The aim of this study was to evaluate terminal care among hospitalized children who died of HIV/AIDS. The design was a retrospective.

The aim of this study was to evaluate terminal care among hospitalized children who died of HIV/AIDS. The design was a retrospective chart review of the terminal hospitalization. The setting was a public, secondary and tertiary children's hospital in Cape Town, South Africa (SA). The patients included a consecutive series of in‐patient deaths from HIV‐related causes. The main outcome measures included: documentation of do not resuscitate (DNR) orders and comfort care plans, intensity of diagnostic and therapeutic interventions in last 24 (...) hours of life, and presence of pain and distress in last 48 hours of life. The results are based on the review of 165 out of 167 in‐patient deaths. Of those, 79% of patients died in general wards. Median age and length of stay were 4 months and 6 days respectively. A total of 84% of patients had a DNR order. DNR orders appeared simultaneously in only 41% of medical and nursing notes. Only 44% of patients had a comfort care plan. Pain and distress in the last 48 hours was documented in 55% of patients who died in the general wards. Respiratory symptomatology and painful skin conditions accounted for most discomfort. Half (36/72) the patients with pain and distress, including 16 with a comfort care plan, received no analgesia. Conclusions drawn found that, despite clinical uncertainty, doctors made tough end of life decisions that included DNR orders and comfort care plans. The lower rate of comfort care plans suggests doctors had difficulty making the transition from curative to palliative care. Many comfort care plans were incoherent and included interventions unlikely to promote patients' comfort. In light of the HIV/AIDS pandemic in SA, reforms are needed to integrate palliative care within mainstream hospital medicine. However, without adequate human resources including trained interpreters, doctors and nurses will struggle to deliver optimal terminal care in acute hospitals. (shrink)

Iris Murdoch's famous case of M and D illustrates the moral importance of learning to see others in a more favourable light through renewed attention. Yet if we do not read this case in the wider context of Murdoch's work, we are liable to overlook the attitudes and transformations involved in coming to change one's mind as M does. Stanley Cavell offers one such reading and denies that the case represents a change in M's sense of herself or the possibilities (...) for her world of the kind exemplified by Nora in Ibsen's A Doll's House. In this essay, I challenge Cavell's reading, suggesting that the case, while it may not be an exemplar of the perfectionist outlook as described by Cavell, can and should be interpreted in perfectionist terms. To see this, I reflect on Murdoch's views on the endless perfectibility of language, the importance of humility, and the role of love and attention in moral learning. I conclude that Murdoch's work uniquely sheds light on how we might cultivate a perfectionist outlook in ourselves and others, and describes the distinctive role that some novels can play in moral education. (shrink)

The principles of equality and equity, respectively in the Bill of Rights and the white paper on health, provide the moral and legal foundations for future health care for children in South Africa. However, given extreme health care need and scarce resources, the government faces formidable obstacles if it hopes to achieve a just allocation of public health care resources, especially among children in need of highly specialised health care. In this regard, there is a dearth of moral analysis which (...) is practically useful in the South African situation. We offer a set of moral considerations to guide the macro-allocation of highly specialised public health care services among South Africa's children. We also mention moral considerations which should inform micro-allocation. (shrink)

The new South African constitution commits the government to guarantee "basic health services" for every child under 18. Primary health care for pregnant women and children under six and elements of essential primary health care have received priority. At present, there is little analysis of the moral considerations involved in making choices about more advanced or costly health care which may, arguably, also be "basic". This paper illustrates some of the tensions in setting priorities for a just macro-allocation of children's (...) health care, given the realities of need and scarce resources, and the commitment to equality of basic opportunities. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Another Look at Flage's Hume Lesley Friedman In recent articles, Daniel Flage (1985a, 1985b) offers an interpretation of Humean memory-ideas as relative ideas: ideas of memory are analogous to definite descriptionsinsofar as they single outexactly one entity.1 Consequently, Flage argues that Hume has provided an adequate distinction between ideas generated by memory and ideas generated by imagination. It is my contention that Flage's reading is neither consonant with (...) Hume's remarks in the Treatise nor successful in reducing the number ofdifficulties with Hume's theory ofmemory. I shall argue that (1) it is not clear that all memory-ideas are complex (an assumption necessary for Flage's interpretation); (2) Flage construes all memory as episodic, but he overlooks semantic memory; and (3) there isa distinction between mis-remembering and imagining which Flage's account cannot accommodate. It is worth noting that Flage contends that he is giving an interpretation ofHume's account ofmemory; he is not simply attempting to find out the truth ofthe matter. That is, Flage's position is that there is good reason to think that Hume construed memory-ideas as relative ideas. Accordingly, Flage must provide evidence, preferably textual, for the claim that Hume held such a view. My position is thatit is unlikely that Hume held such a view, and even if he did, it is inadequate for grounding an external distinction between memory-ideas and imagination-ideas. In short, claiming that Hume was interested in a decisive distinction between ideas ofmemory and ideas ofimagination is to involve Hume in problems with which he was not concerned. Not only are Flage's remarks in conflict with Hume's, but ifwe readhim as Flage suggests, Hume's theory ofmemory becomes considerably more riddled with problems than it is if we do not so read him. Flage and Hume In section 1 of Treatise 1.1, Hume draws his celebrated distinction between ideas and impressions. In the second section he considers impressions in some detail and he does the same for ideas in section three. Following every impression, Hume claims, there is a corresponding idea, either produced by the faculty of memory or the faculty of imagination. He takes it as no less than obvious that memory-ideas are more "lively and strong" than imagination-ideas: Volume XDi Number 1 177 LESLEY FRIEDMAN Tis evident at first sight, that the ideas of the memory are much more lively and strong than those of the imagination, and that the former faculty paints its objects in more distinct colours, than any which are emplo/d by the latter.2 That memory-ideas are more lively than their counterparts in imagination Hume construes as asensible difference between the two. Accordingly, I shall refer to this difference as the internal difference. Thereis,however,another difference betweenthesekinds ofideas, namely, that memory-ideas preserve the order and form of their corresponding simple ideas, while imagination-ideas need not: Tis evident, that the memory preserves the original form, in which its objects were presented, and that where-ever we depart from it in recollecting any thing, it proceeds from some defect or imperfection in that faculty.... The chiefexercise of the memoryis not to preserve the simpleideas, but their order and position.... The same evidence follows us in our second principle, of the Uberty ofthe imagination to transpose andchange its ideas. (T 9-10) I shall refer to the above as the external difference between memory-ideas andimagination-ideas.3 During his discussion ofcausation, Hume elaborates on the above differences. The external difference, he claims, "is not sufficient to... make us know the one from the other; it being impossible to recai the pastimpressions, in order to compare them with our present ideas, and see whether theirarrangementbe exactlysimilar" (T85). He concludes that the difference between memory and imagination is simply that memory-ideas are more forceful and vivacious than imagination-ideas. In short, since the external difference is non-phenomenal, it is inadequate for distinguishing, in practice, between ideas that are the product ofmemory and ideas that are the product of the imagination. Before concluding his discussion of the above differences Hume voices anote ofscepticismconcerningthe internal difference. He argues that theinternal... (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Reply to Flage Lesley Friedman "The chiefexercise of the memory," Hume tells us, "is not to preserve the simple ideas, but their order and position."1 On Daniel Flage's interpretation ofHume, however, it is the only exercise ofthe memory (1985a, 1985b, 1990). Flage's account can accommodate onlymemories of complex ideas; he disallows the possibility of 'preserving* a simple idea in its simplicity. Yet there is an example of a (...) purely simple impression in the Treatise; and since for every impression there is in principle a corresponding idea which we can later recall, this example establishes the existence of a purely simple memory-idea. In what follows I will provide support for this claim, Flage's counterarguments (this volume) notwithstanding. Flage argues that given any perceived object, say a coloured dot, there is a visual field in which we perceive it. This field and the impression we receive from it, "must be a complex impression, that is, an impression that is composed of indefinitely many colour points. In this respect it is analogous to a pointillist painting or, to use a more contemporary example, a computer array composed of pixels" (1993, 190). Flage is probably right about this; from our point of view, it is implausible to suggest that there is any purely simple background, or worse, that there is no impression ofa background at all. Nonetheless, my concern is with what Hume thought and not with what is plausible orimplausible; and Hume does give an example ofa "background" that is notcomplex, namely, the scenarioinwhichwe perceive points oflight in darkness. We may observe, that when two bodies present themselves, where there wasformerly an entire darkness, the onlychange, that is discoverable, is in the appearance ofthese two objects, and that all the rest continues to be as before, a perfect negation oflight, and of every colour'd or visible object. This is not only true of what may be said to be remote from these bodies, but also of the very distance; which is interpos'd betwixt them; that being nothing but darkness, or the negation of light; without parts, without composition, invariable and indivisible. (T 57, bold italics added) I originally considered the ink spot experiment and theidea ofred in the dark as examples ofpurely simple impressions. Let me try this Volume XLX Number 1 199 LESLEYFRIEDMAN again, elaborating a bit more on the latter (what I take to be Hume's example of a version of the ink spot experiment). Early on in the Treatise Hume speaks of"that idea ofred which we form in the dark" (T 3). Let us then consider a red spot in complete darkness. Flage and I agree that this spot is qualitatively simple. Our disagreement is rooted in the nature ofthe "background," in this case the darkness. Flage claims that "the sighted-person sitting in the dark has an impression or impressions, namely, an impression of darkness" (1993, 190); and therefore the impression we have of the spot of red in darkness is not purely simple. In support of this claim he cites the followingevidence: Hume's remarks that (1) "the sighted-person sitting in the dark "receives no other perception... than what is common to him with one born blind' " (ibid., 189; T 55-56), and (2) "the idea of utter darkness can never be the same with that of vacuum" (T 56). Let me take each ofthese in turn. Presumably, the first quote is cited in order to estabUsh that the blind person does indeed have a perception (impression) of darkness. This cannot be right; ifsuch a person had an impression ofdarkness, he would also have an idea of darkness, and if we look to the part of the sentence which Flage leaves out of his quotation, we find the following: "and 'tis certain such-a-one [that is, a blind person] has no idea either of light or darkness" (T 56). Hume's point is simple: the reason that the blind person has no idea ofdarkness is because he has no impression of darkness; and we are in the same position as him when we are sitting in the dark. Nor does the second quote provide evidence for the... (shrink)

Attorneys increasingly rely on the services of mental health practitioners. Although some practitioners lack training, the promise of professional rewards lead some to accept opportunities with resulting ethical quandaries. Due to significant differences between the objectives of traditional mental health services and expert testimony, problems occur when clinicians venture into forensic services. Attorneys and judges, unfamiliar with mental health specialties, may seek to press a mental health practitioner into multiple roles. Although not all multiple roles are ethically inappropriate, caution demands (...) careful parsing of particular roles: (a) academic/behavioral science expert; (b) fact witness as a treating therapist; (c) expert witness based on a clinically oriented assessment; (d) pretrial and/or trial consultant; and (e) professional critic of other experts. Possible ethical issues and risks associated with accepting multiple roles are identified and strategies for avoiding or minimizing harm or exploitation are discussed. (shrink)

Cet ouvrage collectif, fruit d'un colloque tenu au College Saint Hilda d'Oxford au cours de l'été 1993, réunit quatorze contributions qui ont pour point commun d'interroger la relation entre la femme et le livre au Moyen Age exclusivement à partir des images. D'où la participation de la British Library qui accueille ce volume dans sa série consacrée à l'exploration et à la valorisation des manuscrits médiévaux. Le livre est divisé en trois parties : la première est consacrée aux images...

MICHAEL D. RESNIK, Frege and the philosophy of mathematics. Ithaca and London: Cornell University Press, 1980. 244 pp. $16.50. HANS D. SLUGA, Gottlob Frege. London, Boston and Henley: Routledge & Kegan Paul, 1980. xi + 203 pp. £ 12.95.

Inside What Would Plato Do?, you'll find the basics of philosophy, written in an easy, digestible way we can all understand, along with questions to help you apply these important theories to your own life. So, after you've learned about a philosophical concept, you'll then be challenged to test yourself and see how the results can impact your daily life. For instance, after learning about Kant's theory of morality and the importance of intention you're challenged with questions like: Can good (...) people do bad things? Was there a time when you intended to do something helpful that ended up being hurtful? Does that make you a good person (because you intended to do good) or a bad person (because the results were bad)? What Would Plato Do? will not only help you better understand some of the greatest thinkers ever but will also help you think of the world around you in a whole new way! (shrink)

We perceive smells as perduring complex entities within a distal array that might be conceived of as smellscapes. However, the philosophical orthodoxy of Odor Theories has been to deny that smells are perceived as having a distal location. Recent challenges have been mounted to Odor Theories’ veracity in handling the timescale of olfactory perception, how it individuates odors as a distal entities, and their claim that olfactory perception is not spatial. The paper does not aim to dispute these criticisms. Rather, (...) what will be shown is that Molecular Structure Theory, a refinement of Odor Theory, can be further developed to handle these challenges. The theory is further refined by focusing on distal perception that requires considering the perceptual object as mereologically complex persisting odor against a background scene conceived of as a smellscape. What will be offered is an expansion of Molecular Structure Theory to account for distal smell perception within natural environments. (shrink)

When it originated in the late 19th century, psychometrics was a field with both a scientific and a social mission: psychometrics provided new methods for research into individual differences, and at the same time, these psychometric instruments were considered a means to create a new social order. In contrast, contemporary psychometrics - due to its highly technical nature and its limited involvement in substantive psychological research - has created the impression of being a value-free discipline. In this article, we develop (...) a contrasting characterization of contemporary psychometrics as a value-laden discipline. We expose four such values: that individual differences are quantitative (rather than qualitative), that measurement should be objective in a specific sense, that test items should be fair, and that utility of a model is more important than its truth. Our goal is not to criticize psychometrics for employing these values, but rather to bring them into the open and to show that these values are not inevitable and are in need of systematic evaluation. (shrink)

We are immersed within an odorous sea of chemical currents that we parse into individual odors with complex structures. Odors have been posited as determined by the structural relation between the molecules that compose the chemical compounds and their interactions with the receptor site. But, naturally occurring smells are parsed from gaseous odor plumes. To give a comprehensive account of the nature of odors the chemosciences must account for these large distributed entities as well. We offer a focused review of (...) what is known about the perception of odor plumes for olfactory navigation and tracking, which we then connect to what is known about the role odorants play as properties of the plume in determining odor identity with respect to odor quality. We end by motivating our central claim that more research needs to be conducted on the role that odorants play within the odor plume in determining odor identity. (shrink)

This paper is a review of the influence that lógos has had on ancient Greek, Jewish, and Christian writings. During the philosophical era known as Middle Platonism, the concept/ontology of the lógos played a unique role in enabling Pagan, Jewish, and Christian intellectuals to communicate on a small space of common ground.

In Nicomachean Ethics X.7–8, Aristotle defends a striking view about the good for human beings. According to Aristotle, the single happiest way of life is organized around philosophical contemplation. According to the narrowness worry, however, Aristotle's contemplative ideal is unduly Procrustean, restrictive, inflexible, and oblivious of human diversity. In this paper, I argue that Aristotle has resources for responding to the narrowness worry, and that his contemplative ideal can take due account of human diversity.

The field of AI safety aims to prevent increasingly capable artificially intelligent systems from causing humans harm. Research on moral alignment is widely thought to offer a promising safety strategy: if we can equip AI systems with appropriate ethical rules, according to this line of thought, they'll be unlikely to disempower, destroy or otherwise seriously harm us. Deontological morality looks like a particularly attractive candidate for an alignment target, given its popularity, relative technical tractability and commitment to harm-avoidance principles. I (...) argue that the connection between moral alignment and safe behavior is more tenuous than many have hoped. In general, AI systems can possess either of these properties in the absence of the other, and we should favor safety when the two conflict. In particular, advanced AI systems governed by standard versions of deontology need not be especially safe. (shrink)

Father Williams explains how the conscience is formed through our training and experiences and informed by the Holy Spirit, making it an essential tool for daily living. He uses familiar and surprising characters to illustrate the positive choices conscience can direct--and the disaster that results when a conscience is undeveloped or ignored. Questions he tackles include "Is it more important to be smart or good?""Is there a morally right thing to do in every situation?" and "Is the Christian moral life (...) an exciting adventure, or a necessary burden?" Rich, provocative, and practical for everyday decision making, KNOWING RIGHT FROM WRONG is a must-read for all who hunger for personal holiness. (shrink)

Man (Islam); Islamic philosophy; Islamic ethics.

First collected in Italy in 1985, _Art's Claim to Truth_ is considered by many philosophers to be one of Gianni Vattimo's most important works. Newly revised for English readers, the book begins with a challenge to Plato, Aristotle, Kant, and Hegel, who viewed art as a metaphysical aspect of reality rather than a futuristic anticipation of it. Following Martin Heidegger's interpretation of the history of philosophy, Vattimo outlines the existential ontological conditions of aesthetics, paying particular attention to the works of (...) Kandinsky, which reaffirm the ontological implications of art. Vattimo then builds on Hans-Georg Gadamer's theory of aesthetics and provides an alternative to a rationalistic-positivistic criticism of art. This is the heart of Vattimo's argument, and with it he demonstrates how hermeneutical philosophy reaffirms art's ontological status and makes clear the importance of hermeneutics for aesthetic studies. In the book's final section, Vattimo articulates the consequences of reclaiming the ontological status of aesthetics without its metaphysical implications, holding Aristotle's concept of beauty responsible for the dissolution of metaphysics itself. In its direct engagement with the works of Gadamer, Heidegger, and Luigi Pareyson, _Art's Claim to Truth_ offers a better understanding of the work of Vattimo and a deeper knowledge of ontology, hermeneutics, and the philosophical examination of truth. (shrink)

In Plato’s Symposium, the mysterious Apollodorus recounts to an unnamed comrade, and to us, Aristodemus’ story of just what happened at Agathon’s drinking party. Since Apollodorus did not attend the party, however, it is unclear what relevance he could have to our understanding of Socrates’ speech, or to the Alcibiadean “satyr and silenic drama” (222d) that follows. The strangeness of Apollodorus is accentuated by his recession into the background after only two Stephanus pages. What difference—if any—does Apollodorus make to the (...) Symposium? Does his inclusion call the dramatic and philosophical unity of the work into question? I argue that despite initial appearances, Plato has important philosophical reasons for including Apollodorus as a character. Far from being an odd appendage to an otherwise complete narrative, the figure of Apollodorus is useful for our understanding of Socrates’s conception of eros later in the work. (shrink)

Method in Ancient Philosophy brings together fifteen new, specially written essays by leading scholars on a broad subject of central importance. The ancient Greeks recognized that different forms of human activity are guided by different methods of reasoning; examination of how they reasoned, and how they thought about their own reasoning, helps us to see how they came to hold the views they did, and how our own methods of enquiry have developed under their influence. Contributors include Terence Irwin, Patricia (...) Curd, Ian Mueller, Robert Bolton, A.A. Long, Gail Fine, Constance C. Meinwald, Lesley Brown, Gisela Striker, C.D.C. Reeve, Charlotte Witt, Richard Kraut, Sarah Broadie, James Allen, and G.E.R. Lloyd. (shrink)

There is increased interest in deviant behavior in the workplace. However, research is lacking on the moral economy of such behavior. Moral economy is particularly important in contexts where syncretic forces impinge on deviant behavior. Consequently, we use moral economy reasoning to examine the relationship between ethnic obligation and deviant behavior in the African context. In Study 1, data (_N_ = 27, 148) show an inverted U-shape effect of meta-agency and deviant behavior. In Study 2, difference-in-difference (DID) analysis of data (...) (_N_ = 25,387 in 2005 and _N _= 51,587 in 2013) shows significant DID effect of meta-agency. Primary data from Study 3 (_N_ = 229) shows a U-shaped effect of agency and deviant behavior. In Study 4 (_N_ = 333), a replication shows support for the U-shape effect in Study 3. The four studies thus show complex patterns that reflect U-shape and inverted U-shape relationships between ethnic obligation and deviant behavior as indicated by bribery, corruption, and unethicality. Robustness checks support the curvilinear relationships suggesting that the effects are not due to chance. We discuss implications for research and practice. (shrink)

Essays devoted to the work of the late Neil Wilson, Canadian philosopher and contributor to the field of semantic analysis that emerged from the fusion of logic, pragmatism, and ontology. Many of the essays in this volume take their initial inspiration from Wilson's seminal work Substances Without Substrata.

In lieu of an abstract, here is a brief excerpt of the content:On Friedman's Look Daniel E. Flage In a pair of articles and a book (Flage 1985a, 1985b, 1990), I argued that Hume's ideas of memory are relative ideas. In "Another Look at Flage's Hume" (this volume), Lesley Friedman challenges my account on four points. She argues (1) that it is possible to remember simple ideas in their simplicity; (2) that I have misrepresented Humean impressions ofreflection; (3) that (...) I have overlooked the importance of force and vivacity in Hume's account ofmemory; and (4) that there is no textual evidence for claiming that Humean ideas of memory are relative ideas. In addition, she contends that my interpretation cannot account for mis-remembering. In this paper I show that some of the problems Friedman finds with myinterpretation arise from myreading of Lockean distinctions into the Treatise while others stem from my conflation of distinctions drawn in the first Enquiry with comparable distinctions in the Treatise. 1. Remembering simple ideas My argument that Humean ideas ofmemory are relative ideas is based primarily on Hume's remarks in three passages. In Treatise 1.1.3, one finds this: "the imagination is not restrain'd to the same order and form with the original impressions; while the memory is in a manner tytt down in that respect, without any power of variation."1 Later in the same passage one finds this: Tis evident, that the memory preserves the original form, in which its objects were presented, and that where-ever we depart from it in recollecting any thing, it proceeds from some defect or imperfection in that faculty.... The chiefexercise of memory is not to preserve the simple ideas, but their order and position. (T 9) And in Treatise 1.3.5, one finds this: These faculties [memory and imagination] are as little distinguish'd from each other by the arrangement of their complexideas. For tho'itbe apeculiar propertyofthe memory to preserve the original order and position of its ideas, while the imagination transposes and changes them, as it pleases; yet this difference is not sufficient to distinguish them in their Volume XLX Number 1 187 DANIEL E. FLAGE operation, or make us know the one from the other; it being impossible to recai the past impressions, in order to compare them with our present ideas, and see whether their arrangement be exactly similar. (T 85) This is only one characteristic ofideas ofmemory, the other being the greater degree of"force andvivacity" in an idea ofthe memory vis-à-vis an idea ofthe imagination (T 9, 85). I call this characteristic the formal criterion (Flage 1985a, 171); Friedman calls it the external difference (p. 178). These passages show that ideas of the memory represent earlier impressions, or ideas, or "events," or things known.2 How do they do so? Given the remarks on the preservation of"order and form" and "order and position," and given that resemblance alone is not sufficient to distinguish nonmnemonic ideas from mnemonic ideas (see T 9), I argued that there is an implicit causal thesis: an idea ofmemory singles out the impression that was its original cause. It is a relative idea corresponding to a definite description ofthe form, "the impression that is the (original) cause of and exactly (or closely) resembles m," where 'm' denotes a particular positive idea. (Flage 1985a, 172)3 If my account of memory is correct, there is a positive idea ("mental image") that provides the basis for every relative idea of memory. Further, this positive idea must be complex. Friedman objects (pp. 180-81) that insofar as my account requires that there be a complex positive idea that provides the basis for one's relative idea of memory, this conflicts with several passages in the Treatise. She cites the ink spot experiment (T 42) as showing that one can have a simple impression of colour. She remarks, "Since we can have such a simple impression, we can also remember it" (p. 180), adding, "It seems clear that Hume thinks that in the [ink spot] experiment, all that is present in one's visual field is the spot of ink" (ibid.). Since I had argued that "Hume's example ofseeing a minimum... (shrink)