In his Lives, Giorgio Vasari mentions many artists who were talented at music when they were young, prominently Giorgione and Sebastiano del Piombo. Benvenuto Cellini resisted his father's pressure to choose music. Why? How rewarding was a musical profession in Renaissance Italy? It could be very lucrative, both for town musicians such as Cellini's father and for castratos. Moonlighting for banquets, dances, even spying, could bring in additional income. For gentlemen, music was a necessary social grace; they had private tutors, (...) such as Silvestro Ganassi dal Fontego, who was himself a painter as well as a printer. Amateurs could learn from cathedral choirmasters, who were often music theorists, the pinnacle of the profession. The theorist Pietro Aaron, choirmaster at Imola Cathedral, then tutor to the sons of Sebastian Michiel, Grand Prior of the Knights of St John of Jerusalem in Venice, had a wide acquaintance among humanists, noblemen and other musicians, and his letters open a window on the life of a musician. Among his many professions, the writer Antonfrancesco Doni counted music; a madrigal he wrote in 1560 is included in an appendix. The ability to improvise verses and music was much prized, ranging from star performers such as Serafino Aquilano to amateurs such as Niccolò Machiavelli. Portraits of musicians are discussed; they offer important evidence but are difficult to interpret. The theorist Lodovico Zacconi concluded in 1592 that being a musician was not only an honourable and lucrative profession but an enjoyable one. (shrink)

Increasing ethical attention and debate is focusing on whether individuals who take part in clinical trials should be given access to post-trial care. However, the main focus of this debate has been upon drug trials undertaken in low-income settings. To broaden this debate, we report findings from interviews with individuals (n = 24) who participated in a clinical trial of a closed-loop system, which is a medical device under development for people with type 1 diabetes that automatically adjusts blood glucose (...) to help keep it within clinically recommended ranges. Individuals were recruited from UK sites and interviewed following trial close-out, at which point the closed-loop had been withdrawn. While individuals were stoical and accepting of the requirement to return the closed-loop, they also conveyed varying degrees of distress. Many described having relaxed diabetes management practices while using the closed-loop and having become deskilled as a consequence, which made reverting back to pre-trial regimens challenging. Participants also described unanticipated consequences arising from using a closed-loop. As well as deskilling, these included experiencing psychological and emotional benefits that could not be sustained after the closed-loop had been withdrawn and participants reevaluating their pre- and post-trial life in light of having used a closed-loop and now perceiving this life much more negatively. Participants also voiced frustrations about experiencing better blood glucose control using a closed-loop and then having to revert to using what they now saw as antiquated and imprecise self-management tools. We use these findings to argue that ethical debates about post-trial provisioning need to be broadened to consider potential psychological and emotional harms, and not just clinical harms, that may result from withdrawal of investigated treatments. We also suggest that individuals may benefit from information about potential nonclinical harms to help make informed decisions about trial participation. (shrink)

In 2011, Steven Pinker published The Better Angels of Our Nature: Why Violence Has Declined,1 arguing we are the beneficiaries of the "long peace." The problem with invoking long periods of peace is that they are often fleetingly ephemeral and can rapidly turn to hostility. The very year the book was published marked the beginning of the Arab Uprisings, unforeseen and unplanned for, apparently without historical precedent or analogy. The spiraling violence and polarization, as well as the accompanying refugee crisis (...) that has followed, have demonstrated this was a questionable, if not illusory designation. This sustained violence has profound effects on social consciousness across the political spectrum, ushering in... (shrink)

It has long been recognized that cancer onset and progression represent a type of reversion to an ancestral quasi‐unicellular phenotype. This general concept has been refined into the atavistic model of cancer that attempts to provide a quantitative analysis and testable predictions based on genomic data. Over the past decade, support for the multicellular‐to‐unicellular reversion predicted by the atavism model has come from phylostratigraphy. Here, we propose that cancer onset and progression involve more than a one‐off multicellular‐to‐unicellular reversion, and are (...) better described as a series of reversionary transitions. We make new predictions based on the chronology of the unicellular‐eukaryote‐to‐multicellular‐eukaryote transition. We also make new predictions based on three other evolutionary transitions that occurred in our lineage: eukaryogenesis, oxidative phosphorylation and the transition to adaptive immunity. We propose several modifications to current phylostratigraphy to improve age resolution to test these predictions. Also see the video abstract here: https://youtu.be/3unEu5JYJrQ. (shrink)

In February 2022, the Court of Protection was faced with the question of whether a kidney transplant was in the best interests of William Verden. The case highlighted the legal, ethical and clinical complexities of treating potential kidney transplant patients with impaired decision-making. Above all, it exposed the potential risk of discrimination on the basis of disability when treatment decisions in relation to potential kidney recipients with impaired capacity are being made. In this paper, we draw on the Verden case (...) to (1) examine the role of the Court of Protection in cases relating to patients with impaired decision-making capacity who require a transplant, (2) to highlight the lack of empirical data on patients who have faced inequitable access to transplant and (3) highlight the shortcomings of the existing legal and regulatory framework in England and Wales guiding clinical decision making for patients in William’s position. We consequently argue that there is a clear need for action to ensure equitable access to transplant for those in William’s position. Furthermore, we suggest that there is a responsibility incumbent on policy makers and clinicians alike to develop a meaningful, and meaningfully operational, framework centred on preventing discrimination against potential organ recipients based on their decision-making capacity. (shrink)

This research ethics article focuses on an unexpected finding from my Master’s thesis examining bereaved participants’ experiences of taking part in sensitive qualitative research: some participants wanted their real names used in my written dissertation and any subsequent empirical publications. While conducting interviews for my thesis and explaining the consent process, early responses highlighted the problematic notion of anonymity for participants engaged in qualitative research. Several participants asserted the significance of immortalizing their deceased loved ones in the pages of my (...) thesis, retaining ownership over their words and maintaining a public attachment to their personal identity. The preliminary responses also resonate with concerns regarding the ethics of assigning pseudonyms and anonymity to participants in qualitative research. Themes in the extant literature tend to centre on issues of researchers’ accountability and transparency towards participants or respect. The present article contributes to the debates surrounding anonymity and confidentiality within qualitative research, and also expands on specific issues pertaining to bereavement research ethics. (shrink)

Each year, millions of individuals in the United States are treated for a variety of serious medical conditions with prescription drugs whose therapeutic benefits are well known. The vast majority of these medications are used to treat medical and psychiatric illnesses. Generally, they are used as prescribed, and contribute to a better quality of life for persons suffering from debilitating or life-threatening disorders.The fact that a small portion of these medications is diverted by those who seek their psychoactive effects raises (...) the important policy issue: how to make drugs easily available for medical use while limiting access for purposes of abuse.Such a responsibility poses challenges very different from those of the so-called “war” on illicit drugs, because this control must be achieved without impeding patients’ access to medical care. A rational public policy would attempt to achieve a balance between the need to minimize abuse and the need to provide relief. (shrink)

Background:The perceptions of core professional nursing values of men in baccalaureate nursing programs are poorly understood.Objective:The study purpose was to understand and interpret the meaning of core professional nursing values to male baccalaureate nursing students.Research design and context:One-to-one interviews were conducted with male nursing students from a public university in the Midwest, following interpretive phenomenology.Ethical considerations:Measures to protect participants included obtaining Institutional Review Board approval, obtaining signed informed consent, and maintaining confidentiality.Findings:The study revealed five themes and several subthemes under an (...) overarching finding of caring. Acquisition of professional nursing values began prior to the nursing program and continued to varying degrees throughout the program.Discussion:Several implications are offered for nursing education, nursing practice, research, and public policy. These include identification of common values, teaching-learning strategies, inclusive environments, teamwork, and conflict resolution.Conclusion:Caring was revealed using a metaphor of a puzzle. (shrink)

Each year, millions of individuals in the United States are treated for a variety of serious medical conditions with prescription drugs whose therapeutic benefits are well known. The vast majority of these medications are used to treat medical and psychiatric illnesses. Generally, they are used as prescribed, and contribute to a better quality of life for persons suffering from debilitating or life-threatening disorders.The fact that a small portion of these medications is diverted by those who seek their psychoactive effects raises (...) the important policy issue: how to make drugs easily available for medical use while limiting access for purposes of abuse.Such a responsibility poses challenges very different from those of the so-called “war” on illicit drugs, because this control must be achieved without impeding patients’ access to medical care. A rational public policy would attempt to achieve a balance between the need to minimize abuse and the need to provide relief. (shrink)

The gap between the number of organs available for transplant and the number of individuals who need transplanted organs continues to increase. At the same time, thousands of transplantable organs are needlessly overlooked every year for the single reason that they come from individuals who were declared dead according to cardio pulmonary criteria. Expanding the donor population to individuals who die uncontrolled cardiac deaths will reduce this disparity, but only if organ preservation efforts are utilized. Concern about potential legal liability (...) for temporary preservation of organs pending a search for family members appears to be one of the impediments to wider use of donation in cases of uncontrolled cardiac death in states without statutes explicitly authorizing such action. However, we think that the risk of liability for organ preservation under these circumstances is de minimis, and that concerns about legal impediments to preservation should yield to the ethical imperative of undertaking it. (shrink)

In this paper, we assume that organ donation policy in the United States will continue to be based on an opt-in model, requiring express consent to donate, and that families will continue to have the prerogative to make donation decisions whenever the deceased person has not recorded his or her own preferences in advance. The limited question addressed here is what should be done when a potential donor dies unexpectedly, without any recorded expression of his or her wishes at hand, (...) while a family decision is being sought. (shrink)

This article reports a content analysis of advertisements for household goods appearing in Ladies Home Journal between 1909-1910 and 1980, with the aim of understanding the ideological campaign that characterized the years in which households were mechanized and women's domestic labor transformed in the United States. More Journal ads featured directives about housework than descriptions of the product; they emphasized work performance far more frequently than liberation from housework, and they also promoted service to family. These findings supplement other evidence (...) that advertisers' efforts to create a market for household appliances and other means of domestic labor involved promotion of an ideology about housework that reinforced women's dedication to it. (shrink)

On the 4th of December 1967, Hans Kamp sent his UCLA seminar notes on the logic of ‘now’ to Arthur N. Prior. Kamp’s two-dimensional analysis stimulated Prior to an intense burst of creativity in which he sought to integrate Kamp’s work into tense logic using a one-dimensional approach. Prior’s search led him through the work of Castañeda, and back to his own work on hybrid logic: the first made temporal reference philosophically respectable, the second made it technically feasible in a (...) modal framework. With the aid of hybrid logic, Prior built a bridge from a two-dimensional UT calculus to a one-dimensional tense logic containing the ‘now’ operator J. Drawing on material from the Prior archive, and the paper “‘Now”’ that detailed Prior’s findings, we retell this story. We focus on Prior’s completeness conjecture for the hybrid system and the role played by temporal reference. (shrink)

Moral opposition by medical professionals to participation in the process of sentencing for capital crimes, including refusals to provide medical treatment, may compromise the integrity of the legal process.

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the society. (...) Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

The determinative issue in applying the insanity defense is whether the defendant experienced a legally relevant functional impairment at the time of the offense. Categorical exclusion of personality disorders from the definition of mental disease is clinically and morally arbitrary because it may lead to unfair conviction of a defendant with a personality disorder who actually experienced severe, legally relevant impairments at the time of the crime. There is no need to consider such a drastic approach in most states and (...) in the federal courts, where the sole test of insanity is whether the defendant was “unable to appreciate the wrongfulness of his conduct at the time of the offense.” This is because the only symptoms that are legally relevant in such jurisdictions are those that impair reality-testing and thereby affect the person's capacity to understand the nature and consequences of her actions. However, if the test of insanity includes a “volitional prong” (inability to control one's behavior), some way must be found to limit the scope of the defense to the core cases (involving psychotic conditions) to which it has traditionally been applied, and to prevent a shift toward a deterministic account of criminal conduct — i.e., “people can't help being who they are and doing what they do.” The best way of accomplishing this is to limit the definition of mental disease to severe disorders characterized by gross disturbances of the person's capacity to understand reality. (shrink)

In this paper we argue that Prior and Reichenbach are best viewed as allies, not antagonists. We do so by combining the central insights of Prior and Reichenbach in the framework of hybrid tense logic. This overcomes a well-known defect of Reichenbach’s tense schema, namely that it gives multiple representations to sentences in the future perfect and the future-in-the-past. It also makes it easy to define an iterative schema for tense that allows for multiple points of reference, a possibility noted (...) by Prior and demanded by Comrie, and we sketch how this schema can be generalized to a shift-and-restrict pattern in which special propositional symbols act as restrictors on the range of tense operators. (shrink)

The mission of public health is to assure the conditions in which people can be healthy and to reduce the occurrence of death and disability attributable to disease and injury. From the distinctive perspective of public health, the target is the health of the population as a whole, with a particular concern for vulnerable populations within the whole. Although public health is grounded in science, the mission and perspective of the field are shaped by the ever-evolving values of the society. (...) Ethics and law are therefore constituent disciplines of public health policy and practice. One of the major challenges confronting contemporary practitioners of public health is the need to broaden and deepen their understanding of legal and ethical aspects of their work. This special issue of the Joumal of Law, Medicine & Ethics responds to this challenge. This article describes how the mission of public health has come to encompass the prevention and treatment of injury and highlights some of the political and ethical controversies now confronting the field. (shrink)

In his accompanying article, Dr. Kinscherff has convincingly demonstrated why a categorical exclusion of personality disorders from the definition of “mental disease” in insanity defense adjudication is arbitrary, both conceptually and clinically. He explains his position in the context of a vignette involving a hypothetical defendant, Wilhelmina Sykes, charged with ramming her car into another car obstructing her path, causing serious injury to its driver. Dr. Kinscherff correctly points out that the determinative issue in applying the insanity defense in any (...) case, including the hypothetical case involving Ms. Sykes, is whether the defendant experienced a legally relevant functional impairment at the time of the offense. In many states — and in the hypothetical jurisdiction in which Ms. Sykes is being prosecuted — the relevant functional impairments are those that could have affected her ability “to appreciate the wrongfulness of her conduct” or “to conform her conduct to the requirements of the law. (shrink)

Organ transplantation remains one of modern medicine's remarkable achievements. It saves lives, improves quality of life, diminishes healthcare expenditures in end-stage renal patients, and enjoys high success rates. Yet the promise of transplantation is substantially compromised by the scarcity of organs. The gap between the number of patients on waiting lists and the number of available organs continues to grow. As of January 2006, the combined waiting list for all organs in the United States was 90,284. Unfortunately, thousands of potential (...) organs are lost each year, primarily due to lack of consent to donation from the deceased before death, or from the family thereafter. Only fifty percent of potential donors – the “conversion” rate – become actual donors. The costs attributed to organ shortage are substantial – Medicare paid over $15.5 billion in 2002 for treating patients with end-stage renal-disease, who predominate on organ waiting lists. (shrink)

Although death by neurologic criteria is legally recognized throughout the United States, state laws and clinical practice vary concerning three key issues: the medical standards used to determine death by neurologic criteria, management of family objections before determination of death by neurologic criteria, and management of religious objections to declaration of death by neurologic criteria. The American Academy of Neurology and other medical stakeholder organizations involved in the determination of death by neurologic criteria have undertaken concerted action to address variation (...) in clinical practice in order to ensure the integrity of brain death determination. To complement this effort, state policymakers must revise legislation on the use of neurologic criteria to declare death. We review the legal history and current laws regarding neurologic criteria to declare death and offer proposed revisions to the Uniform Determination of Death Act and the rationale for these recommendations. (shrink)

Resumen Los estudiantes universitarios pueden contribuir a la calidad de la democracia de su país en la medida en que aprendan a distinguir cómo la corrupción se instala en su práctica cotidiana, la combatan y se comprometan a estar atentos a la honestidad de sus acciones y la veracidad de su discurso. Describimos las implicaciones de comprender a la democracia como gobierno por discusión y pasamos a proponer a la razón pública como el sine qua non de una democracia que (...) busca hacer justicia social y que requiere ciudadanos dispuestos a debatir ideas con honestidad y rigor crítico, con debates públicos y pasión por la verdad. Estas ideas las contrastamos con los hallazgos de una encuesta sobre corrupción aplicada anualmente a estudiantes universitarios.University students maj contribute to the quality of democracy in their country to the extent that they learn to distinguish how corruption is part of their day-to-day practices, they combat it and commit themselves to be attentive regarding the honesty of their actions and the veracity of their discourse. We describe the implications of understanding democracy as government by discussion; we then propose public reason as the sine qua non of a democracy that seeks social justice and requires citizens willing to debate ideas honestly, rigorously, and critically, in public debates and with a passion for the truth. We contrast these ideas with the findings from a yearly survey of university students. (shrink)

In an explicit attempt to reduce physician paternalism and encourage patient participation in making health care decisions, the informed consent doctrine has become a foundational precept in medical ethics and health law. The underlying ethical principle on which informed consent rests — autonomy — embodies the idea that as rational moral agents, patients should be in command of decisions that relate to their bodies and lives. The corollary obligation of physicians to respect and facilitate patient autonomy is reflected in the (...) rules that have been created to implement consent procedures, especially those requiring disclosure of relevant information.However, there are many practical impediments to patient self-determination in health care decisionmaking. Well-meaning physicians often lack the time to live up to the ideal of facilitating genuine, informed deliberation with and by their patients, and many lack the motivation or skill to do so successfully. (shrink)

This essay appraises the history of the International Academy of Practical Theology, arguing that competing aims have pulled it in different directions. The essay arose initially out of a roundtable on IAPT at an international congress in São Leopoldo, Brazil, in preparation for the next biennial conference there in 2019. Why is there a need for the IAPT? What are some of its developments? Why is it important for South America and Brazil? In response, the essay suggests that the IAPT (...) has struggled to sustain at least two prominent commitments - a desire to enhance practical theology's scholarly visibility and acumen and a real need to become a genuinely international organisation in terms of representation and inclusion. A secondary argument woven through the essay is that collegial friendships across complicated differences of location and perspective have the capacity to moderate and even heal conflicts. (shrink)