps not surprisingly, have disagreed as to the precise nature of the view which Brentano is enunciating in this passage,s Some have supposed that since you can think of, hate, or judge, etc., things which do not exist, e.g., Pegasus, then the immanent object of which Brentano speaks i,s not Pegasus but a "thoughtof Pegasus" (gedachtes Pegasus) which exists in one's mind whenever someone th'mks of Pegasus. Apparently H6fler interpreted the doctrine in this way in a paper which he presented to the Fifth International Psychology Congress in 1905.9.In the light of some passages from Brentano's early writings it appears to be a plausible interpretation. Consider, for example, the following passage: There cannot be anyone who contemplates an A unless there is a contemplated A; and conversely.... The two concepts are not identical but they... (shrink)

ABSTRACT: In a recent article, D. H. Finkelstein offers a new proposal about the distinction between conscious and unconscious belief On his proposal, someone’s belief is conscious if he has an ability to express it simply by self-ascribing it; and someone’s belief is unconscious if he lacks such an ability. In this article, I argue that his proposal is inadequate, and then offer a somewhat different proposal. On my proposal, someone’s belief is conscious if he has self-ascribed this belief without (...) recourse to any evidence about his behaviour; and someone’s belief is unconscious if it is not conscious.RÉSUMÉ: Dans un récent article, D. H. Finkelstein propose une nouvelle distinction entre croyance consciente et inconsciente. Suivant cette proposition, la croyance de quelqu’un est consciente s’il a la capacité de l’exprimer tout simplement en se l’attribuant; sa croyance est inconsciente s’il n’en a pas la capacité. Dans cet article, je fais valoir que cette proposition est inadéquate, et je propose ensuite une nouvelledistinction. Suivant cette distinction, la croyance de quelqu’un est consciente s’il s’attribue cette croyance sans s’appuyer sur aucun élément de preuve au sujet de son comportement; sa croyance est inconsciente si elle n’est pas consciente. (shrink)

Le discours managérial constitue un véritable genre et représente une catégorie particulière au sein des énoncés performatifs. L’objectif annoncé de présentation des orientations stratégiques et de dynamisation des équipes s’accompagne d’une mise en scène particulière qui constitue une des conditions de sa félicité, de son accomplissement. Le contexte d’internationalisation et d’interdépendance dans lequel se déroule l’activité des entreprises renforce la stéréotypie de ce langage qui mobilise un format, un vocabulaire et une syntaxe particulière marqués par l’anglicisme et l’asyncticité. Destiné à (...) unifier et à galvaniser les équipes, ce langage est porteur de signes de pouvoir et de distinction, il exclut plus qu’il n’inclut, génère la perplexité et le désarroi et s’inscrit dans une stratégie du flou qui semble être le seul mode contemporain de l’avenir économique. Circulant à l’envi dans la communauté internationale et de la finance qu’il unifie à sa manière, il a une force incantatoire sur la scène financière et médiatique mais un impact paradoxal sur le travail quotidien des hommes et des femmes. Langage de la spéculation et de l’anticipation, il est plus proche des discours de la performance que des énoncés performatifs.Managerial language is a genre in itself and makes up a particular category of performative speech. The stated objective when presenting strategic goals or team building strategies is always dressed up in a particular way that will determine its aptness and success. The context of internationalisation and interdependence in which business activities take place reinforces a stereotype of management-speak, based on a particular format, vocabulary and grammar permeated by anglicisms and lack of syntax. Aimed at unifying and galvanising business teams, « corpu-speak » conveys a sense of power and distinctiveness, suggests exclusiveness rather than inclusiveness, generates bewilderment and anxiety and is very much at one with the strategy of obfuscation that seems to be the sole contemporary register where the economic future is concerned. Circulating freely within the international and finance community and uniting it as it goes, it acts with the hypnotic effect of incantation on the financial and media scene but has a paradoxical impact on the daily working lives of men and women. As the language of speculation and anticipation, it is more akin to performance discourse than to performative speech. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:HUME ON BLAME AND EXCUSE17. Hume's account of blame and excuse differs in fundamental respects from many contemporary ones. Many contemporary views, ultimately derived from the Kantian dictum that 'ought' implies 'can', base excuses on the nonvoluntary character of an action. For example, H. L. A. Hart argues that the basic requirements for responsibility are that a person have the capacity and a fair opportunity to do what is (...) required. A person is to be excused for an action if he lacked either the capacity or opportunity to do what was required. As these are conditions for an action being voluntary in a suitably narrow sense, Hart primarily bases excuses on the nonvoluntary character of actions. Likewise, Richard Brandt's view, which in many respects is similar to Hume's, requires that the manifestation of a character trait be subject to a high degree of voluntary control before blame.2 is appropriate. Hume, however, explicitly denies that either a character trait or its manifestation in conduct need be subject to voluntary control for blame to be appropriate. The nonvoluntary character of an action does not necessarily excuse one from blame. Hume makes four key claims about blame and excuse. (1) The ultimate objects of praise and blame are mental qualities, not actions. (2) Actions are considered only as signs of mental qualities. (3) The possession and expression of these mental qualities may be appropriate objects of praise or blame even if they are nonvoluntary. (4) Persons have excuses if their actions do not indicate enduring mental qualities. These points need to be substantiated and explained. The first two claims may be considered together. That Hume holds mental qualities are the ultimate objects of praise and blame and that actions are considered only as signs of mental qualities is indisputable. 18. 'Tis evident, that when we praise any actions, we regard only the motives that produced them, and consider the actions as signs or indications of certain principles in the mind and temper. The external performance has no merit. We must look within to find the moral quality. This we cannot do directly; and therefore fix our attention on actions, as on external signs. But these actions are still considered as signs; and the ultimate object of our praise and approbation is the motive, that produced them. For present purposes, only two points need be noted about this passage. First, it clearly states that the ultimate objects of praise and, as he indicates in his following 4 paragraph, blame are always mental qualities. The expression mental qualities is vague, perhaps deliberately so. Sometimes Hume uses the term motive instead. By 'motive' he does not intend any passing desire or further intention which one may have in acting, e.g., embarrassing others. For Hume, some motives are not even dispositions to act. Second, actions or external performances have no merit. They are only signs of mental qualities. Even if the concept of an action includes more than the external behavior, such as the intention, it does not include motives or desires. A difference in intention may entail a difference in action, but a difference in motive does not. The same action may be performed from different motives. Hence, actions are not logically connected with the objects of praise and blame. Hume's claim that actions themselves have no merit, it might be objected, is incorrect. People do constantly evaluate actions. If they did not, then actions would not be considered untoward and a basis for attributing blame. However, Hume does not deny that actions may be evaluated in some way or other, only that they alone have merit or are appropriate objects of praise and blame. Actions may be evaluated without reference to mental qualities, for example, as right or wrong, useful or unuseful. Hume is 19. chiefly concerned with evaluating actions as virtuous or vicious. The terms virtuous and vicious as applied to actions involve an element of praise and blame, whereas the terms right and wrong, at least in most of their uses, do not. Thus, Hume is not denying that actions alone may have merit in the sense of value or utility. Rather, he is denying that actions... (shrink)

The acquisition and evolution of speech production, discourse and communication can be negatively impacted by brain malformations. We describe, for the first time, a case of developmental dynamic dysphasia (DDD) in a right-handed adolescent boy (subject D) with cortical malformations involving language-eloquent regions (inferior frontal gyrus) in both the left and the right hemispheres. Language evaluation revealed a markedly reduced verbal output affecting phonemic and semantic fluency, phrase and sentence generation and verbal communication in everyday life. Auditory comprehension, repetition, naming, (...) reading and spelling were relatively preserved, but executive function was impaired. Multimodal neuroimaging showed a malformed cerebral cortex with atypical configuration and placement of white matter tracts bilaterally and abnormal callosal fibers. Dichotic listening showed right hemisphere dominance for language and functional magnetic resonance imaging (fMRI) additionally revealed dissociated hemispheric language representation with right frontal activation for phonology and bilateral dominance for semantic processing. Moreover, subject D also had congenital mirror movements (CMM), defined as involuntary movements of one side of the body that mirror intentional movements of the other side. Transcranial magnetic stimulation and fMRI during voluntary unimanual (left and right) hand movements showed bilateral motor cortex recruitment and tractography revealed a lack of decussation of bilateral corticospinal tracts. Genetic testing aimed to detect mutations that disrupt the development of commissural tracts correlating with CMM (e.g., Germline DCC mutations) was negative. Overall, our findings suggest that DDD in subject D resulted from the underdevelopment of the left inferior frontal gyrus with limited capacity for plastic reorganization by its homologous counterpart in the right hemisphere. Corpus callosum anomalies probably contributed to hinder interhemispheric connectivity necessary to compensate language and communication deficits after left frontal involvement. (shrink)

Dans un cadre réglementaire de mise sur le marché des substances chimiques, l’information sur les risques chimiques pour la santé et l’environnement doit être généralement produite par les industriels, qui la soumettent aux agences sanitaires. L’accès du public à cette information est régulé par des dispositifs juridiques internationaux, européens et nationaux, et fondé sur les principes de transparence et de liberté d’accès et de réutilisation. Cependant, différents facteurs restreignent l’effectivité du droit à l’information et par conséquent le contrôle démocratique et (...) scientifique sur l’évaluation du risque. Les textes juridiques sont éclatés entre la législation environnementale et celle sur l’accès aux données publiques. Le droit d’accès peut être limité juridiquement pour des raisons de confidentialité et de secret industriel, des dispositions qui permettent aux entreprises de protéger leurs intérêts commerciaux mais qui peuvent être interprétés de manière arbitraire par les agences. Enfin sur le plan pratique, le manque de lisibilité du format, le langage employé et les interfaces peuvent constituer des obstacles à l’accès effectif et à la réutilisation des données.Under the regulations governing marketing authorisation for chemical substances, information on chemical risks to health and the environment generally has to be produced by the industries concerned for submission to the health agencies. Public access to this information is governed by international, European and national legal provisions, and based on the principles of transparency and the freedom to access and re-use the information. However, various factors are restricting the effectiveness of this right to information and, consequently, restricting democratic and scientific oversight of risk assessments. The relevant legal texts are split between environmental legislation and legislation on access to public data. The right of access can be legally limited on grounds of confidentiality and protection of trade secrets, under provisions that allow businesses to protect their commercial interests but which can be interpreted arbitrarily by the health agencies. Finally, on the practical level, the lack of clarity of the format, the language used and the interfaces can be an obstacle to effective access and re-use of the data. (shrink)

Little is known about the consequences of moral distress. The purpose of this study was to identify clinical situations that caused nurses to experience moral distress, to understand the consequences of those situations, and to determine whether nurses would change their practice based on their experiences. The investigation used a descriptive approach. Open-ended surveys were distributed to a convenience sample of 204 critical care nurses employed at a university medical center. The analysis of participants’ responses used an inductive approach and (...) a thematic analysis. Each line of the data was reviewed and coded, and the codes were collapsed into themes. Methodological rigor was established. Forty-nine nurses responded to the survey. The majority of nurses had experienced moral distress, and the majority of situations that caused nurses to experience moral distress were related to end of life. The nurses described negative consequences for themselves, patients, and families. (shrink)

During the co-evaluation of student teacher of trainees’ learning with the associate teacher, several supervisors experience a discomfort with their role, their actions and their posture. For some, this discomfort is due to a lack of continuous training preventing their professional development. By creating a community of practice, we supported the reflection and analysis of student teaching supervision that take place within triads, made up of the trainees’, the associate teacher and the supervisors. Our objective was to study the (...) contributions of this community to their practices. In this article, we first present the problematic. We then present the conceptual framework consisting of experiential learning, professional development and the community of practice. The methodological approach is then explained, followed by data collected by means of semi-directed individual interviews with the supervisors of the community of practice. The results of the reported practice highlight the contributions of the community of practice to the professional development of its members. (shrink)

This paper is a sequel to my [7]. It focuses on the notion of natural number as introduced in section 11 of that paper with regard to forms of induction and recursive definitions. One point is that this notion of natural number is somewhat weaker than the classical one in so far as it is defined in terms of a weak implication. The other point is the lack of even a weak form of extensionality. As a main result of (...) the present paper it will turn out that the means provided in [7] are sufficient to account for an interpretation of primitive recursive arithmetic. (shrink)

Survivors of childhood brain tumors face many obstacles to living independently as adults. Causes for lack of independence are multifactorial and generally are investigated in terms of physical, cognitive, and psychosocial treatment–related sequelae. Little is known, however, about the role of expectation for survivors’ function. From a mixed–methods study including qualitative interviews and quantitative measures from 40 caregiver–survivor dyads, we compared the data within and across dyads, identifying four distinct narrative profiles: (A) convergent expectations about an optimistic future, (B) (...) convergent expectations about a less optimistic future, (C) non–convergent expectations about a less optimistic future, and (D) non–convergent expectations about an unclear future. Dyads both do well and/or struggle in systematically different manners in each profile. These profiles may inform the design of interventions to be tested in future research and help clinicians to assist families in defining, (re–)negotiating, and reaching their expectations of function and independence. (shrink)

Die Untersuchung gliedert sich in einen allgemeinen und einen besonderen Teil. Der allgemeine Teil, der die ersten neun Kapitel umfasst, hat es mit den Veränderungen zu tun, denen die Funktion des Kunstwerkes in seiner technisch reproduzierten Gestalt unterworfen ist. Die Qualität seiner technischen Reproduktion und die Geschwindigkeit ihrer Herstellung sind seit den einschlägigen Erfindungen des letzten Jahrhunderts in schnellem Wachstum begriffen. Die Zeit, die zwischen der Erfindung der Lithographie und der des Tonfilms liegt, umfasst kaum mehr Jahrzehnte als die zwischen (...) der Erfindung des Holzschnitts und der der Lithographie liegenden Jahrhunderte. Der Film ist die derzeit fortgeschrittenste künstlerische R ‘produktionstechnik. Er bedeutet in der Geschichte der Kunst etwas grundlegend Neues, nämlich die Reproduktion eines auf Reproduzierbarkeit angelegten Kunstwerkes. Der besondere Teil der Untersuchung hat es mit dem Film als der der Kunst in der Epoche ihrer technischen Reproduzierbarkeit spezifischen Form zu tun.Das erste Kapitel der Untersuchung entwickelt den Unterschied zwischen manueller und technischer Reproduktion des Kunstwerkes. Das zweite* umschreibt den jeder Reproduktion entzogenen Bereich der Echtheit, der die Aura des Kunstwerkes bildet. Das dritte bestimmt den Charakter der gegenwärtigen Wahrnehmung als bestimmt durch den Verfall der Aura. Das vierte weist die Fundierung der Echtheit in den Zusammenhängen des Rituals auf. Das fünfte hat es mit dem Unterschied des auf dem Ritual beruhenden Kultwertes des Kunstwerks von seinem Ausstellungwert zu tun. Das sechste zeigt, welchen verschiedenen Entwicklungsstufen der Technik Kultwert und Ausstellungswert des Kunstwerkes entsprechen. Das s'ebte handelt von dem beginnenden Übergewicht des Ausstellungswertes über den Kultwert in der Photographie. Das achte beleuchtet die Sonderstellung der griechischen Kunst durch ihren fast völligen Mangel an technischen Reproduktionsverfahren. Das neunte weist auf die Schwierigkeiten hin, die der überkommenen Aesthetik durch die Photographie und den Film erwachsen.Der zweite Teil der Untersuchung zieht aus den Analysen des ersten Teils die Folgerungen für die Filmtheorie. Er beschäftigt sich mit den Umständen, die aus dem Film dasjenige Kunstwerk machen, an dem die derzeitige Funktionsänderung sich am deutlichsten abnehmen lässt. Diese Funktionsänderung besteht in der Überführung des Kunstwerkes aus der ritualen in die politische Praxis.The investigation is divided into two parts, the first conceived on general lines and the second dealing with one specific aspect of the question. The general part deals with the changes to which the function of a work of art is subjected in its technically reproduced form. The quality of its technical reproduction and the speed with which the same is established have made great progress since the inventions of last century in that sphere. The period of time existing between the invention of lithography and that of the sound film contains scarcely more decades than there are centuries between the invention of the wood-cut and that of lithography. The film, at present, has the most highly developed technic of artistic reproduction. In the history of art the film represents something fundamentally new, namely, the reproduction of a work of art which aims precisely at such reproducibility. The second part of the investigation deals with the film as the specific form of art in the era of technical reproducibility.The first chapter develops the difference between manual and technical reproduction of a work of art. The second delimits the sphere of authenticity which forms the aura of a work of art and which is withdrawn from every reproduction. The third defines the character of modern perception as determined by the deterioration of the aura. The fourth chapter shows that the foundation of authenticity lies in the associations of ritual. The fifth deals with the difference between the cult-value based on ritual and the exhibition-value of a work of art. The sixth shows the various stages in the development of technical art to which the cult-value and the exhibition-value of a work of art correspond. The seventh treats the beginnings of the predominance of the exhibition-value over the cult- value in photography. The eighth throws light on the special position of Greek art due to its being almost completely lacking in methods of technical reproduction. The ninth draws attention to the difficulties which arise for traditional esthetics Through photography and the film.The second part of the investigation draws from the analyses of the first part certain conclusions concerning the theory of film-making. It concerns itself with the circumstances which make the film the work of art from which the modern change of function can be most clearly deduced. This change of function consists in the transference of the work of art from the realm of ritual to that of politics. (shrink)