Clinical ethics consultations exist to support patients, families and clinicians who are facing ethical or moral challenges related to patient care. They provide a forum for open communication, where all stakeholders are encouraged to express their concerns and articulate their viewpoints. Ethics consultations can be requested by patients, caregivers or members of a patient’s clinical or supportive team. Althoughpatientsand by extension their families (especially in cases of decisional incapacity) are the common denominators in most ethics consultations, these constituents are theleastlikely (...) to request them. At many healthcare organisations in the USA, ethics consultations are overwhelmingly requested by physicians and other clinicians. We believe it is vital that healthcare institutions bridge the knowledge gaps and power imbalances over access to ethics consultation services through augmented policies, procedures and infrastructure. With enhanced education and support, patients and families may use ethics consultation to elevate their voices and prioritise their unique characteristics and preferences in the delivery of their healthcare. Empowering patients and families to request ethics consultation can only strengthen the patient/family–clinician relationship, enhance the shared decision-making model of care and ultimately lead to improved patient-centred care. (shrink)

In a healthcare setting, a multitude of ethical and moral challenges are often present when patients and families direct uncivil behavior toward clinicians and staff. These negative interactions may elicit strong social and emotional reactions among staff, other patients, and visitors; and they may impede the normal functioning of an institution. Ethics Committees and Clinical Ethics Consultation Services (CECSs) can meaningfully contribute to organizational efforts to effectively manage incivility through two distinct, yet inter-related channels. First, given their responsibility to promote (...) a humane, respectful, and professional climate, many CECSs and Ethics Committees may assist institutional leadership in evaluating and monitoring incivility policies and procedures. Second, when confronted with individual incidents of patient/family incivility, Ethics Consultants can and often do work with all stakeholders to address and mitigate potentially deleterious impacts. This manuscript presents an overview of the multifaceted ethical implications of incivility in the healthcare environment, discusses the inherent qualifications of Ethics Consultants for assisting in the management of incivility, and proposes specific mitigating actions within the purview of CECSs and Ethics Committees. We also invite healthcare organizations to harness the skills and reputation of their CECSs and Ethics Committees in confronting incivility through comprehensive policies, procedures, and training. (shrink)

Research partnerships between institutions in the Global North and institutions in the Global South have many potential benefits, including sharing of knowledge and resources. However, such partnerships are traditionally exploitative to varying degrees. In order to promote equity in South‐North research partnerships, it is necessary to learn from the experiences of researchers collaborating internationally. This study analyzed transcripts from eleven semi‐structured qualitative interviews with researchers working at Clínica de Familia La Romana, an institution in the Dominican Republic with decades of (...) experience with research and research partnerships with institutions from the Global North. The findings of this study suggest that respect for resources invested in research, as well as for the researchers and institutions themselves, are vital components to a successful global health research partnership. These findings have implications for individual research partnerships, as well as the policies of journals and institutions providing funding that affect these partnerships. (shrink)

Introduction By the late fifth century BCE Panini had composed the Astadhyayi, consisting of nearly 4000 rules giving a precise and fairly complete ...

This research presents a computer model called EUREKA that begins with novice‐like strategies and knowledge organizations for solving physics word problems and acquires features of knowledge organizations and basic approaches that characterize experts in this domain. EUREKA learns a highly interrelated network of problem‐type schemas with associated solution methodologies. Initially, superficial features of the problem statement form the basis for both the problem‐type schemas and the discriminating features that organize them in the P‐MOP (Problem Memory Organization Packet) network. As EUREKA (...) solves more problems, the content of the schemas and the discriminating features change to reflect more fundamental physics principles. This changing network allows EUREKA to shift from a novicelike means‐ends strategy to a more expertlike “knowledge development” strategy in which the presence of abstract concepts are triggered by problem features. In this model, the strategy shift emerges as a natural consequence of the evolving expertlike organization of problem‐type schemos. EUREKA captures many of the descriptive models of novice expert differences, and also suggests a number of empirically testable assumptions regarding problem‐solving strategies and the representation of problem‐solving knowledge. (shrink)

German legislation demands that decisions about the treatment of mentally incompetent patients require an ‘informed consent’. If this was not given by the patient him-/herself before he/she became incompetent, it has to be sought by the physician from a guardian, who has to be formally legitimized before. Additionally this surrogate has to seek the permission of a Court of Guardianship (Vormundschaftsgericht), if he/she intends to consent to interventions, which pose significant risks to the health or the life of the person (...) under his/her care. This includes ‘end-of-life decisions’. Deviations from this procedure are only allowed in acute emergencies or cases of ‘medical futility’. On the basis of epidemiological and demographical data it can be shown that the vast majority of surrogate decisions on incompetent patients in Germany is not covered by legally valid consent. Moreover, the data suggests that if consent were to be requested according to the legal regulations, both the legal and medical system could realistically never cope with the practical consequences of this. Additionally, empiric research has revealed serious deficits concerning medical ‘end of life-decisions’ and practical performance in palliative care. As a consequence a multidisciplinary discussion has developed in Germany about the reform of present legislation with respect to key-issues like• the assessment of mental competence• the options for exercising patient self-determination via advance directives and durable powers of attorney• the improvement of palliative care facilities,• the clarification of formal procedures for surrogate decision-making in health care and towards the end of life• and the possibilities and their limitations of controlling these decision-making processes ‘externally’ (e.g., by Guardianship Courts or committees).The authors discuss those proposals, which clearly dominate the present debate: They all aim to comply with the scientific basis of German law, jurisdiction and the European traditions of philosophy of health care and bioethics. (shrink)

It is quite extraordinary, philosophically speaking, that according to the orthodox interpretation: (a) quantum mechanics is a complete and comprehensive theory of microphysics, and yet (b) the role of measurement, in quantum mechanics, cannot be analyzed in terms of the collective effects of the microphysical particles making up the apparatus. It follows that, if the orthodox interpretation is correct, the measurement apparatus and its quantum physical effects cannot be accounted for microreductively. This is significant because it is widely believed that (...) the relation between physical wholes and parts is microreductive. Indeed, many philosophers are persuaded of the inevitability of universal microreduction to the basic elements of microphysics. This is the viewpoint embodied in the program for the unity of science, espoused in recent years, most notably by Robert Causey (1977). (shrink)

The origins of field guides and other plant identification manuals have been poorly understood until now because little attention has been paid to 18th century botanical identification guides. Identification manuals came to have the format we continue to use today when botanical instructors in post-Revolutionary France combined identification keys (step-wise analyses focusing on distinctions between plants) with the "natural method" (clustering of similar plants, allowing for identification by gestalt) and alphabetical indexes. Botanical works featuring multiple but linked techniques to enable (...) plant identification became very popular in France by the first decade of the 19th century. British botanists, however, continued to use Linnaeus's sexual system almost exclusively for another two decades. Their reluctance to use other methods or systems of classification Can be attributed to a culture suspicious of innovation, anti-French sentiment and the association of all things Linnaean with English national pride, fostered in particular by the President of the Linnean Society of London, Sir James Edward Smith. The British aversion to using multiple plant identification technologies in one text also helps explain why it took so long for English botanists to adopt the natural method, even after several Englishmen had tried to introduce it to their country. Historians of ornithology emphasize that the popularity of ornithological guides in the 19th and 20th centuries stems from their illustrations, illustrations made possible by printing technologies that improved illustration quality and reduced costs. Though illustrations are the most obvious features of late 19th century and 20th century guides, the organizational principles that make them functional as identification devices come from techniques developed in botanical works in the 18th century. (shrink)

Changing Generations, a study of intergenerational relations in Ireland undertaken between 2011 and 2013 by the Social Policy and Ageing Research Centre, Trinity College, Dublin, and the Irish Centre for Social Gerontology, NUI Galway, used the Constructivist Grounded Theory method to interrogate support and care provision between generations. This article draws on interviews with 52 women ages 18 to 102, allowing for simultaneous analysis of older and younger women’s perspectives. The intersectionality of gender and class emerged as central to the (...) analysis. Socioeconomic positions shape contrasting forms of interdependency among family generations, ranging from “enmeshed” lives among lower socioeconomic groups to “freed” lives among higher socioeconomic groups. Women are initiating changes in how care and support flow across generations. Older women in higher socioeconomic groups are attuned to how emotional capital women expend across family generations can constrain women’s lives. In an expression of solidarity, older women are renegotiating the place of care labor in their own lives and in the lives of younger women. A new reciprocity emerges that amounts to women “undoing gender.” This process is, however, deeply classed as it is women in higher socioeconomic groups whose resources best place them to renegotiate care. (shrink)

The origins of field guides and other plant identification manuals have been poorly understood until now because little attention has been paid to 18th century botanical identification guides. Identification manuals came to have the format we continue to use today when botanical instructors in post-Revolutionary France combined identification keys with the "natural method" and alphabetical indexes. Botanical works featuring multiple but linked techniques to enable plant identification became very popular in France by the first decade of the 19th century. British (...) botanists, however, continued to use Linnaeus's sexual system almost exclusively for another two decades. Their reluctance to use other methods or systems of classification Can be attributed to a culture suspicious of innovation, anti-French sentiment and the association of all things Linnaean with English national pride, fostered in particular by the President of the Linnean Society of London, Sir James Edward Smith. The British aversion to using multiple plant identification technologies in one text also helps explain why it took so long for English botanists to adopt the natural method, even after several Englishmen had tried to introduce it to their country. Historians of ornithology emphasize that the popularity of ornithological guides in the 19th and 20th centuries stems from their illustrations, illustrations made possible by printing technologies that improved illustration quality and reduced costs. Though illustrations are the most obvious features of late 19th century and 20th century guides, the organizational principles that make them functional as identification devices come from techniques developed in botanical works in the 18th century. (shrink)

The Arthaśāstra: Selections from the Classic Indian Work on Statecraft. Edited and Translated, with an Introduction, by Mark McClish and Patrick Olivelle. Indianapolis: Hackett, 2012. Pp. lxvi + 169. $52, £37.95 ; $16.95, £12.95.

Accounts of creation in Sanskrit literature include a number of hymns in the R̥gveda principal among which are R̥V 10.72, 10.81–82, 10.90, 10.121, and 10.129. Later accounts appear in the Mānavadhārmaśāstra, the Mahābhārata, and purāṇas. Scholars generally describe these accounts as various, mutually inconsistent myths, or as superseded stages of philosophical thought. Even recent treatments of Indian cosmogony that praise the poetic subtlety and prowess of their composers consider their work as products of individual poetic imagination. Yet, despite the variety (...) of expression in the various accounts, they appear to convey a consistent model of the origin of the world. Moreover, the model of the absolute and the first stages of creation mirror the descriptions of the development of enlightenment in foundational texts of Vedānta and systematic analyses of Yoga. The descriptions of creation may therefore rather be the result of the special insight of enlightened sages than the results of individual imagination. (shrink)

It is a puzzle of long standing in Indo-Iranian studies that the cognates of the Vedic devás and their eventual rivals and eternal enemies, the ásuras, have entirely opposite valuations in Old Iranian, where Ahura Mazdāh is the chief of the pantheon and the daēuuas are considered demons. This puzzle is complicated by the fact that in early Vedic the ásuras do not have the demonic role they play in later Vedic and in fact are themselves sometimes identified as devás. (...) Numerous solutions to this problem have been advanced. This article re-examines the evidence in detail and suggests a new explanation, set in the larger Near Eastern cultural context. (shrink)