Although tissue plasminogen activator (tPA) is the only medication approved by the United States Food and Drug Administration (FDA) for acute ischemic stroke, there is no consensus about the need for informed consent for its use. As a result, hospitals throughout the U.S. have varying requirements regarding obtaining informed consent from patients for the use of tPA, ranging from no requirement for informed consent to a requirement for verbal or written informed consent. We conducted a study to (1) determine current (...) beliefs about obtaining patients’ informed consent for tPA among a large group of stroke clinicians and (2) identify the ethical, clinical, and organizational factors that influence tPA consent practices. Semi-structured interviews were conducted by trained and experienced investigators and research staff to identify key barriers to implementing acute stroke services. Part of the interview explored current beliefs and practices around informed consent for tPA.This was a multicenter study that included 38 Veterans Health Administration (VHA) hospital locations. Participants were 68 stroke team clinicians, serving primarily on the neurology (35 percent) or emergency medicine (41 percent) service. We conducted thematic analysis based on principles of grounded theory to identify codes about consent for tPA. We used interpretive convergence to ensure consistency among the individual investigators’ codes and to ensure that all of the investigators agreed on coding and themes.We found that 38 percent of the stroke clinicians did not believe any form of consent was necessary for tPA, 47 percent thought that some form of consent was necessary, and 15 percent were unsure. Clinicians who believed tPA required informed consent were divided on whether consent should be written (40 percent) or verbal (60 percent). We identified three factors describing clinicians’ attitudes about consent: (1) legal and policy factors, (2) ethical factors, and (3) medical factors.The lack of consensus regarding consent for tPA creates the potential for delays in treatment, uneasiness among clinicians, and legal liability. The identified factors provide a potential framework to guide discussions about developing a standard of care for acquiring the informed consent of patients for the administration of tPA. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Will to Power in Nietzsche’s Published Works and the NachlassLinda L. WilliamsIt is universally acknowledged by scholars of Nietzsche’s work that will to power is one of the most important notions in Nietzsche’s writings, but strangely, like the other “central” notions of eternal recurrence and the Übermensch, there are relatively few aphorisms in either the published or unpublished material that include the term. In the case of will to (...) power, however, Nietzsche promises in a footnote in On the Genealogy of Morals to discuss and explore the notion of will to power in a book entitled The Will to Power. 1 Giorgio Colli and Mazzino Montinari, among others, have argued persuasively that Nietzsche abandoned this project. 2 Nevertheless, the phrase “will to power” remains the most notorious feature of Nietzsche’s philosophy, probably due to its unfortunate and mistaken connections with the Third Reich. As Walter Kaufmann notes, the notion of will to power did not “spring fully formed from Nietzsche’s brow like Pallas Athena.” 3 This was an idea that evolved over time. This paper examines both the published and his unpublished writings (the Nachlass) to gain a better understanding of how this important phrase developed.The Nachlass can be divided roughly into three different kinds of work. 4 The first kind is comprised of the works Nietzsche was editing right before his collapse. These works are Ecce Homo, Nietzsche Contra Wagner, and The Antichrist, and they were so polished that we can safely take them as [End Page 447] equal in status to the works that Nietzsche had already published or, like Twilight of the Idols, were being published at the time of his collapse. The second kind are Nietzsche’s early, finished pieces that were never published, the so-called Schriften, primarily his lectures and writings while he was employed at Basel. These pieces are presumably complete and polished, although Nietzsche chose not to publish them, but they do not affect this inquiry, since will to power was a relatively late concept for Nietzsche.The third kind of work consists of Nietzsche’s notes, which vary from sentence fragments or single sentences to sketchy outlines of various projects to several long paragraphs in essay form. Nietzsche’s notebooks looked like anyone’s notebook, with passages lined out, words jotted in the margins, and overwriting. Some of the entries in the Nachlass can be found with only minor revisions in the books Nietzsche had published, and since he painstakingly recopied his books in his neatest handwriting right before he sent them to his editor, these strikingly similar entries are most probably the penultimate copy drafts of the published aphorisms.The writings that did not find their way into publication in any form are problematic. Are they rough drafts of some future work which Nietzsche was unable to complete due to his illness? If so, some of these controversial notes would have been waiting for years. Are they ideas that Nietzsche entertained but ultimately rejected? If so, we should not place them on par with the ideas in his published works. Even if we consider these notes rough drafts of future works, it remains unclear whether we should consider what is written in these notes to be as indicative of what Nietzsche thought as the works he authorized for publication. Sometimes what is written in the unpublished notes on a particular topic is very different from what is written on that topic in the published works. Bernd Magnus made this kind of case against the Nachlass notes concerning eternal recurrence, 5 and I want to make a similar claim about the notes concerning will to power. Reviewing the Nachlass notes in conjunction with the published aphorisms will give us a better understanding of how the published and unpublished notes differ.The term “will to power” (Wille zur Macht) first appeared in publication in Thus Spoke Zarathustra. 6 In the aphorism “On 1001 Goals” Nietzsche describes a people’s tablets of good and bad as the voice of its will to power. Wille zur Macht appears in only two more aphorisms in the course of this long work, in “On Self-Overcoming” and in... (shrink)

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

This collection of essays, offered in honor of the distinguished career of prominent political philosophy professor Clifford Orwin, brings together internationally renowned scholars to provide a wide context and discuss various aspects of the virtue of “humanity” through the history of political philosophy.

Most secondary sources about Fear and Trembling do not mention the weaning passages that appear in the "Attunement" chapter. Edward Mooney's book, Knights of Faith and Resignation: Reading Kierkegaard's Fear and Trembling (1991), devotes almost two pages of his commentary to the weaning sentences. While what Mooney suggests was quite helpful in directing my thoughts on this subject, I will present a more sustained discussion of the weaning sentences than Mooney's and argue that the weaning passages are more instrumental in (...) Kierkegaard's presentation of the Abraham and Isaac story than previously imagined. They foreshadow the main theme of Fear and Trembling—the existential leap of faith by the knight of faith. (shrink)

While many writers have advocated the importance of narrative as a means of engaging with the problem of extinction, this paper considers what the qualities of visual aesthetics bring to this field. In addressing this question, the discussion turns to the problem of the ethical limits of art raised by Adorno and takes a theoretical turn away from posthumanism to consider how visual responses can redirect attention back to human agency. The focus of visual analysis is on five paintings by (...) the contemporary Iranian artist Naeemeh Naeemaei. Neither exclusively Western nor overtly internationalist in their approach, these artworks refer to the effects of both hunting and the erosion of trans-national habitats as causes of extinction, yet they also show how human affective responses to extinction can extend across geo-political borders to a more global imaginary. As such, Naeemaei’s artworks are regarded as a form of immanent critique of anthropogenic forcing. Her works adapt older traditions in Persian humanism and art to show not only how the human dominion of nonhuman animals has led to extinction, but also how this leads to an almost incalculable sense of human loss. I argue that Naeemaei’s affective imagery of loss is not simply yet another example of how the lifeworld of animals can only be understood from an anthropocentric worldview, but instead points to our inability to yet fully register the immeasurable losses of extinction and what this yet unchartered grief might imply for potential human agency. (shrink)

Health care decision making has changed profoundly during the past several decades. Advances in scientific knowledge, technology, and professional skill enable medical providers to extend and enhance life by increasing the ability to cure disease, manage disability, and palliate suffering. Ironically, the same interventions can prolong painful existence and protract the dying process. Recognizing that medical interventions, especially lifesustaining measures, are not always medically appropriate or even desired by a patient or family, health care professionals endeavor to determine who should (...) make health care decisions and according to what standards. The importance that Western culture places on individual rights and self-determination is reflected in the growing advocacy for patient autonomy and the discrediting of physician paternalism. However, the question of autonomy becomes more complex when patients lack the capacity to decide for themselves.Advance directives represent one response to the dilemma of decision making for incapacitated patients. The original advance directive, the living will, is a written list of instructions reflecting the individual's wishes about care, usually at the end of life. (shrink)

Health care decision making has changed profoundly during the past several decades. Advances in scientific knowledge, technology, and professional skill enable medical providers to extend and enhance life by increasing the ability to cure disease, manage disability, and palliate suffering. Ironically, the same interventions can prolong painful existence and protract the dying process. Recognizing that medical interventions, especially lifesustaining measures, are not always medically appropriate or even desired by a patient or family, health care professionals endeavor to determine who should (...) make health care decisions and according to what standards. The importance that Western culture places on individual rights and self-determination is reflected in the growing advocacy for patient autonomy and the discrediting of physician paternalism. However, the question of autonomy becomes more complex when patients lack the capacity to decide for themselves.Advance directives represent one response to the dilemma of decision making for incapacitated patients. The original advance directive, the living will, is a written list of instructions reflecting the individual's wishes about care, usually at the end of life. (shrink)

. Genuine Reality is recommended reading for all soul-searchers."—George Gurley, Chicago Tribune "Ms. Simon . . . has provided an ideal pathway for James's striding. . . . [Y]ou become engaged in his struggles as if they were your own. ...

: Ursula Le Guin's "The Ones Who Walk Away from Omelas" (1973), a staple of short fiction anthologies, was inspired by James's "The Moral Philosopher and the Moral Life." In Le Guin's moral tale, a devastating bargain causes some citizens of Omelas to reject their apparently utopian community. Although critics have seen this rejection as a Jamesian act of pragmatism and free will, this essay examines the story in the context of "The Moral Philosopher" and other writings by James on (...) pragmatism, its moral consequences, free will, and faith to refute that conclusion. I argue, instead, that James's work suggests responses that reflect his thinking about the limits and meaning of possibility and about sustaining belief in a transcendent force. (shrink)

In lieu of an abstract, here is a brief excerpt of the content:Hobbes on the Grand Tour: Paris, Venice, or London?Linda Levy PeckHobbes scholars have long been frustrated by how little contemporary evidence exists for the period when, after graduating from University in 1608, Hobbes was appointed by Lord Cavendish as tutor to his son Sir William Cavendish. Based on a license to travel granted in February 1610 1 and a parenthetical date in a late seventeenth-century source, 2 scholars (...) from George Croom Robertson (1886) to John Stoye (1952 and 2nd ed. 1989), Miriam Reik (1977), Noel Malcolm (1981), Arnold A. Rogow (1986), Richard Tuck (1989 and 1993), and Johann Sommerville (1992) have asserted that Hobbes and Cavendish left on the Grand Tour in 1610. Scholars have claimed that the trip to France, Italy, and perhaps Germany lasted anywhere from three to five years, and they have speculated as to where Hobbes and Cavendish went and whom they met. Robertson wroteThe first journey, which lay through France, Germany, and Italy, was begun in the year when France and Europe were thrown into consternation by the deed by Ravaillac; and so readily does the fanatic’s name slip from his pen even half a century later, that we may well suppose the future apostle of the inviolability of the sovereign to have been moved by what he may have heard or seen of the tragic event and its consequences at the time. 3 [End Page 177]Arnold A. Rogow in Thomas Hobbes, Radical in the Service of Reaction, expands on Robertson’s point by suggesting thatthe tour of 1610, close in time to the murder of Henry IV, if not overlapping it, may have been decisive in convincing Hobbes of the dangers to society and civil peace of religious fanaticism. Guy Fawkes and his coconspirators in the 1605 Gunpowder Plot and François Ravaillac were all fanatical Catholics, and Hobbes, although he wrote nothing about these conspiracies at the time, may have decided when still a young man that the single most important condition for domestic order and stability was the total and absolute submission of religion to political authority. 4While noting that the first forty years were the “dark years” in Hobbes life, Miriam Reik agrees on the date of the trip: “In 1610, the Baron sent his son for that indispensable part of a seventeenth century nobleman’s education, the Grand Tour; Hobbes went along as an escort the journey receives scant notice in his writing.” 5 Stoye commented that “Perplexed biographers can only state that Hobbes accompanied Cavendish on a journey to France and Italy, commencing in the year 1610.” 6Noel Malcolm tried to establish a chronology for the Grand Tour in his article “Hobbes, Sandys and the Virginia Company,” 7 demonstrating that Cavendish was back in England for the Parliament of 1614 to which he was elected although he was soon back in Venice on a second trip. 8 Later, in his De Dominus (1984), 9 Malcolm suggested in a footnote that the account book of the first Earl of Devonshire (Chatsworth, Hardwick Ms. 29), supported only one trip between 1614 and 1615 but he provided no detailed evidence. In his edition of Thomas Hobbes: The Correspondence (1994) Malcolm remains cautious and does not address the issue. Richard Tuck, however, is more confident: he writes that “And when Lord Cavendish sent his son off on what would later be called ‘the Grand Tour’ between 1610 and 1615, Hobbes accompanied him as a tutor.” 10 Tuck argues that Hobbes and Cavendish met Paolo Sarpi and other Venetian controversialists at the height of the Venetian interdict controversy between 1610 and 1615. [End Page 178]Between 1610 and 1615 Hobbes accompanied Cavendish as his tutor... on a tour of Europe in which Venice seems to have been a particularly important stopping-place. (Noel Malcolm (1981, pp. 319–20) claims that Cavendish sat in the 1614 Parliament, and that therefore the tour must have been interrupted; but it is probable that Cavendish’s cousin (also called William), later the Earl of New-castle, was elected for both East Retford and the county of Derbyshire, and that he was the only William Cavendish in the 1614 Parliament... (shrink)

Stephen Cox writes of the complexities that guided this well-known columnist, literary critic, best-selling novelist, avid reader, and intellectual, Mary Isabel Bowler Patterson, better known as Isabel Paterson or “I.M.P.” This edited collection includes a well-chosen selection of her essays, reviews, and letters. Combining both formal and colloquial prose, Paterson’s writings incorporated quips about such people as Sinclair Lewis and Henry David Thoreau, as well as candid discussions of William F. Buckley, Jr., Buffalo Bill, and Cecil Rhodes. The more than (...) one hundred names mentioned in the collection included such diverse figures as Virginia Woolf, John Pierpont Morgan, H.G. Wells, Henry Hazlitt, and Jasper Elliot Crane. (shrink)

In December 1990, an empirical study assessing hospital ethics committee (HEC) success was completed. Success was measured in terms of the number of interventions undertaken by the committees in four functional areas: education, guidelines development, prospective and retrospective case review. Some commonly quoted success determinants, such as multidisciplinarity, physician chairpersons, and a high institutional status of the chairperson were found not to foster success; the latter two, actually decreased committee success.

The dramatic increases in the survival rate of prematurely born, very low birth weight infants (<1500 g) have created concern about the possible sequelae experienced by these children, in terms of both severe problems and less severe learning and behavior problems. The methodological difficulties involved in answering questions about the outcomes of these children, including the choice of appropriate outcome measures, the analysis of individual variation, the problems associated with dropouts, the relevant comparison groups, the importance of survival rate, and (...) the question of correcting for the degree of prematurity, are considered. In spite of the difficulties in interpreting the studies, the research indicates that many premature children have learning disabilities, particularly in the perceptual and visual motor functioning and some aspects of language and reading. In addition, ethical issues related to prematurity are discussed, including parents’ rights, decision-making, and cost and treatment. Finally, some solutions are proposed involving the use of risk indices for the early detection of developmental problems. (shrink)

As hospital ethics committees become more common in American hospitals, their degree of success should be measured. Just as new technological procedures are evaluated, institutional innovations should also be evaluated. Currently, little is known about the success of HECs, and some authors have wondered whether these committees serve any useful purpose at all. This article reviews the descriptive results of a 1990 study on HEC success as they pertain to the question of how to measure committee success.

In 1983, we were declared a nation at risk. Now, over a decade later the declaration seems to ring even more true, but for different reasons. Our communities have become killing fields, and the assassins that stalk our streets are our children. We sit frozen in horror as the daily news bombards us with the images of children murdering other children and adults for the thrill of it, as a rite of initiation, as an act of racial hatred, for profit, (...) and in anger and retaliation. (shrink)

In 1965, Vice-President Hubert Humphrey addressing the White House Conference on Education stated that our country would go down in history for havin used its educational system to overcome problems of illiteracy, unemployment, crime and violence, urban decay, and even war among nations. Yet, within a few years cries from concerned citizens questioned the ability of the schools to even teach children how to read and write.

An onslaught of ethically questionable actions by top government, business, and religious leaders during the 1980s has brought the issue of ethics in decision making to the forefront of public consciousness. This study examines the ethical orientation of university students in four decision-making situations. The dependent variable — ethical orientation toward work-related decisions — is measured through student responses to questions following four work-related vignettes. Possible responses to each vignette are structured to permit categorization of respondents into two broad orientations: (...) egoistic and ethical. Independent variables are academic major, ethics in business orientation, gender, and religiosity. Generally, students tended to choose an ethical orientation over an egoistic orientation in each vignette. Business majors were generally no less likely to choose an ethical orientation toward work-related decisions than nonbusiness majors. Respondents characterized by moral unity (belief in the consistency between general ethical principles and work-related ethical standards) were more likely to have an ethical orientation toward work-related decisions than those subscribing to the amoral theory of business. Females showed a consistent tendency to be more ethically oriented toward work-related decisions than males. Finally, respondents high on religiosity tended to be more ethically oriented. (shrink)