Objectives—While clinical practice is complicated by many ethical dilemmas, clinicians do not often request ethics consultations. We therefore investigated what triggers clinicians' requests for ethics consultation. Design—Cross-sectional telephone survey.Setting—Internal medicine practices throughout the United States.Participants—Randomly selected physicians practising in internal medicine, oncology and critical care.Main measurements—Socio-demographic characteristics, training in medicine and ethics, and practice characteristics; types of ethical problems that prompt requests for consultation, and factors triggering consultation requests. Results—One hundred and ninety of 344 responding physicians (55%) reported requesting ethics (...) consultations. Physicians most commonly reported requesting ethics consultations for ethical dilemmas related to end-of-life decision making, patient autonomy issues, and conflict. The most common triggers that led to consultation requests were: 1) wanting help resolving a conflict; 2) wanting assistance interacting with a difficult family, patient, or surrogate; 3) wanting help making a decision or planning care, and 4) emotional triggers. Physicians who were ethnically in the minority, practised in communities under 500,000 population, or who were trained in the US were more likely to request consultations prompted by conflict. Conclusions—Conflicts and other emotionally charged concerns trigger consultation requests more commonly than other cognitively based concerns. Ethicists need to be prepared to mediate conflicts and handle sometimes difficult emotional situations when consulting. The data suggest that ethics consultants might serve clinicians well by consulting on a more proactive basis to avoid conflicts and by educating clinicians to develop mediation skills. (shrink)
The effects of aging on the cognitive and affective dimensions of theory of mind , and on the latter’s links with other cognitive processes, such as information processing speed, executive functions and episodic memory, are still unclear. We therefore investigated these effects in young , middle-aged and older adults , using separate subjective and objective assessment tasks. Furthermore, a novel composite task probed participants’ abilities to infer both cognitive and affective mental states in an interpersonal context. Although age affected the (...) objective ToM tests, results revealed a direct aging effect on the second-order ToM, but an indirect one on the first-order cognitive ToM, mediated mainly by age-related declines in executive functions. This study supports the notion of an age-related distinction between subjective and objective assessments of ToM, and confirms that ToM is a complex mental ability with several characteristics reliant to some extent on executive processes. (shrink)
Research shows that commitment-based interventions are among the most effective strategies to encourage pro-environmental behaviors, but methods to elicit commitments from a large number of individuals are often costly and unrealistic. Predictions requests—a commitment-type strategy—are an effective mass-communication strategy and have the potential to influence pro-environmental behavior among large audiences. This research is the first to demonstrate that prediction requests in a consumer behavior context influence preference for environmentally friendly products. In addition, this research examines the role of individual and (...) contextual factors in influencing the efficacy of prediction requests. Study 1 shows that exposure to an advertisement with a prediction request leads to increased preferences for environmentally sustainable household cleaning products, compared to a control advertisement, and that this effect is greater when the prediction request is paired with an audience cue . Study 2 indicates that the effect of prediction requests on preference for sustainable products is greater for individuals with interdependent self-construal. Substantive implications and directions for future research are discussed. (shrink)
Background: Informed consent in clinical research is mandated throughout the world. Both patient subjects and investigators are required to understand and accept the distinction between research and treatment.Aim: To document the extent and to identify factors associated with therapeutic misconception in a population of patient subjects or parent proxies recruited from a variety of multicentre trials .Patients and methods: The study comprised two phases: the development of a questionnaire to assess the quality of informed consent and a survey of patient (...) subjects based on this questionnaire.Results: A total of 303 patient subjects or parent proxies were contacted and 279 questionnaires were analysed. The median age was 49.5 years, sex ratio was 1 and 61% of respondents were professionally active. Overall memorisation of the oral or written communication of informed consent was good , and satisfaction with the process was around 70%. Therapeutic misconception was present in 70% of respondents, who expected to receive better care and ignored the consequence of randomisation and treatment comparisons. This was positively associated with the acuteness and severity of the disease.Conclusion: The authors suggest that the risk of therapeutic misconception be specifically addressed in consent forms as an educational tool for both patients and investigators. (shrink)
Clinical Study Agreements can have profound effects both on the protection of human subjects and on the independence of investigators to conduct research with scientific integrity. Sponsors, institutions, and even investigators may fail to give adequate attention to these issues in the negotiation of CSAs. Despite the key role of CSAs in structuring ethically important aspects of research, they remain largely unregulated and unreviewed for adherence to ethical norms. Academic institutions routinely enter into research contracts that fail to meet adequate (...) ethical standards. This is a failing that can have serious consequences.Accordingly, it is necessary that some independent body have the authority both to review research contracts for compliance with norms of subject protection and ethical integrity, and to reject studies that fail to meet ethical standards. Such review should take place prior to the start of research, not later. Because of its expertise and authority, the institutional ethics review board is the appropriate body to undertake such review. Much recent commentary has focused on contractual restrictions on the investigator’s freedom to publish research findings. The Olivieri experience, and that of other investigators, has brought freedom of publication issues into sharp focus. Clinical study agreements also raise a number of other ethical issues relating to human subjects and research integrity, however, including disclosures relating to patient safety, data analysis and reporting, budget, confidentiality, and premature termination of the study. This paper describes the ethical issues at stake in structuring such agreements and suggests ethical standards to guide institutional ethics review. (shrink)
The practice of nonphysician ethicist-consultants giving ethics advice concerning the appropriate medical treatment of patients in hospitals is a relatively recent development. Although only a minority of hospitals make substantial use of any formal ethics consulting service, the number is growing and apparently will continue to do so. Indeed, at least among urban teaching hospitals, some sort of ethics consulting service is increasingly commonplace.
A systematic philosophy that presupposes an ecocentric world view, rather than a homocentric or egocentric world view, can be a viable resource for investigating issues in environmental philosophy and conservation ethics. Generally speaking, the Japanese philosophical and religious tradition represents a commitment to ecocentrism. This philosophical orientation is in concert with the world view of manynaturalists. We explore one example of ecocentrism by unveiling the crosscultural connection between the naturalistic philosophy of Louis Agassiz, a nineteenth-century French-American biologist, and the early (...) writings of Nishida Kitarō, a twentieth-century Japanese philosopher. We suggest that the central player in understanding the ecocentric connection between Agassiz and Nishida is American philosopher-psychologist William James. James was once a student of Agassiz and his writings influenced Nishida's early work. Related issues concerning conservation ethics and the Japanese intellectual tradition are also addressed. (shrink)
This work is a concise study of the central concepts in Wittgenstein's later philosophy of psychology. Schulte uses Wittgenstein's manuscripts from 1945-49 to illuminate central arguments and ideas more accessible through these manuscripts than through the published texts. Specifically Schulte is concerned with manuscripts 130-8 which deal with the logic of psychological concepts, the concepts of thinking, understanding, sensation, and perception, as well as with philosophical method, philosophical argumentation, and an analysis of conditional statements. Also included in the manuscripts are (...) remarks on aesthetics and ethics. Schulte's book clarifies Wittgenstein's thoughts on these subjects and connects these developments in his thinking to his work in the late 1940s. Experience and Expression includes discussion of language games, the classifications of psychological concepts, expression, experience, objects of vision, memory, and emotion, as well as belief, supposition and assertion. (shrink)
In Vanuatu, small-scale farmers’ subsistence still largely relies on the sustainable use and maintenance of a wide-ranging biodiversity out of which root and tuber crops provide the bulk of daily subsistence. In neighboring countries, foreign influence since the first European contacts, further associated changes and the introduction of new crop species have induced a loss of cultivated diversity. This paper presents a baseline study of the diversity of root and tuber crops in ten communities throughout Vanuatu. In a context where (...) the smallholders’ agrosystems are increasingly considered as key components for the global conservation of crop genetic resources, this study provides clues to better understand the effective roles of biodiversity in traditional agrosystems. It also provides insights on the rationale behind the constitution of agricultural portfolios and discusses how the cultivated diversity allows communities to cope with changes and pressures. The paper also shows that recently introduced crops neither seem to have compromised agricultural diversity nor drastically changed the agrosystems in Vanuatu. On the contrary, such crops are used by farmers to strengthen the resilience of their agrosystems. A discussion then presents the idea of continuity through change and novelty as a critical factor for resilience. The paper concludes by discussing the role of indigenous agriculture and culture in ensuring food security and in development strategies in a larger context. (shrink)
El libro “Aventuras de la epistemología ambiental” de Enrique Leff nos presenta un análisis crítico de las concepciones del ambiente a las que nos han habituado las ciencias normales y el perfil de un nuevo saber ambiental. El autor se plantea el objetivo de ofrecernos elementos para “irrigar” lo que llama “el territorio de la naciente epistemología ambiental”.Mis primeras miradas al libro me hicieron pensar que las verdaderas aventuras epistemológicas de Leff se hallarían en sus publicacione..
Deduction systems and graph transformation systems are compared within a common categorical framework. This comparison results in a proposal for a new deduction method in diagrammatic logics, allowing the deletion of intermediate lemmas.
In this excellent introductory study, Schulte provides a clear, concise account of Wittgenstein's life and works. Schulte captures the flavor of Wittgenstein's life: the passion and intensity, as well as the desire for solitude and loneliness which inform his writings. The first chapter presents a sensitive and thoughtful picture of Wittgenstein as a man who loved to make things. We suffer with Wittgenstein as he lives to see the suicides of three of his four brothers and contemplates suicide himself, and (...) we feel gladdened when an uncle persuades Wittgenstein to choose a creative endeavor--the writing of his first book. Schulte portrays Wittgenstein in search of the "decent" life. His book is to be commended for introducing us to the Wittgenstein whose forceful personality so markedly colors his work. (shrink)
Le problème du fondement de la raison ne peut se résoudre que par le principe de transcendance. Les principes rationnels ne sont pas constitutifs d’un esprit pur, qui imposerait, du dehors, ses formes aux objets de sa pensée ; ils naissent dans le progrès et l’effort de l’esprit, pour se dépasser lui-même.
Il s’agira ici de faire apparaître la régressivité — possibilité perpétuelle d’adjoindre un degré supplémentaire à l’énoncé — comme le principe même de l’ironie, ce qui conduit à la concevoir non comme une grille sémiotique et axiologique, mais comme une dynamique.La réflexion part de la cellule de base qu’est le signe ironique en tant que structure hiérarchisée à deux degrés, selon la conception traditionnelle. Cette dualité est d’abord analysée du point de vue sémantique, dans le cadre tropologique, puis sur les (...) plans axiologique, actantiel et énonciatif, ce qui aboutit à l’hypothèse de l’ironie comme trope métadiscursif, cumulant l’usage et la mention . Dans ce cadre, l’ironie se conçoit comme une représentation de représentation, comme un processus d’auto-duplication agissant par réflexivité critique et comique, et donc capable de se perpétuer virtuellement à l’infini puisque, s’appliquant à lui-même, il peut toujours ajouter un degré au précédent, sans pour autant l’annuler : le signe à deux niveaux ne constitue que la réalisation minimale de l’ironie, dont le second degré peut lui-même être réfléchi par un troisième, etc. Le « pouvoir réfléchissant » de l’ironie fait ainsi sa « force ascensionnelle » régressive, selon deux expressions empruntées à Proust.Interne au signe, ce dynamisme permet aussi, à l’échelle d’une oeuvre, de greffer différentes sortes d’ironie les unes sur les autres : la puissance créatrice du processus régressif conduit à envisager son rôle dans l’oeuvre d’art, en l’occurrence À la recherche du temps perdu, dont le texte multiplie de façon exemplaire et retorse les strates d’ironie. La Recherche, qui aura préalablement servi de support à toutes les analyses, permettra, par l’intermédiaire de Bergotte — écrivain ironiste dont le génie consiste dans le « pouvoir réfléchissant » et l’énergie créatrice dans la « force ascensionnelle » —, de poser la question de l’actualisation de la régressivité ironique dans l’oeuvre littéraire.Regressivity, as the perpetual possibility of adding a further degree to an utterance is the very principle of irony, which is thus conceived not under a semiotic and axiological grid, but as a dynamics.Reflection starts from the ironic sign as the basic cell and as a two tiered hierarchical structure, according to the traditional conception. This duality is first analysed from a semantical point of view, within the tropological framework, then on the axiological, actancial and utterance theoretic levels. This leads us to the hypothesis that irony is a metadiscursive trope, bringing together use and mention . Within this framework, irony is a representation of representation, an auto-duplicative process which acts through critical and comical reflectivity, and which is liable to perpetuate itself indefinitely, since, being auto-applicative, a new degree can always be added to the previous one, without cancelling itself : the two tiered sign being only the minimal realisation of irony, whose second degree can itself be reflected through a third, and so on. The “reflective power” of irony thus produces its “ascending force”.This mechanism internal to the sign allows also, at the level of the work, to plug different kinds of ironies onto each other : the creative power of the regressive process allows us to envisage its role in the work of art, in the case at hand in Remembrance of Things Past, whose text multiplies the various layers of irony. Proust’s work, which is here the basis of all our analyses, allows Bergotte — the ironist writer whose genius consists in the “reflective power” and in the “ascending force” — to raise the question of the actualisation of the ironical regressivity of the literary work. (shrink)
Essays in Memory of Richard Helgerson: Laureations brings together new essays by leading literary scholars of the British and European middle ages and early modern period who have been influenced by the groundbreaking scholarship of Richard Helgerson. The contributors evince the ongoing impact of Helgerson's work in critical debates including those of nationalism, formal analysis, and literary careerism.