A report of a problem-based learning project on the ethics of terminal care, offered as one of the options available to first year MB ChB students in Edinburgh University Medical School. The project formed part of the 'clinical correlation course' in the new curriculum. Six students took part under the supervision of two clinical tutors and a moral philosopher. The course was case-based and practical with students being given the opportunity over a period of eight weeks to meet patients, relatives (...) and hospital staff at a local geriatrics hospital and terminal care home. The main issue studied was the degree of choice available to patients electing to be treated at home, in hospital or in a hospice. Other issues included: pre-death, disposal of the dead, certification of death, communication with relatives and follow-up bereavement services. (shrink)

SummaryThe dichotomy between ‘scientific’ and ‘practical’ approaches to guideline development is false and divisive. Instead we should concentrate on developing mechanisms to develop and implement valid guidelines to improve patient care. The development of valid guidelines requires considerable expertise and is time consuming and expensive. It is most efficiently done at a regional or national level. The implementation of valid guidelines requires local action including the identification and modification of valid guidelines and a coordinated evidence-based implementation strategy (Grimshaw & (...) Eccles 1998). (shrink)

Eye-tracking techniques were used to measure men’s attention to back-posed and front-posed images of women varying in waist-to-hip ratio (WHR). Irrespective of body pose, men rated images with a 0.7 WHR as most attractive. For back-posed images, initial visual fixations (occurring within 200 milliseconds of commencement of the eye-tracking session) most frequently involved the midriff. Numbers of fixations and dwell times throughout each of the five-second viewing sessions were greatest for the midriff and buttocks. By contrast, visual attention to front-posed (...) images (first fixations, numbers of fixations, and dwell times) mainly involved the breasts, with attention shifting more to the midriff of images with a higher WHR. This report is the first to compare men’s eye-tracking responses to back-posed and front-posed images of the female body. Results show the importance of the female midriff and of WHR upon men’s attractiveness judgments, especially when viewing back-posed images. (shrink)

Owing to unique features of their design, cluster randomized trials complicate the interpretation of standard ethics guidelines. The recently published Ottawa statement on the ethical design and conduct of cluster randomized trials provides researchers and research ethics committees with detailed guidance on the design, conduct, and review of cluster trials. The Ottawa statement sets out 15 recommendations, including guidance on the justification of study design, the need for research ethics committee review, the identification of research participants, obtaining informed consent, the (...) role of gatekeepers in protecting cluster interests, the assessment of benefits and harms, and the protection of vulnerable participants. (shrink)

Soma‐to‐germline feedback is forbidden under the neo‐Darwinian paradigm. Nevertheless, there is a growing realization it occurs frequently in immunoglobulin (Ig) variable (V) region genes. This is a surprising development. It arises from a most unlikely source in light of the exposure of co‐author EJS to the haplotype data of RL Dawkins and others on the polymorphism of the Major Histocompatibility Complex, which is generally assumed to be the most polymorphic region in the genome (spanning ∼4 Mb). The comparison between the (...) magnitude of MHC polymorphism with estimates for the human heavy chain immunoglobulin V locus (spanning ∼1 Mb), suggests IGHV could be many orders of magnitude more polymorphic than the MHC. This conclusion needs airing in the literature as it implies generational churn and soma‐to‐germline gene feedback. Pedigree‐based experimental strategies to resolve the IGHV issue are outlined. (shrink)

Background. The concept of empathy in students has gained significant attention in medical education. Whether implementing formal educational interventions to promote long-term and effective empathy levels leads to sustained increased empathy levels in students, is however less clear. Objectives. The study aimed to evaluate the trajectory of medical students’ self-perceived empathy levels during their 6-year MB ChB degree. Methods. A longitudinal, prospective study was conducted over 4 years. A cohort of 292 medical students was invited to participate. Participants completed the (...) Jefferson Scale of Empathy for Students (JSE-S) at three intervals during their studies. The students attended two workshops related to empathic patient interactions during this time. The JSE-S mean score by age and gender was compared, making use of a linear regression model. Results. A total of 119 students completed the study. Students’ total empathy levels were similar during the first and the last measuring point (110), but there was a significant rise in the intermediate measuring point (113.3). When the male and female cohorts’ scores were interpreted separately, both genders demonstrated a similar pattern to the total score, although females’ JSE-S scores were higher than the males. Conclusion. The results of the study confirm that educational interventions can increase students’ self-perceived empathy levels; however, we suggest that students require reinforcement and multiple opportunities to practise and observe empathic communication with patients to sustain high levels of empathy. Follow-up sessions to specifically target the promotion of empathy should be implemented; otherwise the long-term effect of educational interventions might be limited. (shrink)

J.N. Findlay was a South African philosopher who published from the late 1940s into the 1980s. He had a prestigious international academic career, holding many academic posts around the world. This article uses a textual comparative approach and focuses on Findlay’s Gifford Lecture at St Andrews University between 1965 and 1970. The objective of the article is to highlight the extent to which Findlay’s philosophical writings were influenced by Mahāyāna Buddhism. Although predominantly a Platonist, Findlay drew influence from Asian philosophy (...) and religion, particularly Mahāyāna Buddhism. In these lectures, he applies the metaphor of the Platonic Cave to investigate Hegelian and Husserlian approaches to knowledge. Though he was a leading Hegel and Husserl scholar, his reading of these two philosophers is strongly influenced by Mahāyāna Buddhism, resulting in a unique mystical interpretation of these two philosophers. Revisiting Findlay’s writings is significant for two reasons; firstly, he investigated Buddhism prior to the Asian religions being included in Religious Studies departments’ purview in South African universities, and secondly, his interpretation of two prominent Western philosophers along Buddhist lines provides an early attempt at decolonising the predominance of Western philosophical views of knowledge.Contribution: This contribution forms part of a larger collection of essays investigating philosophical works that have had a significant impact on the study of religion. This contribution investigates the Buddhist influence on J.N. Findlay’s philosophical readings of Husserl and Hegel. (shrink)

My object in this paper is to suggest a few reflections on some themes in Bentham's work which others as well as I have noted, without perhaps developing them as fully as might with advantage be done. There will be nothing like full development in the limited compass of what is said here, but what is said may at least indicate possible directions for further exploration. The greater part of the paper will be concerned with the notion of natural authority; (...) but I want to begin by taking a broader, though no doubt rather superficial, view of the role in Bentham's thinking of the concepts of ‘nature’ and ‘the natural’. (shrink)

The object of this article is to examine, with the work of Jeremy Bentham as the principal example, one strand in the complex pattern of European social theory during the second half of the eighteenth century. This was of course the period not only of the American and French revolutions, but of the culmination of the movements of thought constituting what we know as the Enlightenment. Like all great historical episodes, the Enlightenment was both the fulfilment of long-established processes and (...) the inauguration of new processes of which the fulfilment lay in the future. Thus the seminal ideas of seventeenth-century rationalism realized and perhaps exhausted their potentialities in the eighteenth-century Enlightenment. The ideas with which this article is concerned, however—conveniently grouped and labelled as the ideas of utilitarianism—only began to achieve systematic development in these later decades of the eighteenth century. Within that period—during the first half and more of Bentham's long life—attempts to apply those ideas to the solution of social problems met largely with failure and frustration. Yet unrealized potentialities remained, the realization of which was reserved for a time when the world of the philosophes no longer existed. The movements for social and political reform which have played so large a part in modern history since the French Revolution may be judged in widely differing ways; but whatever the verdict, these movements surely cannot be understood without due consideration of that part of their origins which lies in eighteenth-century utilitarianism. (shrink)

In this essay I propose to offer some observations in due course on how Christian thought and practice in general might profit from a central theme in the theology of Rāmānuja, a Tamil Vaisnava Brahmin whose traditional date straddles the eleventh and twelfth centuries of the Christian era. The central theme I have in mind is expressed in Rāmānuja's view that the ‘world’ is the ‘body’ of Brahman or God. We shall go on to explain what this means, but let (...) me state first that my overall aim is to further inter-religious understanding, especially between Christian and Hindu points of view. In professing a concern for inter-religious dialogue I know that I reflect a longstanding interest of Professor H. D. Lewis. I shall seek to show that the Christian religion can profit both from the content and the method of Rāmānuja's body-of-God theology. To this end this essay is divided into two sections. Section I is the longer: it contains an analysis of what Rāmānuja did mean by his body-of-God theme – doubtless unfamiliar ground for most of the readers of this essay – and serves as a propaedeutic for what follows in section 2. In section 2 I shall attempt to ‘extrapolate’ Rāmānuja's thinking into a Christian context, with dialogue in mind. Section 2 cannot be appreciated for the promise I hope it holds out without the detail of the first section. (shrink)

In ‘Belief-In and Belief in God’ , J. N. Williams suggests that belief in God cannot be rational unless one has rational beliefs that God exists. While agreeing with his conclusion , I disagree at almost every step with his method of arriving at it. In particular I suggest that Williams goes astray concerning the dual aspect of belief in , the nature of performatives, the arousal of belief states, and the correct account of belief in God.

The ethics of the Flexibility In duty hour Requirements for Surgical Trainees trial have been vehemently debated. Views on the ethics of the FIRST trial range from it being completely unethical to wholly unproblematic. The FIRST trial illustrates the complex ethical challenges posed by cluster randomised trials of policy interventions involving healthcare professionals. In what follows, we have three objectives. First, we critically review the FIRST trial controversy, finding that commentators have failed to sufficiently identify and address many of the (...) relevant ethical issues. The 2012 Ottawa Statement on the Ethical Design and Conduct of Cluster Randomized Trials provides researchers and research ethics committees with specific guidance for the ethical design and conduct of CRTs. Second, we aim to demonstrate how the Ottawa Statement provides much-needed clarity to the ethical issues in the FIRST trial, including: research participant identification; consent requirements; gatekeeper roles; benefit-harm analysis and identification of vulnerable participants. We nonetheless also find that the FIRST trial raises ethical issues not adequately addressed by the Ottawa Statement. Hence, third and finally, we raise important questions requiring further ethical analysis and guidance, including: Does clinical equipoise apply to policy interventions with little or no evidence-base? Do healthcare providers have an obligation to participate in research? Does the power-differential in certain healthcare settings render healthcare providers vulnerable to duress and coercion to participant in research? If so, what safeguards might be implemented to protect providers, while allowing important research to proceed? (shrink)

The full range of Bentham's engagement with Blackstone's view of law is beyond the scope of a single article. Yet it is important to recognize at the outset, even in a more restricted enquiry into the matter, that the engagement, begun when Bentham, not quite sixteen years of age, started to attend Blackstone's Oxford lectures, was indeed a lifelong affair. Whatever Bentham had in mind when, at the age of eighty, in 1828, he began to write a work entitled ‘A (...) familar view of Blackstone: or say Blackstone familiarized’, the manuscripts at least suffice to prove that ‘Our Author’ was still in the forefront of his mind at that octogenarian but still indefatigably active stage of his career. Every aspect of Bentham's multifarious intellectual activity over the intervening decades had been touched in some measure by his response to Blackstone's ideas. It still seems true to say what was said a dozen years ago: It would be an exaggeration to say that Bentham elaborated his own conception of law by way of a constant and conscious dialectic with the views of Blackstone. But it would be an exaggeration for which the evidence would afford some excuse. (shrink)

J.G.A. Pocock has been a dominant force in the history of political thought since his first major work, The Ancient Constitution and the Feudal Law, was published in 1957. This article is focused on the contribution he has made to the study of the revolutions of seventeenth-century England and the extraordinary body of political discourse to which they gave rise. It begins with an examination of the ways in which ideas about continuity, innovation, institutions and historiography have shaped his approach (...) to the history of political thought and their application to seventeenth-century conditions. Central to a fundamental continuity in his ideas over the last five decades have been notions about the interface of 'paradigms' with both language and socio-political circumstance in the construction and deconstruction of both historiographies and political theories. The article then offers a critical assessment of his contribution to our understanding of the English Revolution. (shrink)

Professor Lewis and I have some important differences of opinion regarding the identity and distinctness of conscious persons, which it will be well to try to clarify on the present occasion, first of all by enumerating a number of points on which we are, I think, in agreement. Both of us believe in the existence of individual persons, each of whom can be said to live in a ‘world’ of his own intentional objectivity, a world ‘as it is for him’, (...) which differs in a considerable extent, both in content and emphasis, from the world as it is for anyone else. Both of us further believe that all these intentionally objective worlds for a large part coincide in content, and are in fact excerpted from a more comprehensive real world which is common to us all, and which, in addition to in some sense including all such intentionally objective worlds, also includes many real material objects which exist regardless of our intentionality, and which further includes our own material bodies, which appear in so central a manner in each of our intentionally objective worlds. Both of us believe in matter as a transcendent reality, as well as an intentional object, and are content to accept the dicta of science as to the most probable view of its structure. We are in fact quite Cartesian and Lockean in our belief in the primary and secondary qualities of matter. We believe further that our intentional subjectivity is geared causally into our material objectivity, and that the gearing takes place, in some inscrutable manner, in our nervous systems. We both also believe that our intentional subjectivity transcends bodily mechanisms and instrumentalities, and can be liberated from the latter, but that, when thus liberated, our subjectivity may still affect some sort of an intentionally objective material body such as we wear in dreams, a body in which it will manifest itself to itself and to others much as we do in our dreams and fantasies. (shrink)