Background Regionalised models of health care delivery have important implications for people with disabilities and chronic illnesses yet the ethical issues surrounding disability and regionalisation have not yet been explored. Although there is ethics-related research into disability and chronic illness, studies of regionalisation experiences, and research directed at improving health systems for these patient populations, to our knowledge these streams of research have not been brought together. Using the Canadian province of Ontario as a case study, we address this gap (...) by examining the ethics of regionalisation and the implications for people with disabilities and chronic illnesses. The critical success factors we provide have broad applicability for guiding and/or evaluating new and existing regionalised health care strategies. Discussion Ontario is in the process of implementing fourteen Local Health Integration Networks (LHINs). The implementation of the LHINs provides a rare opportunity to address systematically the unmet diverse care needs of people with disabilities and chronic illnesses. The core of this paper provides a series of composite case vignettes illustrating integration opportunities relevant to these populations, namely: (i) rehabilitation and services for people with disabilities; (ii) chronic illness and cancer care; (iii) senior's health; (iv) community support services; (v) children's health; (vi) health promotion; and (vii) mental health and addiction services. For each vignette, we interpret the governing principles developed by the LHINs – equitable access based on patient need, preserving patient choice, responsiveness to local population health needs, shared accountability and patient-centred care – and describe how they apply. We then offer critical success factors to guide the LHINs in upholding these principles in response to the needs of people with disabilities and chronic illnesses. Summary This paper aims to bridge an important gap in the literature by examining the ethics of a new regionalisation strategy with a focus on the implications for people with disabilities and chronic illnesses across multiple sites of care. While Ontario is used as a case study to contextualize our discussion, the issues we identify, the ethical principles we apply, and the critical success factors we provide have broader applicability for guiding and evaluating the development of – or revisions to – a regionalised health care strategy. (shrink)

1. In Authority and Estrangement, Richard Moran shows us with marvelous clarity how our capacity for avowal is constitutive of our freedom as rational agents. But philosophers also need to acknowledge that avowal plays a crucial role in keeping us unfree. This eludes Moran’s attention, I suspect, because he uses the therapeutic situation as a contrasting paradigm to our ordinary capacity for avowal.

We just lived through a global pandemic, and we are entering a period in which the alarming impacts of anthropogenic climate change are becoming increasingly ha.

In his Natural Theology, the eighteenth-century Anglican theologian William Paley compares a watch with objects in nature, arguing that “every manifestation of design, which existed in the watch, exists in the works of nature…” Charles Darwin read Paley's Natural Theology as a young man and offered natural selection as an alternative, naturalistic explanation of Paley's explanandum: the appearance of design in nature. Many of Paley's successors diverged from him in their approach to the living world. This chapter examines some of (...) these alternative approaches and the extent to which the literature of natural theology had trodden the path between Paley's watchmaker and Darwin's natural selection prior to the publication of the latter's Origin of Species. In particular, it focuses on the Bridgewater Treatises, a series of eight highly popular works published in the 1830s, which illustrate the far-reaching development that took place in natural theology in Britain during the early nineteenth century. (shrink)

The everyday expressions of nursing practices are driven by their entanglement in complex flows of social, cultural, political and economic interests. Early expressions of trained nursing practice in the United States and Europe reflect claims of moral, spiritual and clinical exceptionalism. They were both imposed upon—and internalized by—nursing pioneers. These claims were associated with an endogenous narrative of discipline and its physical manifestation in early nursing schools and hospitals, which functioned as “total institutions.” By contrast, the external forces—diffuse yet pervasive—impacting (...) upon contemporary nursing more closely align with the power dynamics explored in Gilles Deleuze's concept of the Society of Control. The example of sensor technology and telemetric monitoring of nurses’ locations in the clinical setting exemplifies the intense presence of surveillance, performance metrics and the “rationalization” of nursing practice. It falls upon nurses to recognize, accept or challenge these dynamics in order to shape the future of nursing practice into a discipline which embodies our values and priorities. (shrink)

Research investigating the brain basis of language comprehension has associated the left anterior temporal lobe with sentence-level combinatorics. Using magnetoencephalography, we test the parsing strategy implemented in this brain region. The number of incremental parse steps from a predictive left-corner parsing strategy that is supported by psycholinguistic research is compared with those from a less-predictive strategy. We test for a correlation between parse steps and source-localized MEG activity recorded while participants read a story. Left-corner parse steps correlated with activity in (...) the left ATL around 350–500 ms after word onset. No other correlations specific to sentence comprehension were observed. These data indicate that the left ATL engages in combinatoric processing that is well characterized by a predictive left-corner parsing strategy. (shrink)

The scope and audacity of Bhaṭṭoji Dīkṣita’s contributions to Sanskrit grammar has made him one of early-modern India’s most influential, if not controversial, intellectuals. Yet for as consequential as Bhaṭṭoji’s has been for histories of early-modern scholasticism, his extensive corpus of non-grammatical writings has attracted relatively little scholarly attention. This paper examines Bhaṭṭoji’s work on Vedānta, the Tattvakaustubha, in order to gage how issues of language became an increasingly important site of inter-religious critique among early-modern Vedāntins. In the Tattvakaustubha, Bhaṭṭoji (...) reproaches Madhvācārya, the founder of the eponymous Mādhva or Dvaita Vedānta system, for his use of ungrammatical words. In extending his accusations of grammatical negligence to include Madhva’s early commentator Jayatīrtha, Bhaṭṭoji sought to undermine Mādhva claims to authoritative scriptural exegesis. Bhaṭṭoji’s provocation impelled later Mādhva scholars like Rāghavendratīrtha to bring a sharper set of grammatical tools to core commentarial works. Where others have pointed to Vyāsatīrtha as a turning point for Mādhva scholastic discourse in the areas of Pūrva Mīmāṃsā and Navya Nyāya, this paper suggests that it was the post-Bhaṭṭoji scholar Rāghavendratīrtha who brought a hitherto unrivaled grammatical expertise to Mādhva writings. That both Mādhva and Advaita Vedāntins wielded grammatical legitimacy as a cudgel against the other raises important socio-historical questions about the relationship between text-criticism, conceptions of scholastic legitimacy, and inter-religious contestation in early-modern South Asia. (shrink)

Tracing a central theme of Plato's Republic , G. R. F. Ferrari reconsiders in this study the nature and purpose of the comparison between the structure of society and that of the individual soul. In four chapters, Ferrari examines the personalities and social status of the brothers Glaucon and Adeimantus, Plato's notion of justice, coherence in Plato's description of the decline of states, and the tyrant and the philosopher king—a pair who, in their different ways, break with the terms of (...) the city-soul analogy. In addition to acknowledging familiar themes in the interpretation of the Republic —the sincerity of its utopianism, the justice of the philosopher's return to the Cave—Ferrari provocatively engages secondary literature by Leo Strauss, Bernard Williams, and Jonathan Lear. With admirable clarity and insight, Ferrari conveys the relation between the city and the soul and the choice between tyranny and philosophy. City and Soul in Plato's Republic will be of value to students of classics, philosophy, and political theory alike. (shrink)

The Industrial Revolution caused an expansion of our ideas of property to include other forms of wealth, such as innovations and productive techniques. And the modern age has caused a further expansion of our ideas of property to include inchoate items, particularly information. The Framers of the U.S. Constitution presumed that government not only took an expansive view of the nature of property rights, they also believed that such rights should be protected. To James Madison and the other Framers, property (...) was a “broad and majestic term” that “embraces everything which may have a value to which man may attach a right.”. (shrink)

The existence of a meaningful distinction between economic rights and “other rights” has been a cornerstone of constitutional law for the past sixty years. During this period, the federal courts consistently have taken the position that Congress is free to abuse citizens’ economic liberties, but is not permitted to interfere with such other, noneconomic “rights” as freedom of expression, freedom of assembly, and freedom of religion.

ABSTRACTNovelty held a special attraction for book buyers in the sixteenth and seventeenth centuries, but new texts carried more risk for the publisher than titles already proven to be good sellers. Canny bookseller-publishers therefore adopted a publishing strategy that would benefit from the commercial safety of proven sellers while simultaneously exploiting the cachet of the ‘new’. They could maximise the sales potential of a book by reprinting an already market-tested text but repackaging it with new and improved ingredients, often provided (...) by the text's original author. Such enlargements were never left unpublicised on the title page which, as the primary means of marketing texts in the early modern book trade, had to function both as a dust-jacket-style advertisement intended for bookstall browsers, and as a discrete advertisement posted remote from the physical volume. Given the safe bet of reprints and the marketability of new material, the promotional nature of title pages therefore necessitated revised, augmented, or otherwise enlarged editions to be produced by the author and bookseller to attract attention and sales. (shrink)

In this essay, I identify the reasons that libertarian principles have failed to capture the popular imagination as an acceptable form of civil society. By the term “libertarian” I mean a belief in and commitment to a set of methods and policies that have as their common aim greater freedom under law for individuals. The term “freedom” in this context means not only a commitment to civil liberties, such as freedom of expression, but also to economic liberties, including a commitment (...) to a laissez-faire policy of free enterprise and free trade between countries. Libertarians, therefore, are committed to the absolute minimum state intervention in the economy as well as in people's private lives. In a world constrained by these libertarian principles, people should be permitted to do as they please, constrained only by rules that prevent them from encroaching on the liberty of others. (shrink)

With a textual record spanning dozens of languages—to say nothing of its oral histories—Advaita Vedānta’s multilingual archive presents obvious and daunting challenges for scholars of South Asian intellectual and religious histories. The papers in this issue build on recent multilingual and contextual approaches to South Asian intellectual history by reading a rich corpus of Advaita Vedānta material in Persian, Marathi, Tamil, Sanskrit and Braj Bhasha. In bringing these sources and their authors into conversation with one another, this issue acknowledges Advaita (...) Vedānta’s broad appeal in early-modern and colonial South Asia; but it also attests to Advaita Vedānta’s heterogeneous, textured, and even contested historical development. The following papers chart Advaita Vedānta across five unique social, linguistic, intellectual, and geographical spaces from the middle of the sixteenth century to the middle of the nineteenth century. While no single issue could contextualize something as historically recalcitrant as Advaita Vedānta, we see this special issue as a step on the long and necessary road to historicizing Vedānta, broadly, and Advaita Vedānta, specifically. (shrink)

With a textual record spanning dozens of languages—to say nothing of its oral histories—Advaita Vedānta’s multilingual archive presents obvious and daunting challenges for scholars of South Asian intellectual and religious histories. The papers in this issue build on recent multilingual and contextual approaches to South Asian intellectual history by reading a rich corpus of Advaita Vedānta material in Persian, Marathi, Tamil, Sanskrit and Braj Bhasha. In bringing these sources and their authors into conversation with one another, this issue acknowledges Advaita (...) Vedānta’s broad appeal in early-modern and colonial South Asia; but it also attests to Advaita Vedānta’s heterogeneous, textured, and even contested historical development. The following papers chart Advaita Vedānta across five unique social, linguistic, intellectual, and geographical spaces from the middle of the sixteenth century to the middle of the nineteenth century. While no single issue could contextualize something as historically recalcitrant as Advaita Vedānta, we see this special issue as a step on the long and necessary road to historicizing Vedānta, broadly, and Advaita Vedānta, specifically. (shrink)

Criteria of empirical significance are supposed to state conditions under which reference to an unobservable object or property is “empirically meaningful.” The intended kind of empirical meaningfulness should be necessary for admissibility into the selective contexts of scientific inquiry. I defend Justus’s recent argument that the reasons generally given for rejecting the project of defining a significance criterion are unpersuasive. However, as I show, this project remains wedded to an overly narrow conception of its subject matter. Even the most cutting (...) edge significance criteria identify empirical significance with predictive power, and thereby rule out vocabulary with legitimate scientific functions. In a nutshell, the problem is that there are terms that reduce the computational burden of extracting predictions from theory, and that may therefore be scientifically useful, but that do not add to the theory’s observational consequences, and so are ruled scientifically inadmissibility by existing significance criteria. I spell out this objection by specifying shortcut terms that are ruled inadmissible by Creath’s and Schurz’s criteria. Having objected in this way to extant criteria, and to the equation of empirical significance with predictive power in general, I discuss an approach to defining empirical significance that is capable of avoiding my objection and, more ambitiously, that may break the cycle of “punctures and patches” that has plagued the project from the beginning. I gloss Goldfarb and Ricketts’s idea of “case-by-case” delineations of empirically significant terms as the provision of special rather than general explications of the informal concept of empirical significance. (shrink)

Cultural group selection theorists propose that humans evolved prosocial preferences. These claims revolve largely around the centrality of punishment in cultural groups, which helped to eliminate free riders. The purpose of this paper is to explore whether distinguishing between free-riding as an action, and free riders as entities, undermines or supports this view. I develop three individual-based models of the Prisoner’s Dilemma. The first model shows that strong reciprocity removes overt freeriders from a population, and maintains a high rate of (...) cooperation. In the second, I introduce individuals that mimic cooperative preferences, but who defect when they trick opponents into cooperating. I show that strong reciprocity is robust against this strategy, but not because individuals are replaced by strong reciprocators. Finally, I introduce a third strategy, covert mimicry, where some mimics may defect without detection. I draw attention to the problem highlighted in these models, which is that cooperation may be maintained in populations only because freeriders are not presented with the opportunity to defect. I discuss this problem in the context of cultural group selection and the human capacity for innovation, and suggest that hypotheses relying on prosocial preferences for maintaining cooperation require some revision. (shrink)

In the epilogue to Memory, History, Forgetting, Paul Ricoeur introduces an overlooked “vertical” axis into the problem of forgiveness. This verticality runs from the “depth” of fault to the “height” of forgiveness. For Ricoeur, forgiveness only appears an impossible “exchange” if one excludes this verticality from the question. Instead, he calls forgiveness “difficult” because it traverses from height to depth. This article argues that Ricoeur’s notion of the horizontal and the vertical in Memory, History, Forgetting is best understood as an (...) allusion to his account of time and eternity in Chapter 1 of Time and Narrative, volume 1, even though Ricoeur himself does not explicitly make this connection. In light of the ontological tenor of this connection, the author also suggests a slight modification of Ricoeur’s account, calling forgiveness “improbable” rather than difficult. (shrink)

In the epilogue to Memory, History, Forgetting, Paul Ricoeur introduces an overlooked “vertical” axis into the problem of forgiveness. This verticality runs from the “depth” of fault to the “height” of forgiveness. For Ricoeur, forgiveness only appears an impossible “exchange” if one excludes this verticality from the question. Instead, he calls forgiveness “difficult” because it traverses from height to depth. This article argues that Ricoeur’s notion of the horizontal and the vertical in Memory, History, Forgetting is best understood as an (...) allusion to his account of time and eternity in Chapter 1 of Time and Narrative, volume 1, even though Ricoeur himself does not explicitly make this connection. In light of the ontological tenor of this connection, the author also suggests a slight modification of Ricoeur’s account, calling forgiveness “improbable” rather than difficult. (shrink)

This commentary describes a new physician who encountered a patient in crisis in a nonmedical environment. It discusses professional obligations, ethical principles, errors committed, and reasoning behind such errors. Unusual circumstances, uncertainty about how to properly identify oneself as a physician, self-doubt, and discomfort with practicing outside one’s scope of training are recognized as reasons behind these errors. Medical students should be reminded of their ethical obligation to offer emergency care within their limitations, instructed how to identify themselves, and guided (...) to become competent team leaders. Resident doctors should continue to receive instruction as they internalize ethical principles and identify their scopes of practice. Practicing physicians should be competent in offering basic emergency care if needed. (shrink)

Physicians often struggle with ethical issues surrounding intervention in their relatives’ health care. Many editorials, letters, and surveys have been written on this topic, but there is no systematic review of its prevalence. An Ovid Medline search was conducted for articles in English, written between January 1950 and December 2010, using the key words family member, relatives, treatment, prescribing, physician, and ethics. The search identified 41 articles (editorials, letters, and surveys). Surveys were reviewed to explore demographics of these treating physicians (...) and reasons for and against intervention. Physicians often intervene directly or indirectly in the health care of relatives. The most common reasons were convenience, cost savings, and the perception of having greater knowledge or concern than colleagues. Lost objectivity, fear of misdiagnosis, and inability to provide complete care were the main considerations against intervention. The characteristics of treating doctors were nonspecific. Most surveys recommend against this practice except for emergencies or minor ailments. This review included only a few surveys with small sample size and only assessed scientific literature written in English after 1950. Survey data may be biased by physicians’ self-reporting. In conclusion, most doctors occasionally intervene in their relatives’ care. The decision to do so is determined by multiple factors. Physicians should treat only short-term or minor illnesses within their scope of practice. Future research should evaluate doctors’ attitudes toward their relatives, medical student feelings about treating family, and intervention frequencies of medical and nonmedical professionals. (shrink)

This article analogizes the state, in its role as tax collector, to that of an investor, or to be more precise, that of a residual claimant on the earnings of all of the people and firms subject to the taxing power of the state. The relationship between modern democracy and its citizens would be strengthened if this analogy were more widely acknowledged because it recognizes citizen-taxpayers as contracting partners with the state. Unlike other libertarian conceptions of the state's taxing authority, (...) the framework developed here does not jeopardize the state's ability to collect the revenues it needs to provide for the protections of its citizens. The state-as-investor framework developed in this Article leads to a number of tax policy improvements. The framework suggests limits on the government's ability to change people's tax status after they have already embarked on careers and made the sunken, non-diversifiable investments in human capital that such career training requires. The framework advanced here also suggests that people should be able to make a once-in-a lifetime payment in lieu of taxes to the state in order to discharge their tax liability. This approach articulated here also seems superior to the utopian suggestion offered by Ayn Rand that taxation be voluntary, as well as to the unrealistic suggestion made by Nozick that income taxes are violative of man's natural rights. (shrink)

The way things are supposed to be : reputational theory and its demise -- Thriving the new way : with little or no reputation : the Goldman Sachs story -- The way things used to be : when reputation was critical to survival -- Individual reputation unhinged from the firm : hardly anybody goes down with the ship -- Proof in the pudding : Michael Milken, Junk Bonds, and the decline of Drexel and -- Nobody else -- The new, post-reputation (...) Wall Street : accounting firms -- The new, post-reputation Wall Street : law firms -- The new, post-reputation Wall Street : credit rating agencies -- The new, post-reputation Wall Street : stock exchanges -- The SEC and reputation -- The SEC : captured and quite happy about it -- Where we are and where we are headed : a conclusion of sorts -- Index. (shrink)

Compares the differing answers as to whether human rulers or the law should be supreme in the works of Plato and Aristotle.

BackgroundSarcomas are a diverse group of neoplasms that vary greatly in clinical presentation and responsiveness to treatment. Given the differences in the sites of involvement, rarity, and treatment modality, a multidisciplinary approach is required. Previous literature suggests patients with sarcoma suffer from poorer quality of life especially physical and functional wellbeing. Adolescent and young adult patients are an underrepresented population in cancer research and have differing factors influencing QoL.MethodsRetrospective analysis of Young Adult patients enrolled in the Sarcoma Tissue Repository at (...) University of Iowa. QoL was assessed using the self-report FACT-G questionnaire at enrollment and 12 months post-diagnosis; overall scores and the 4 wellbeing subscales were calculated. Linear mixed effects models were used to measure the association between the rate of change in FACT-G subscale scores and baseline clinical, comorbidity, and treatment characteristics.Results49 patients were identified. 57.1% of patients had a malignancy involving an extremity. Mean FACT-G scores of overall wellbeing improved from baseline to 12 months. Social and emotional wellbeing did not differ significantly between baseline and 12 months. Physical wellbeing and functional wellbeing scores improved from baseline to 12 months. No difference was seen for FACT-G overall scores for age, sex, laterality, marital status, performance status, having children, clinical stage, limb surgery, chemotherapy, or tumor size. A difference was demonstrated in physical wellbeing scores for patients with baseline limitation compared to those with no baseline limitation. A difference was demonstrated in social wellbeing based on anatomical site.ConclusionYoung adults with sarcoma treated at a tertiary center had improvements in overall reported QoL at 12 months from diagnosis. Overall baseline QoL scores on FACT-G were lower than the general adult population for YA patients with sarcoma but at 12 months became in line with general population norms. The improvements seen merit further investigation to evaluate how these change over the continuum of care. Quality of life changes may be useful outcomes of interest in sarcoma trials. (shrink)

Quevedo brings together a number of philosophical traditions in the Suenos. One chapter of the thesis examines Quevedo's use of Epicurean dream theory as well as the larger ramifications of the dream setting for the satires. Another chapter analyzes the exact nature of Quevedo's sceptical views and their classical sources with emphasis on the content of El mundo por de dentro. Included is a discussion of the moral philosophy presented in the Suenos, deriving primarily from Stoic sources. In each case, (...) Quevedo reconciles these classical influences with Christian doctrine, leading to a discussion in the thesis as to the exact nature of his Christian beliefs as they are expressed in the Suenos, i.e., whether Quevedo was indeed an existentialist and nihilist as many have labeled him. (shrink)

In the central section of the _Protagoras_, the discussion between Socrates and Protagoras has broken down in a seemingly irresolvable dispute about methodology - Protagoras wants to make long speeches, while Socrates wants to proceed by means of the short questions and answers characteristic of the elenchus. The onlookers offer solutions in an attempt to restart the discussion. This section appears to be a mere dramatic interlude, but I argue that in fact it constitutes a parable establishing links between philosophy, (...) education, and politics in which authority and control are contrasted with genuine democratic discussion. (shrink)

Locates, discusses, and explains the transition between Nietzsche's middle and late periods represented by the first four books of _The Gay Science_.

When this invaluable account of ‘one of the most successful of all publishers and printers of nineteenth- and twentieth-century science’ was first issued in 1984, it began with a survey of the underdeveloped literature on the history of scientific periodicals, and more generally of science publishing. A decade and a half later, in this considerably expanded second edition— issued to celebrate the bicentenary of the launch of the Philosophical Magazine in 1798—the authors had only a couple of extra titles to (...) add. Since then, a number of important works have addressed this theme, but the field remains wide open.1 Most of the key technicians of print—the publishers, printers, and engravers—who were responsible for the production of scientific books in nineteenth-century Britain are still unknown. Neither has serious attention been devoted to the manner in which such technicians interacted with men of science on a day-to-day basis, or to the impact of their craft skills or trade practices on the development of science. My object in this brief account is to use the example of Richard Taylor, as represented by Brock and Meadows’ pioneering study, to review some of these important issues. (shrink)

The process of standardising reduced forms in English, such as clippings and informal forms, used in academic chat discourse is the focus of this article. Textchat data from an introductory MA linguistics course run by a university in Sweden involving non-native English-speaking students and their native English-speaking teachers is analysed to identify if any forms are standardised. Topic-specific forms are seen to be standardised as much as are high frequency forms, although few have been standardised. It is the students above (...) all who lead the process, and the teachers do not have much influence even if they use a different reduction. (shrink)

Data from academic seminars conducted through Skype textchat is analysed in this chapter, and the focus is on examples of how users mark community membership. Membership is marked explicitly by using pronominals and the metonymic use of the seminar group name. It is also marked implicitly by using reduced forms, which are stereotypical examples of a textchat speech style. I argue that these are markers of stance-taking, where community membership is recovered pragmatically as a weak implicature. Dis-alignment with the community (...) is also seen, as individuals can also implicate their independence as setters of linguistic norms. (shrink)