Background:The Taiwan Nursing Accreditation Council has proposed eight core professional nursing qualities including ethical literacy. Consequently, nursing ethics education is a required course for student nurses. These courses are intended to improve the ethical literacy. Moral sensitivity is the cornerstone of ethical literacy, and learning moral sensitivity is the initial step towards developing ethical literacy.Objectives:To explore the effect of nursing ethics educational interventions based on multiple teaching strategies on student nurses moral sensitivity. Based on the visual, auditory and kinaesthetic model, (...) three strategies were developed for determining the programme components and corresponding learning styles.Research design:This was a quasi-experimental study.Participants:A total of 234 junior-college student nurses participated in this study. All participants were aged 18–19 years.Ethical considerations:The study protocol was approved by the institutional review boards of Kaohsiung Veterans General Hospital. Only the participants who signed an informed consent form took part in the study. The participants were permitted to withdraw from the study at any point if they wished to do so without affecting their academic score.Results:The scores of Modified Moral Sensitivity Questionnaire for Student Nurses were significantly improved after the intervention of integrating multiple teaching strategies. Significant relationships were observed between the satisfaction scores of two teaching strategies and moral sensitivity. The results indicated that using multiple teaching strategies is effective for promoting nursing ethics learning.Conclusion:This strategy was consistent with the student nurses’ preferred learning style and was used to correct their erroneous ethical conceptions, assisting in developing their ethical knowledge. (shrink)

The following brief memoir of Wittgenstein needs a few preliminary words of explanation. Among those who attended his lectures and discussions in the years it covers was D. G. James, who later became Professor of English at Bristol University and then Vice-Chancellor of Southampton University. I met him both in Bristol and Southampton, and on one occasion suggested to him that some of us who had known Wittgenstein, but who had not become professional philosophers, might write down our recollections of (...) him, and that he and I should start. What prompted the suggestion was, I think, the publication of Norman Malcolm's book, and a feeling that the non-professionals might have something to contribute to the assessment of Wittgenstein, particularly as a person. I wrote a preliminary draft and sent it to James; but he never responded, there was much else to do, I let the matter rest, and now James is dead. I wrote in about the year 1960 on holiday and away from any books of reference and from my own notes of Wittgenstein's lectures and conversations. I have shown the typescript to a few interested people, but because of its preliminary and unfinished nature have not previously thought of publication. It has recently been suggested to me that it might be of more general interest, and I publish it now as it was written, with one or two trifling alterations. I am well aware of its limitations. It was intended to give an impression of Wittgenstein as a person rather than as a philosopher, and the rather miscellaneous collection of remarks in section 3 have that in view rather than any more strictly ‘philosophical’ intention. Others may well question some of the detail and disagree with some of the opinions expressed. And there are some things which I might put rather differently today. But if the memoir has any interest it is best left as it was written. (shrink)

Years ago, one of us had the opportunity to talk with a starting guard in the National Basketball Association about his health care. The player, then a rookie, did not have his own personal doctor. Instead, he received his health care from the team doctor. This athlete was very well paid and could have received care anywhere he wished in the area. But he came from a very poor neighborhood. Growing up, he said, he had no health care other than (...) hearing and eye tests done at his school and maybe vaccinations given by the school nurse. The player said he now felt fine and trusted his team to look out for his health since they were paying him a lot of money and obviously wanted him on the court. While it might seem obvious that conflicts of role could arise for doctors working simultaneously for a team and for an athlete—wanting to please coaches, owners, and maybe fans while looking out for the athletes on the team—that is not how this young player saw things. He trusted his team and those who worked for them, and he figured that their interest in keeping him healthy overlapped nicely with his interest in staying healthy. As someone who did not get much access to health care as a child and had little need for it, he did not have concerns about conflicts of interest and second opinions foremost in his mind. But as is clear from a recent scandal involving the National Football League and concussion research, there are reasons for concern when athletes deal with health care workers paid by their teams. (shrink)

Wisdom is a multi-component trait that is important for mental health and well-being. In this study, we sought to understand gender differences in relative strengths in wisdom. A total of 659 individuals aged 27–103 years completed surveys including the 3-Dimensional Wisdom Scale and the San Diego Wisdom Scale. Analyses assessed gender differences in wisdom and gender’s moderating effect on the relationship between wisdom and associated constructs including depression, loneliness, well-being, optimism, and resilience. Women scored higher on average on the 3D-WS (...) but not on the SD-WISE. Women scored higher on compassion-related domains and on SD-WISE Self-Reflection. Men scored higher on cognitive-related domains and on SD-WISE Emotion Regulation. There was no impact of gender on the relationships between wisdom and associated constructs. Women and men have different relative strengths in wisdom, likely driven by sociocultural and biological factors. Tailoring wisdom interventions to individuals based on their profiles is an important next step. (shrink)

Elephants show a rich social organization and display a number of unusual traits. In this paper, we analyse reports collected over a thirty-five year period, describing behaviour that has the potential to reveal signs of empathic understanding. These include coalition formation, the offering of protection and comfort to others, retrieving and 'babysitting' calves, aiding individuals that would otherwise have difficulty in moving, and removing foreign objects attached to others. These records demonstrate that an elephant is capable of diagnosing animacy and (...) goal directedness, and is able to understand the physical competence, emotional state and intentions of others, when they differ from its own. We argue that an empathic understanding of others is the simplest explanation of these abilities, and discuss reasons why elephants appear to show empathy more than other non-primate species. (shrink)

Elephants show a rich social organization and display a number of unusual traits. In this paper, we analyse reports collected over a thirty-five year period, describing behaviour that has the potential to reveal signs of empathic understanding. These include coalition formation, the offering of protection and comfort to others, retrieving and 'babysitting' calves, aiding individuals that would otherwise have difficulty in moving, and removing foreign objects attached to others. These records demonstrate that an elephant is capable of diagnosing animacy and (...) goal directedness, and is able to understand the physical competence, emotional state and intentions of others, when they differ from its own. We argue that an empathic understanding of others is the simplest explanation of these abilities, and discuss reasons why elephants appear to show empathy more than other non-primate species. (shrink)

It is reported that medical students both in the U.S. and Poland have experience of interacting with pharmaceutical company representatives (pharma reps) during their school years. Studies have warned that the interaction typically initiated by the pharma reps’ general gift-giving eventually leads to the quid pro quo relationship between the pharma company and the future doctors, the result of which is that the doctors will prescribe their patients drugs in favor of the pharma company. Built upon the existing finding, this (...) research engages in analysis with three foci. The first is to compare attitudinal differences of the American and Polish medical students as they interact with pharma reps. Second, it investigates the role of the different economic and cultural elements (respectively in the U.S. and Poland) in the students’ attitudinal differences. Last, it suggests that the medical schools in both countries should have strict policies and effective education curriculum to help their students better prepare to interact ethically with pharma reps. Since there has been no direct comparative cultural analysis of this kind which is known in a published literature or report, the authors believe that the paper will serve as a catalyst for further research in the area. (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)

BackgroundIn the Canadian Alliance for Healthy Hearts and Minds (CAHHM) cohort, participants underwent magnetic resonance imaging (MRI) of the brain, heart, and abdomen, that generated incidental findings (IFs). The approach to managing these unexpected results remain a complex issue. Our objectives were to describe the CAHHM policy for the management of IFs, to understand the impact of disclosing IFs to healthy research participants, and to reflect on the ethical obligations of researchers in future MRI studies.MethodsBetween 2013 and 2019, 8252 participants (...) (mean age 58 ± 9 years, 54% women) were recruited with a follow-up questionnaire administered to 909 participants (40% response rate) at 1-year. The CAHHM policy followed a restricted approach, whereby routine feedback on IFs was not provided. Only IFs of severe structural abnormalities were reported.ResultsSevere structural abnormalities occurred in 8.3% (95% confidence interval 7.7–8.9%) of participants, with the highest proportions found in the brain (4.2%) and abdomen (3.1%). The majority of participants (97%) informed of an IF reported no change in quality of life, with 3% of participants reporting that the knowledge of an IF negatively impacted their quality of life. Furthermore, 50% reported increased stress in learning about an IF, and in 95%, the discovery of an IF did not adversely impact his/her life insurance policy. Most participants (90%) would enrol in the study again and perceived the MRI scan to be beneficial, regardless of whether they were informed of IFs. While the implications of a restricted approach to IF management was perceived to be mostly positive, a degree of diagnostic misconception was present amongst participants, indicating the importance of a more thorough consent process to support participant autonomy.ConclusionThe management of IFs from research MRI scans remain a challenging issue, as participants may experience stress and a reduced quality of life when IFs are disclosed. The restricted approach to IF management in CAHHM demonstrated a fair fulfillment of the overarching ethical principles of respect for autonomy, concern for wellbeing, and justice. The approach outlined in the CAHHM policy may serve as a framework for future research studies.Clinical trial registrationhttps://clinicaltrials.gov/ct2/show/nct02220582. (shrink)

A cross-sectional study to ascertain what the Singapore population would regard as material risk in the anaesthesia consent-taking process and identify demographic factors that predict patient preferences in medical decision-making to tailor a more patient-centered informed consent. A survey was performed involving patients 21 years old and above who attended the pre-operative evaluation clinic over a 1-month period in Singapore General Hospital. Questionnaires were administered to assess patients’ perception of material risks, by trained interviewers. Patients’ demographics were obtained. Mann–Whitney U (...) test and Kruskal-Wallis one-way analysis of variance was used. Statistical significance was taken at p < 0.05. Four hundred fourteen patients were eligible of which 26 refused to participate and 24 were excluded due to language barrier. 364 patients were recruited. A higher level of education, being employed and younger age group are factors identified in patients who wanted greater participation in medical decisions. Gender, marital status, type of surgery, and previous surgical history did not affect their level of participation. The complications most patients knew about were Nausea, Drowsiness and Surgical Wound Pain. Patients ranked Heart Attack, Death and Stroke as the most significant risks that they wanted to be informed about in greater detail. Most patients wanted to make a joint decision with the anaesthetist, instead of letting the doctor decide or deciding for themselves. Discussion with the anaesthetist is the preferred medium of communication compared to reading a pamphlet or watching a video. Age and educational level can influence medical decision-making. Despite the digital age, most patients still prefer a clinic consult instead of audio-visual multimedia for pre-operative anaesthetic counselling. The local population appears to place greater importance on rare but serious complications compared to common complications. This illustrates the need to contextualize information provided during informed consent to strengthen the doctor-patient relationship. (shrink)

W. H. Auden, the sometimes Greta Garbo of twentieth-century poetry, once told Stephen Spender that he liked America better than England because in America one could be alone. Further, in his introduction to The Criterion Book of Modern American Verse Auden remarked that while in England poets are considered members of a “clerkly caste,” in America they are an “aristocracy of one.” Certainly it does seem to be the individual poet—Whitman, Williams, Olson, Plath, O’Hara, Ginsberg—who has altered the landscape of (...) American poetry and prosody, not the group. And most American literary “movements,” as Robert Creeley has pointed out, are simply comprised of a few people who on occasion drink together, and who are as likely as not to end the evening in violent argument over an aesthetic or political point. Yet the notion of schools or movements remains, in mainstream historical criticism at least, a vital one. How many introductions to anthologies of American poetry, for example, continue to use such rubrics as the Transcendentals, the Populists, the Black Mountain poets, the Beats, the New York group? And while established poets often rebel from any sense that they are part of a larger community, which by definition is self-limiting, they are often complicit in their initial categorization. For poets as well as critics the idea of a school is often a useful fiction serving as both a kind of protective hothouse and a platform for getting a hearing.The most recent “group” of American poets—the first since the anthology wars of the early sixties really to be of more than passing interest and perhaps to be actually capable of bringing about a major shift of attention in American poetry and poetics—is the so-called “Language” school. Individual volumes by poets often considered part of this group number well into three figures now and there have been important journals and anthologies produced in a serious and sustained fashion by these writers. Yet in part because of what seems the essentially hermetic character of the project , there has been little notice of this activity by academic critics or reviewers.1 What I’d like to do here is briefly map a few major aspects of the territory, describing some of the practical and theoretical questions which seem to occupy many of these writers in their ongoing critique of the “workshop poem.” 1. Two important exceptions are discussions of some of this work in Stephen Fredman, Poet’s Prose: The Crisis in American Verse and Marjorie Perloff’s review “The Word as Such: L=A=N=G=U=A=G=E Poetry in the Eighties,” American Poetry Review 13 : 15-22. All further references to Perloff’s article, abbreviated “WS,” will be included in the text. For a discussion of the various Language poetry journals and anthologies, see my chapter “American Poetry, 1940s to the Present” in American Literary Scholarship: An Annual/1983, ed. Warren French , pp. 349-74. Lee Bartlett, an associate professor of English, has directed the University of New Mexico’s creative writing program for five years. Coeditor of the critical journal American Poetry, his Talking Poetry: Conversations in the Workshop with Contemporary Poets will be published this fall. Currently he is writing a biography of William Everson. (shrink)

This study investigated the effects of psychobiological characteristics of non-obese women with a high level of weight suppression on explicit-implicit and approach-avoidance response toward food cues, depending on hunger-satiety states. The 634 participants were divided into two groups according to their weight history. If the difference between their highest weight over the last year and their current weight was more than 5%, they were assigned to the “H-WS” group. If the difference in weight was less than 5%, they were assigned (...) to the “low level of weight suppression” group. Explicit approach and avoidance toward food were measured by self-report questionnaires. Implicit approach and avoidance toward food cues were measured using an eye-tracker. Fasting blood samples were obtained to measure fasting serum leptin levels. After this, participants consumed a standard breakfast to control the satiety level. After breakfast, explicit-implicit approach-avoidance responses were repeatedly measured at the satiety states. Self-reported body shape concerns, drive for thinness, ambivalent food craving, and bulimic behavior were also assessed. The results showed that the H-WS group had lower leptin levels, and higher body shape concerns, drive for thinness, ambivalent food craving, and bulimic behaviors compared to the L-WS group. At the explicit level, the H-WS group reported lower approach and higher avoidance to food compared to the L-WS group, regardless of hunger-satiety state. Whereas, at the implicit level, the H-WS group showed higher approach during satiety rather than during hunger states. Regardless of the hunger-satiety state, there were no significant group differences with regard to implicit avoidance between the two groups. Thus, we confirmed that a high level of avoidance toward foods was observed in the H-WS group at the explicit level but not at the implicit level. Moreover, in contrast with a high level of explicit avoidance toward palatable foods, inhibition for implicit approach toward high-calorie foods seemed to be blunted after food consumption in the H-WS group. These inconsistencies may be associated with ambivalent food craving and vulnerability to bulimic behavior among H-WS individuals. (shrink)

Originally published in 1936, this book presents the ancient Greek text of the paraphrases and quotations of Zeno's philosophical arguments, together with a facing-page English translation and editorial commentary. Detailed notes are incorporated throughout and a bibliography is also included. This book will be of value to anyone with an interest in Zeno and ancient philosophy.

A short time ago, D. D. Lee wrote in Philosophy of Science: “Grammar contains in crystallized form the accumulated and accumulating experience, the Weltanschauung of a people.“ He thus called our attention once more to a theme which was much discussed during the 19th century but which has been in disrepute for some time in philosophical circles. It is a theme, however, which is not without merit. More than seven years of intensive study of primitive languages have convinced me that (...) the work started by Wilhelm von Humboldt deserves serious consideration even at present, and from the ethnological as well as from the philosophical point of view. (shrink)

This reconsideration of the descriptive and normative components of my earlier comparisons of Mencius and Aquinas suggests that the strengths of Aquinas’s account were highlighted while some of his shortcomings and the corresponding strengths in Mencius were missing. This is made clear by considering the treatment of their respective ideas about optimal human fulfillment and even clearer by considering their understanding of the relationship between theoretical and literary accounts of that fulfillment. The third subject, their different treatments of people’s failure (...) to attain fulfillment, is more complicated, however, and involves a set of truly vexing issues. (shrink)

A concern central to virtually all full-blooded instances of religious ethics is how persuasively to represent a world central to our fulfillment that far exceeds our normal understanding. The treatment of three kinds of language in an early Daoist text, the Zhuangzi (Chuang Tzu), contains an especially profound discussion and expression of such persuasive presentations in religious ethics. This study examines it and concludes by viewing Dante's Commedia through the perspectives Zhuangzi's ideas and practices present.

An ethics of bewilderment, which differs dramatically from the more familiar ethics of ease, is best understood through poetic presentations. Using examples drawn from Chinese and Western sources—notably Du Fu and Dante—this inquiry treats bewilderment as both an emotion and a virtue. Both these forms of bewilderment involve an acknowledgment of how minimal is the ethical confidence we have, given the feelings we have and the judgments we must make, but they also extend in productive ways the implications of that (...) acknowledgment. (shrink)

Complex tensions define us, and that is why rational evaluative analysis and the deliberate application of principles to cases can, at best, claim to account for only a limited register in the full compass of ethical voice. Close analysis of brief texts from the "Mencius" and Dante's "Inferno" discloses in both an approach to ethical reflection that aims to expand the capacity for virtue, the ethical skillfulness exercised in response and evaluation, through affective engagement of the reader. This approach, a (...) kind of "re- flexive tropology," may involve us in a Han-tan walk. Nevertheless, if virtue and models of the self are interconnected, then right self-understanding is where the foundations of virtue are laid. Because the religious orientation calls into question the false fixities that inform ordinary activities and ordi- nary models of the self, it is crucial to the work of distinguishing among true and false forms of virtue. (shrink)

A concern central to virtually all full-blooded instances of religious ethics is how persuasively to represent a world central to our fulfillment that far exceeds our normal understanding. The treatment of three kinds of language in an early Daoist text, the Zhuangzi (Chuang Tzu), contains an especially profound discussion and expression of such persuasive presentations in religious ethics. This study examines it and concludes by viewing Dante's Commedia through the perspectives Zhuangzi's ideas and practices present.

William James, concerned with the issue of the applicability of traditional religious virtues to modern society, argues for the significance of ascetic virtues in general and voluntary poverty in particular, not least because of their contribution to the actualization of benevolence. Examining and evaluating his account uncovers the ways in which James is a virtue theorist, some distinctive characteristics of religious virtues, and both the possibilities and difficulties in any modern defense of a traditional virtue that appears as odd as (...) does voluntary poverty. (shrink)

The object of this paper is to show the predominance of the influence of geometrical ideas in Aristotle's account of first principles in the Posterior Analytics— to show that his analysis of first principles is in its essentials an analysis of the first principles of geometry as he conceived them. My proof of this falls into two parts. I. A consideration of the parallel between Aristotle's and Euclid's account of first principles. II. A comparison between the general movement of thought (...) in the Aristotelian παγωγ and πδειξις and in the δινοια and νησις of the Platonic dialectic. (shrink)

The second edition of H. P. Lee's The Australian Judiciary provides a timely update to this seminal text. The only definitive survey of the entire Australian judiciary, this text describes and evaluates the work, techniques, problems and the future of the different tiers of courts and judges. It discusses the role of the judiciary as the third sector of government and analyses and comments on judicial conduct, judicial independence and impartiality, the work of judges beyond the courts, the accountability of (...) judges and the dangers to judicial institutions. It is an excellent reference work which will appeal to legal scholars and practitioners throughout Australia and internationally. (shrink)

The object of this paper is to show the predominance of the influence of geometrical ideas in Aristotle's account of first principles in the Posterior Analytics— to show that his analysis of first principles is in its essentials an analysis of the first principles of geometry as he conceived them. My proof of this falls into two parts. I. A consideration of the parallel between Aristotle's and Euclid's account of first principles. II. A comparison between the general movement of thought (...) in the Aristotelian παγωγ and πδειξις and in the δινοια and νησις of the Platonic dialectic. (shrink)

The two passages in question are I. the discussion of Justice in Bk. V. chs. I-II, and in particular the definition and subdivisions of Corrective Justice ; and II. the discussion of the voluntaryand προαρεσς in Bk. III chs. II-II. My object is to show that each is better understood if it is seen in the light of contemporary legal ideas and practice.

The paper surveys the problem of language and translation in Antoine Berman’s pioneering achievements. This French philosopher of translation was deeply influenced not only by Schleiermacher, who affirmed the unity of thought and expression, but also by Benjamin, who drew attention to the formalism of language. In Berman’s view the essence of language lies in signifiers and letters. He criticized the Platonic view of language and translation which endows non-sensual, mental, and universal elements, with a higher ontological status. Thus Berman (...) proposed a modern theory of translation without Platonism. Meanings can be realized through and within letters not only in the source language, but also in the target language. In this sense, Berman’s philosophy of translation clearly reflects “the achievements of modern semiotics” . The paper criticizes the conception of translation as trapped within the logic of identity, which ignores the differences between, and the multiplicity of, languages as a result of a deep-rooted drive to obtain a universal meaning. The paper shows that Berman’s philosophy reflects and accepts this multiplicity allowing thereby the logic of difference/otherness to flourish in translation. (shrink)

The two passages in question are I. the discussion of Justice in Bk. V. chs. I-II, and in particular the definition and subdivisions of Corrective Justice ; and II. the discussion of the voluntaryand προαρεσς in Bk. III chs. II-II. My object is to show that each is better understood if it is seen in the light of contemporary legal ideas and practice.

I start with two contradictory statements: Jaeger, Aristotle, p. 330: ‘Thus all indications point to a late date for the origin of the philosopher's zoological works.’ D'Arcy Thompson, Historia Animalium, Prefatory Note: ‘It can be shown that Aristotle's natural history studies were carried on, or mainly carried on, in his middle age, between his two periods of residence at Athens.‘.

The following remarks on the aviary simile have been prompted by Professor Hackforth's article in C.Q. January 1938, pp. 27 ff., in which he in turn comments on certain points in Professor Cornford's treatment in his Plato's Theory of Knowledge. Commenting on 199c–d C. suggests that P.'s criticism in that passage might be met by the inclusion in the aviary of ‘complex objects such as the “sum of 7 and 5”.… It is this object that I identify with 11 when (...) I make my false judgement.… False judgement can be explained as the wrong putting together of two pieces of knowledge’—i.e. 11 and ‘the sum of 7 and 5’. C. further suggests that P. has overlooked this possibility because he persists in speaking as if we judged not ‘that the sum of 7 and 5 is 11’ but that ‘12 is 11 ’. H. replies that this criticism of C.'s is not valid because P. understands the knowledge of 11 and 12 to include a knowledge of the various sums that make up these numbers. There could, therefore, be no ‘question of “putting together” such a piece of knowledge as 7 + 5 = 12 with a different piece of knowledge, viz. the knowledge of 12. They are not different pieces; they are the same piece.’. (shrink)

The following remarks on the aviary simile have been prompted by Professor Hackforth's article in C.Q. January 1938, pp. 27 ff., in which he in turn comments on certain points in Professor Cornford's treatment in his Plato's Theory of Knowledge. Commenting on 199c–d C. suggests that P.'s criticism in that passage might be met by the inclusion in the aviary of ‘complex objects such as the “sum of 7 and 5”.… It is this object that I identify with 11 when (...) I make my false judgement.… False judgement can be explained as the wrong putting together of two pieces of knowledge’—i.e. 11 and ‘the sum of 7 and 5’. C. further suggests that P. has overlooked this possibility because he persists in speaking as if we judged not ‘that the sum of 7 and 5 is 11’ but that ‘12 is 11 ’. H. replies that this criticism of C.'s is not valid because P. understands the knowledge of 11 and 12 to include a knowledge of the various sums that make up these numbers. There could, therefore, be no ‘question of “putting together” such a piece of knowledge as 7 + 5 = 12 with a different piece of knowledge, viz. the knowledge of 12. They are not different pieces; they are the same piece.’. (shrink)