In the United States, there has been a continuous debate between those who favour collective bargaining for nurses and those who believe it is not professional. Likewise, the controversy over whether nurses should strike has been longstanding and continues today. Those who oppose the idea of nurses striking often state that they are abandoning their patients, and that it is not ethical, even though federal legislation requires a 10- day strike notice so that management can make patient care arrangements. The (...) American Nurses Association (ANA) has supported the right of nurses to strike, as a last resort and after careful consideration of every factor. This support has divided the membership of ANA and the nursing profession, even though the strikes have been used sparingly and effectively by nurses in this country; and so the debate continues. (shrink)

Brock Macdonald1, Evi Vakiani2, Rhonda K Yantiss3, Jun Lee4, Robert S Brown Jr5, Samuel H Sigal61Division of Gastroenterology, Department of Medicine, University of California-San Francisco, San Francisco, CA, 2Department of Pathology, Memorial Sloan–Kettering Cancer Center, New York, NY, 3Department of Pathology and Laboratory Medicine, New York Weill Cornell Medical College, New York, NY, 4Division of Nephrology, Department of Medicine, Weill Cornell Medical College, New York, NY, 5Division of Gastroenterology, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, (...) NY, 6Division of Gastroenterology and Hepatology, Department of Medicine, New York University, New York, NY, USA: The use of sirolimus as an alternative to calcineurin inhibitors for posttransplant immunosuppression is associated with a variety of inflammatory conditions. In this report, we describe the case of a 34-year-old man who developed abnormal liver tests 6 years after live-donor kidney transplantation and 5 years after initiation of sirolimus-based immunosuppression. Elevated aminotransferase levels persisted after withdrawal of potentially hepatotoxic medications, and serologic evaluation for viral hepatitis, autoimmune disease, and genetic disorders was unrevealing. Liver biopsy revealed prominent hepatocellular injury associated with a mixed inflammatory infiltrate and liver tests normalized within 2 weeks of discontinuation of sirolimus. In this report, we review previous reports of sirolimus hepatotoxicity and propose a unifying hypothesis for the various inflammatory conditions that have been attributed to sirolimus.Keywords: sirolimus, immunosuppression, transplant, inflammatory conditions, hepatotoxicity. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:The Patient Self-Determination ActElizabeth Leibold McCloskey (bio)What are the ethics of extending the length of life? We know that we cannot artificially end life (Thou Shalt not Kill), but how about artificially extending life? Is that always good, sometimes good?... In ethics, is keeping people alive the highest good? Should our priority be to keep people breathing?... What does basic religious ethics say about this?(John C. Danforth, letter to (...) the author, 19 August 1989)The Patient Self-Determination Act, signed into law as part of the Omnibus Budget Reconciliation Act of 1990 (OBRA '90) last November, marks the first time that Congress has passed legislation concerning the ethics of life-sustaining medical treatment. The bill was spearheaded by Senator John C. Danforth (RMO), who has a special interest in this area. An Episcopal priest, Danforth was formerly an assistant chaplain at New York's Memorial Sloan-Kettering Cancer Center and now sits as a senior member of the Senate Finance Committee, which oversees Medicare and Medicaid. Although Senator Danforth's legislative initiative was not a result of the Cruzan case, it was in his state of Missouri that the U.S. Supreme Court case involving removal of Nancy Cruzan's feeding tube arose (Cruzan v. Director of Missouri Department of Health, U.S. Supreme Court, 58 LW 4916, 26 June 1990). From his unique vantage point, he felt it was time to craft a legislative response to some of the difficult issues surrounding prolongation of life.The short answer to Senator Danforth's questions about when to artificially extend life is simple enough: people must be free to determine that for themselves. Common law and common sense dictate such a conclusion; living will and health care proxy statutes, enacted in almost every state, codify that right. The Catholic moral tradition teaches that one is not morally obligated to use extraordinary means to prolong life, a tradition shared both by the mainline Protestant and the reform and conservative Jewish community. Yet most people are unaware of their fundamental legal right to make such decisions, and as court cases from Quinlan (In re Quinlin, 137 N.J. Super. 227, 1975) to Cruzan demonstrate, few know [End Page 163] how to make arrangements for this right to be exercised if they become incapacitated.Meanwhile, health care practices are often driven by a denial of death. When Senator Danforth and Senator Daniel Patrick Moynihan (D-NY) introduced the bill on October 17, 1989, Senator Danforth said:More and more it is arguable that we play God by subjecting people to unwanted and sometimes unnecessary treatment, treatment that unnaturally prolongs the dying process. Our health care system has become obsessed with extending life, at times neglecting the caring component of medicine and trampling on the rights of patients.(Congressional Record 1989, 135:5.13566)The American Hospital Association estimates that 70 percent of deaths now occur after a determination to withhold or withdraw medical treatment. Many of those decisions are made without the benefit of an incapacitated patient's views, yet a Harvard study revealed that 95 percent of the population would like to prepare in advance for such decisions. Only 4 percent of hospitals have a systematic method of asking patients if they have an advance directive. Family members confront painful choices in the face of uncertainty about their loved one's wishes and it can be even more painful when a family knows the patient's desires but providers and the courts act otherwise because clear evidence is lacking.The Patient Self-Determination Act is rooted in the belief that people should be given information that enables them to specify the extent of medical treatment they wish to receive should they become incapacitated. The public should be educated about applicable state laws that protect the individual's right to make such choices through the use of an advance directive.The Act moves toward that goal by promoting knowledge of state laws. It requires every hospital, nursing home, home health agency, hospice, and health maintenance organization that participates in Medicaid or Medicare to routinely give all adult patients information about advance directives. Patients will also be given information on the... (shrink)

In his concept of an anthropological physiology, F.J.J. Buytendijk has tried to lay down the theoretical and scientific foundations for an anthropologically-oriented medicine. The aim of anthropological physiology is to demonstrate, empirically, what being specifically human is in the most elementary physiological functions. This article contains a sketch of Buytendijk''s life and work, an overview of his philosophical-anthropological presuppositions, an outline of his idea of an anthropological physiology and medicine, and a discussion of some episternological and methodological problems. It is (...) demonstrated that Buytendijk''s design of an anthropological physiology is fragmentary and programmatic and that his methodology offers few points of contact for specific anthropological experimental research.Notwithstanding, it is argued that Buytendijk''s description of the subjective, animated body forms a pre-eminent point of reference for all research in physiology and psychology in which the specific human aspect is not ignored beforehand. (shrink)

In an article in Philosophy R. G. Swinburne set out to argue that none of Hume's formal objections to the design argument ‘have any validity against a carefully articulated version of the argument’ . This, he maintained, is largely because Hume's criticisms ‘are bad criticisms of the argument in any form’ . The ensuing controversy between Swinburne and Olding 1 has focused upon the acceptable/unacceptable aspects of the dualism presupposed in Swinburne's defence of the design argument; upon whether any simplification (...) is achieved by reducing scientific explanation to agent explanation; and upon the problems which arise from taking a man's acting upon his body as the analogy for understanding a disembodied agent acting upon matter. In this article I shall refer to the Swinburne-Olding controversy when appropriate but my main concern is to return to Swinburne's original article and argue, seriatim , that Hume's individual criticisms of the design argument are for the most part a great deal more powerful than Swinburne allowed. I shall contend that cumulatively they destroy the design argument as any sort of rational foundation for theistic belief. But first I shall indicate briefly the character of the argument together with one or two of the distinctions and refinements in terms of which it has been found helpful to carry on the discussion in recent years. (shrink)

I want to consider in this paper a question that is looming large in the theology of most world religions, not least in the Christian tradition. The following discussion will be confined to the Christian standpoint, though I hope mutatis mutandis the main points will be seen to apply to other religious perspectives as well. Specifically then, this question can be ex–pressed in two ways. We may ask, in the context of the contemporary dialogue situation, how is the committed Christian (...) to regard the adherents of non–Christian religions? and what status do these alien belief–systems have with respect to the Christian faith–response? Both forms of the issue are often discussed it seems to me without due attention being given to an important distinction between them. So, at the outset, it will be useful to make one or two observations about this. First of all, it is inevitable, I think, that an evaluational factor is implied by both formulations. We are pondering a basically Christian assessment of religious traditions that are non–Christian, and any solution suggested which eventually eliminates a one-sided overall perspective will apparently put us in a dilemma. For, on the one hand, a Christian theology of religions will be expected to produce a Christian result; on the other hand, a finally nonevaluational solution seems unable to be called a Christian view of things at all. In the event of such a ‘neutral theology’ as the latter resulting , is the dilemma that becomes apparent a genuine one, or can it be resolved by a more stringent analysis of the relevant issues? (shrink)

The Endangered Species Act of 1973 is America's strongest environmental law. Its citizen-suit provision—permitting “any person” whomsoever to sue on behalf of a threatened or endangered species—awards implicit intrinsic value, de facto standing, and operational legal rights to listed species. Accordingly, some cases had gone forward in the federal courts in the name of various listed species between 1979 and 2004, when the Ninth Circuit Court of Appeals ruled that animals could not sue in their own name. Because the Supreme (...) Court has interpreted its habitat destruction as the “taking” of a listed species, some have argued that enforcement of the ESA's critical-habitat-protection provision is a “regulatory taking” of private property without just compensation, contrary to the Fifth Amendment of the Constitution. The courts have not agreed. The ESA citizen-suit provision appears to waive federal-court standing requirements devolved from Article III of the U.S. Constitution, creating much confusion and mutually contradictory rulings. A series of cases reconciles the ESA's citizen-suit provision with the particularized and concrete “injury-in-fact” standing requirements devolved from Article III. (shrink)

Flew's challenge to the religious believer asks him to specify what would count as a disproof for, e.g. ‘There is a God’. A statement of such a specifiable condition I called an ‘empirical denial’. In my earlier paper I was concerned to show that a statement is a statement whether or not it has such an empirical denial. I was not particularly concerned to show that there are some statements which do not have an empirical denial; my concern was to (...) show that it is not essential that they do. It was in connection with this point that the statement ‘John loves Mary’ was discussed. But this very same example may indeed serve as an example of a statement for which, in certain complex situations, there is no empirical denial. That is, in some circumstances, no matter what empirical conditions are specified, when the statement ‘John loves Mary’ is made, they could obtain and still John might love Mary, as the developing situation would make clear. If the condition specified is that John is cruel to Mary and shows no concern for her, details could always emerge in such a situation to explain why, even though he loved her, he was cruel and showed no concern. And so on. (shrink)

The aim of this paper is to give a characterisation of religion and the Religious Spirit, basing itself on the Platonic assumption that there are Forms, salient jewels of simplicity and affinity, to be dug out from the soil of vague experience and cut clear from the confusedly shifting patterns of usage, which will give us conceptual mastery over the changeable detail in a given sector. It will further be Platonic in that it will not seek to discount the deep (...) gulfs between the species into which religion qua genus divides itself, i.e. its theistic, polytheistic and atheistic subvarieties, taking it to be of the essence of a true genus to extend itself over mutually exclusive species, only being what it is by including in its sense the alternatives which are thus mutually exclusive. And my treatment will be Platonic, thirdly, in that it will endeavour to delimit the Religious Spirit by, on the one hand, setting it over against what it excludes, all purely this-world talk and life which is quite irreligious, and by, on the other hand, opposing it to forms of talk and life which fall short of it in various ways or which deviate from it variously, thereby likewise contributing to our understanding of what it is. The practice of Plato, which could study the deviations from his ideal city in order to confirm his notion of its structure and excellence, and which also paired every ideal pattern with its opposite— piety with impiety, justice with self-interested tyranny, etc.—is plainly one to be followed: Plato, as we know from a citation from his contemporary Hermodorus in one of the Aristotelian commentators, always set beside the ‘in itself’ of the pure Form the deviant and the wholly negative which were nonetheless part of its sense. Religion will therefore stand before us as a target that it is possible to fall short of or miss altogether as well as to hit squarely, and we shall try by a series of glancing darts to end by hitting it squarely. (shrink)

The Limits of Thought is a series of penetrating dialogues between the great spiritual leader, J. Krishnamurti and the renowned physicist, David Bohm. The starting point of their engaging exchange is the question: If truth is something different than reality, then what place has action in daily life in relation to truth and reality? We see Bohm and Krishnamurti explore the nature of consciousness and the condition of humanity. These enlightening dialogues address issues of truth, desire awareness, tradition, and love. (...) Limits of Thought is an important book by two very respected and important thinkers. Anyone interested to see how Krishnamurti and Bohm probe some of the most essential questions of our very existence will be drawn to this great work. (shrink)

In ‘ The Life and Opinions of Tristram Shandy ’ Laurence Sterne writes: That of all the several ways of beginning a book which are now in practice throughout the known world, I am confident my own way of doing it is the best—I'm sure it is the most religious—for I begin with writing the first sentence—and trusting to Almighty God for the second.

In the introductory chapter to this collection, the editors point out that, until recently, most Anglophone Spinoza scholarship has been focused on the metaphysics and epistemology of the Ethics. But according to Kisner and Youpa, Spinoza thought that metaphysics and epistemology were significant chiefly because they are required for understanding the more important part of his project—the ethical doctrine developed in the last three parts of the work. Ethica was so-titled because it is a book about ethics.In recent years, the (...) scholarly community has begun to shift its attention to bring itself more in line with Spinoza's intentions—to focus more directly on his ethical views. The volume under review presents... (shrink)

Although Professor of Philosophy at Calvin College, Alvin Plantinga has developed a theodicy that is fundamentally Arminian rather than Calvinistic. Anthony Flew, although the son of an Arminian Christian minister, regards the Arminian view of ‘free will’ to be both unacceptable on its own terms and incompatible with classical Christian theism. In this paper I hope to disentangle some of the involved controversy regarding theodicy which has developed between Plantinga and Flew, and between Flew and myself. The major portion of (...) this paper is devoted to showing that Plantinga's theodicy contains some serious flaws and undesirable implications. (shrink)

This book contains new essays in honor of Melvin J. Lerner, a pioneer in the psychological study of justice. The contributors to this volume are internationally renowned scholars from psychology, business, and law. They examine the role of justice motivation in a wide variety of contexts, including workplace violence, affirmative action programs, helping or harming innocent victims and how people react to their own fate. Contributors explore fundamental issues such as whether people's interest in justice is motivated by self-interest or (...) a genuine concern for the welfare of others, when and why people feel a need to punish transgressors, how a concern for justice emerges during the development of societies and individuals, and the relation of justice motivation to moral motivation. How an understanding of justice motivation can contribute to the amelioration of major social problems is also examined. (shrink)