Clear guidelines addressing the ethically appropriate use of anti-infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti-infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant pathogens, (...) (5) placing unreasonable costs on a capitated hospice system. Although anti-infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision-making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti-infectives. In this article we articulate important elements in ethical decision-making in the application of anti-infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases. (shrink)

ABSTRACT Clear guidelines addressing the ethically appropriate use of anti‐infectives in the setting of hospice care do not exist. There is lack of understanding about key treatment decisions related to infection treatment for patients who are eligible for hospice care. Ethical concerns about anti‐infective use at the end of life include: (1) delaying transition to hospice, (2) prolonging a dying process, (3) prescribing regimens incongruent with a short life expectancy and goals of care, (4) increasing the reservoir of potential resistant (...) pathogens, (5) placing unreasonable costs on a capitated hospice system. Although anti‐infectives are thought to be relatively safe, they can place a burden on patients and be inconsistent to particular care plans. The current complex, and at times fragmented, medical care often fails to address these issues in decision‐making. In many ways, the ethics governing the end of life decisions related to dialysis, hydration/nutrition, and hypercalcemia parallel those of anti‐infectives. In this article we articulate important elements in ethical decision‐making in the application of anti‐infectives for patients who are eligible for hospice care, and we point to the need for prospective studies to help refine particular guidelines in these cases. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Matter and Spirit in the Age of Animal MagnetismEric G. WilsonDuring the Romantic period, writers on both sides of the Atlantic explored the sleepwalker as a merger of holiness and horror. Emerging when scientific thinkers for the first time were connecting spirit to electricity and magnetism, the somnambulist became to certain Romantics a disclosure of the difficulty of harmonizing unseen and seen, agency and necessity. This problem prominently arose (...) in Anton Mesmer's late eighteenth-century experiments in animal magnetism, in which the sleepwalker proved a paradox: an opaque revelation of transparent currents and an unconscious vehicle of sophisticated thought. Romantics such as Coleridge embraced the somnambulist as an embodiment of these troubles involved in relating motion and meaning. Coleridge and those who responded to him saw in the hypnotized human this sobering possibility: the invisible requires the visible to make itself manifest while the visible needs the invisible to become significant. 1 This is sublime and sinister: to elevate a material form to spiritual power is transcendence; to sink the boundless into a body is grotesque.Here I explore the philosophical implications of animal magnetism, the place of the sleepwalker in the history of ideas, and the role of the hypnotized human in Romantic writers, especially Coleridge. I also meditate on relationships between matter and spirit, machine and human, word and thing. Along the way, I place the history of ideas and the works of Romantic writers in mutually illuminating dialogues. The literary texts shed fresh light on philosophical problems while the ideas reveal hidden literary elements.The somnambulistic trance had been around long before Mesmer's magnetic sleeps. For centuries, shamans had used auto-hypnosis to sound [End Page 329] their souls and other-hypnosis to cure their tribe-members' ailments. However, somnambulism could not become a scientific phenomenon until Europeans in laboratories began to study electricity and magnetism. In the early modern period, Paracelsus argued that a vital fluid courses through the cosmos. The human being draws this flow like a magnet attracts force. When the body pulls to itself evil effluvia, it falls ill. To return patients to health, Paracelsus placed magnets on painful areas. He hoped to extract the unwanted current and return it to the cosmic swirl. 2 In "magnetizing" spirit, Paracelsus opened a door for empirical inquiry into the invisible world. In 1600, William Gilbert claimed that magnets correspond to the earth: both are animated by universal attraction and repulsion. 3 By the end of the seventeenth-century, Newton proposed that things are impelled by a force that draws and repels. Newton's theory of gravity inspired natural philosophers of the next centuries to search for a principle of which the magnet and the spark are manifestations. 4During the second half of the eighteenth century and the early part of the nineteenth, natural philosophers explored electricity and magnetism with unprecedented precision. In 1752, Benjamin Franklin revealed the mystery of lightning and perhaps the spark of life. 5 Inspired by Franklin, F. C. Oetinger, J. L. Fricker, and Prokop Divisch developed a theology of electricity, based on the belief that God is the electrical current. 6 Later in the century, Luigi Galvani and Alessandro Volta debated over whether the galvanic flow might be the origin and principle of life itself. 7 A few years before Franklin harvested lightning, John Michell argued that the magnetic force is not constrained to lodestones but is possibly pervasive. Some years later, Franz Aepinus suggested that magnetism and electricity manifest a deep energy. Soon after, C. A. de Coulomb discovered the mathematical law by which electrical and magnetic forces operate (Whittaker, pp. 50–59).These findings led to the breakthroughs of the nineteenth century. 8 In 1807, Humphry Davy hypothesized that chemical elements interact through electromagnetic affinity or repulsion. 9 In 1820, H. C. Oersted demonstrated the correspondence between electricity and magnetism. The same year, A. M. Ampere formulated the laws by which electrical and magnetic currents interact (Whittaker, pp. 81–86). Michael Faraday in 1831 revealed electromagnetic induction and thus inaugurated a second Copernican revolution: he showed that matter is not solid and discrete but a field of electromagnetic energy. 10 The dreams of [End... (shrink)

At some point in the future – perhaps within the next few decades – it will be possible for foetuses to develop completely outside the womb. Ectogenesis, as this technology is called, raises substantial issues for the abortion debate. One such issue is that it will become possible for a woman to have an abortion, in the sense of having the foetus removed from her body, but for the foetus to be kept alive. We argue that while there is a (...) right to an abortion, there are reasons to doubt that there is a right to the death of the foetus. Our strategy in this essay is to consider and reject three arguments in favour of this latter right. The first claims that women have a right not to be biological mothers, the second that women have a right to genetic privacy, and the third that a foetus is one's property. Furthermore, we argue that it follows from rejecting the third claim that genetic parents also lack a right to the destruction of cryopreserved embryos used for in vitro fertilization. The conclusion that a woman possesses no right to the death of the foetus builds upon the claims that other pro-choice advocates, such as Judith Jarvis Thomson, have made. (shrink)

In this paper, we argue that promoting patient values is a legitimate goal of medicine. Our view offers a justification for certain current practices, including birth control and living organ donation, that are widely accepted but do not fit neatly within the most common extant accounts of the goals of medicine. Moreover, we argue that recognising value promotion as a goal of medicine will expand the scope of medical practice by including some procedures that are sometimes rejected as being outside (...) the scope of acceptable medical practice, such as certain forms of physician-assisted death. We then rebut some common and possible objections to this view. Our aim is not to argue that other accounts are mistaken—except when they argue for a single goal that does not include patient values—but rather to show that value promotion should play a more central role in discussions about the goals of medicine. (shrink)

Since field experiments in democratic politics influence citizens and the relationships among citizens, they are freighted with normative significance. Yet the distinctively democratic concerns that bear upon such field experiments have not yet been systematically examined. In this paper, we taxonomize such democratic concerns. Our goal is not to justify any of them, but rather to reveal their basic structure, so that they can be scrutinized at further length. We argue that field experiments could be democratically objectionable even if they (...) are not decisive – even if they do not swing the results of elections or other political decisions. Rather, if a class of campaign experiments is objectionable, one reason for this is that they undermine citizens’ equal standing. The ideal of equal standing affords nuanced judgments about the permissibility of field experiments in democratic politics. (shrink)

Pulvermüller's work in extending Hebb's theory into the realm of language is exciting. However, we feel that what he characterizes as a single cell assembly is actually a set of cooperating cell assemblies that form parts of larger cognitive structures. These larger structures account more easily for a variety of phenomena, including the psycholinguistic.

Page's target article makes a good case for the strength of localist models. This can be characterized as an issue of where new information is integrated with respect to existing knowledge structures. We extend the analysis by discussing the dimension of when this integration takes place, the implications, and how they guide us in the creation of cognitive models.

The Bible has influenced contemporary culture both positively and negatively. The present volume is a collection of papers that were discussed at an international colloquium on the use of the Bible in Ethics in the Department of Biblical Studies at the University of Sheffield in April 1995. Participants came from many parts of the world and from different backgrounds, and the papers reflect their varied interests and the contexts in which they work. The contributors, in addition to the three editors, (...) are John Barton, Bruce Birch, Mark Brett, Mark Chapman, David Clines, Philip Davies, Cheryl Exum, Stephen Fowl, Norman Gottwald, John Haldane, Walter Houston, Sharon Ringe, Chrisopher Rowland, Lisa Sowle Cahill and Gerald West. (shrink)

Although Glenberg 's theory benefits from the incorporation of a suppression concept, a more differentiated view of suppression would be even more effective. We propose such a concept, showing how it accounts for phenomena that Glenberg describes and also for phenomena that he ignores.

The underrepresentation of females in mathematics-related fields may be explained by gender differences in mathematics self-concept (rather than ability) favoring males. Mathematics self-concept typically declines with student age, differs with student ethnicity, and is sensitive to teacher influence in early schooling. We investigated whether change in mathematics self-concept occurred within the context of a longitudinal intervention to raise and sustain teacher expectations of student achievement. This experimental study was conducted with a large sample of New Zealand primary school students and (...) their teachers. Data were analyzed using longitudinal multilevel modelling with mathematics self-concept as the dependent variable and time (which represents students’ increasing age each year), gender, and ethnicity entered as predictors and achievement in mathematics included as a control variable. Interaction terms were also explored to investigate changes over time for different groups. All students demonstrated a small increase in mathematics self-concept over the three-year period of the current study but mathematics self-concept was consistently greater for boys than girls. Māori, Asian, and Other students’ initial mathematics self-concept was higher than that of New Zealand European and Pacific Islanders’ (after controlling for achievement differences). However, a statistically significant decline in mathematics self-concept occurred for Māori students alone by the end of the study. The expected age-related reduction over time in student mathematics self-concept appeared to be mitigated in association with the longitudinal study. Nevertheless, the demonstration of a comparatively lower mathematics self-concept remained for girls overall and declined for Māori. Our results reinforce implications for future research into mathematics self-concept as a possible determinant of female student career choices. (shrink)

This comprehensive volume marks a new standard in scholarship in the still emerging field of the philosophy of chemistry. With selections drawn from a wide range of scholarly disciplines, philosophers, chemists, and historians of science here converge to ask some of the most fundamental questions about the relationship between philosophy and chemistry. What can chemistry teach us about longstanding disputes in the philosophy of science over such issues as reductionism, autonomy, and supervenience? And what new issues may chemistry bring to (...) the forefront now that it has joined physics and biology as a serious topic for philosophical reflection? This newest addition to the prestigious Boston Studies in the Philosophy of Science series marks the true arrival of philosophy of chemistry within the corpus of the philosophy of science. (shrink)

Here is a thoroughly updated edition of a classic in palliative medicine. Two new chapters have been added to the 1991 edition, along with a new preface summarizing where progress has been made and where it has not in the area of pain management. This book addresses the timely issue of doctor-patient relationships arguing that the patient, not the disease, should be the central focus of medicine. Included are a number of compelling patient narratives. Praise for the first edition "Well (...) written. . .should be read by everyone in medical practice or considering a career in medicine."---JAMA. "Memorable passages, important ideas, and critical analysis. This is a book that clinicians and educators should read."---New England Journal of Medicine. (shrink)

Recently, in this journal, Jeremy Gwiazda has offered a critique of our separationist view of hell. His objection relies on two key assumptions, and we show in our reply that both assumptions can be denied.

Social referencing informs and regulates one’s relation with the environment as a function of the perceived appraisals of social partners. Increased emphasis on relational and social contexts in the study of emotion makes this interpersonal process particularly relevant to the field. However, theoretical conceptualizations and empirical operationalizations of social referencing are disjointed across domains and populations of study. This article seeks to unite and refine the study of this construct by providing a clear and comprehensive definition of social referencing. Our (...) perspective presents social referencing and social appraisal as coterminous processes and emphasizes the importance of a relational and interpersonal approach to the study of emotion. We conclude by outlining possible lines of research on this construct. (shrink)

“What is the structure of thought?” is as central a question as any in cognitive science. A classic answer to this question has appealed to a Language of Thought (LoT). We point to emerging research from disparate branches of the field that supports the LoT hypothesis, but also uncovers diversity in LoTs across cognitive systems, stages of development, and species. Our letter formulates open research questions for cognitive science concerning the varieties of rules and representations that underwrite various LoT-based systems (...) and how these variations can help researchers taxonomize cognitive systems. (shrink)

Clinical ethics consultation is largely outside the scope of regulation and oversight, despite its importance. For decades, the bioethics community has been unable to reach a consensus on whether there should be accountability in this work, as there is for other clinical activities that influence the care of patients. The American Society for Bioethics and Humanities, the primary society of bioethicists and scholars in the medical humanities and the organizational home for individuals who perform CEC in the United States, has (...) initiated a two‐step quality attestation process as a means to assess clinical ethics consultants and help identify individuals who are qualified to perform this role. This article describes the process. (shrink)

" Dr. Cassell discusses the world of the sick, the healing connection and healer's battle, the role of omnipotence in the healer's art, illness and disease, and ...

Research uses of human bodies maintained by mechanical ventilation after being declared dead by neurological criteria, were first published in the early 1980s with a renewed interest in research on the newly or nearly dead occurring in about last decade. While this type of research may take many different forms, recent technologic advances in genomic sequencing along with high hopes for genomic medicine, have inspired interest in genomic research with the newly dead. For example, the Genotype-Tissue Expression program through the (...) National Institutes of Health aims to collect large numbers of diverse human tissues with the eventual goal of elucidating the genetic bases of common diseases through a better understanding of the relationship between genetic variation and gene expression. (shrink)

Physicians place significant weight on the distinction between acts and omissions. Most believe that autonomous refusals for procedures, such as blood transfusions and resuscitation, ought to be respected, but they feel no similar obligation to accede to requests for treatment that will, in the physician’s opinion, harm the patient (e.g., assisted death). Thus, there is an asymmetry. In this paper, we challenge the strength of this distinction by arguing that the ordering of values should be the same in both cases. (...) The reason for respecting refusals is that, in such cases, autonomy outweighs well-being. We argue that the same should be true in request cases, which means that requests should not be denied only due to the treatment being too harmful in the physician’s opinion. Our strategy is to consider and reject a number of arguments for the asymmetrical view, including an appeal to the doing–allowing distinction and positive and negative rights. The duty to respect refusals is still greater than the duty to grant requests on our view, but, by arguing that the ordering of values is the same in both cases, we show that there is less of a distinction in healthcare between requests and refusals than many currently believe. (shrink)

Presents general information about meteorology, weather, and climate and includes more than thirty activities to help study these topics, including making a ...

Three experiments investigated the relationship between subjective experience and attentional lapses during sustained attention. These experiments employed two measures of subjective experience to examine how differences in awareness correspond to variations in both task performance and psycho-physiological measures . This series of experiments examine these phenomena during the Sustained Attention to Response Task . The results suggest we can dissociate between two components of subjective experience during sustained attention: task unrelated thought which corresponds to an absent minded disengagement from the (...) task and a pre-occupation with one's task performance that seems to be best conceptualised as a strategic attempt to deploy attentional resources in response to a perception of environmental demands which exceed ones ability to perform the task. The implications of these findings for our understanding of how awareness is maintained on task relevant material during periods of sustained attention are discussed. (shrink)